That goes for you, our providers, as much as it does for our members. You may want to give copies to close friends or family members as well. UHSM is not insurance. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. This means the PHCS Savility network offers the same quality for which PHCS Network has been recognized since 2001. You also have the right to ask us to make additions or corrections to your medical records (if you ask us to do this, we will review your request and figure out whether the changes are appropriate). These services are covered under the Option Plan nationwide. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. With discounts averaging 42% for physicians and specialiststhe types of services most typically used with these plansHealth Depot members get more value for their benefit dollars. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. Testing that exceeds this maximum is the members responsibility. UHSM Providers - PHCS PPO Network We believe there is no such thing as a standard cost management approach. You will get most or all of your care from plan providers, that is, from doctors and other health providers who are part of our plan. Members are no longer eligible for coverage after their 40th birthday. If you are relocating out of ConnectiCare's network or retiring, please notify your patients at least ten (10) days in advance, in writing, in addition to notifying ConnectiCare and, if applicable, your contracted PHO/IPA in writing sixty (60) days in advance. To get any of this information, call Member Services. Female members may directly access a women's health care specialist within the network for the following routine and preventive health care services provided as basic benefits: Annual mammography screening (age restrictions apply) Members have an in-network deductible for some covered services. If you need more information, please call our Member Services. All oral medication requests must go through members' pharmacy benefits. For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. PHCS is the leading PPO provider network and the largest in the nation. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Customer Service at 800-337-4973 Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. The ConnectiCare Medicare Advantage network. We have partnered with TALON to bring you access to MyMedicalShopper; which provides you the ability to shop for healthcare services based on price, quality, and location. Coverage for skilled nursing facility (SNF) admissions with preauthorization. Members have the responsibility to: Members rights and our obligations are limited to our ability to make a good faith effort in regard to: Each time a member receives services, you should confirm eligibility. These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (medical coverage) and may offer extra benefits too. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Providers - INSURANCE BENEFIT ADMINISTRATORS If you need more information, please call Member Services. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. TTY users should call 877-486-2048, or visit www.medicare.govto view or download the publication Your Medicare Rights & Protections. Under Search Tools, select find a Medicare Publication. If you have any questions whether our plan will pay for a service, including inpatient hospital services, and including services obtained from providers not affiliated with our plan, you have the right under law to have a written/binding advance coverage determination made for the service. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. To inquire about an existing authorization - (phone) 800-562-6833 You may also call the Office for Civil Rights at 800-368-1019 or TTY:800-537-7697, or your local Office for Civil Rights. Your plan does require Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. Answer 4. We also cover additional benefits beyond Original Medicare alone. To begin the precertification process, your provider(s) should contact UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! While you may contact us by telephone, you will be asked to place your concerns in writing. Your right to get information about your prescription drugs, Part C medical care or services, and costs Please call Member Services if you have any questions. If you are admitted to the hospital, they will ask you whether you have signed an advance directive form and whether you have it with you. Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and If you do, please call Member Services. Pay applicable copayments, deductibles or coinsurance. Bone Mineral Density exams ordered more frequently than every twenty-three (23) months Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. You have the right to refuse treatment. You have the right to get full information from your providers when you go for medical care, and the right to participate fully in decisions about your health care. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. Question 5. You have the right to an explanation from us about any prescription drugs or Part C medical care or service not covered by our plan. How to manage the front desk when they ask who you are insured with? Eligibility and Benefits | ConnectiCare What to do if you think you have been treated unfairly or your rights are not being respected? We must investigate and try to resolve all complaints. UHSM is a different kind of healthcare, called health sharing. You have chosen PHCS (Private Healthcare Systems, Inc.). ConnectiCare offers both employer-sponsored plans and individual insurance plans. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? Click Here to go to the PHCS / Multiplan Provider Search. You have the right to get information from us about our plan. If there are unusual and extraordinary circumstances, or the enrollees PCP is unavailable or inaccessible, the enrollee may seek urgent care treatment at the nearest facility. Members must reside in the service area. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. Information is protected as outlined in ConnectiCare's policies. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. If you have any questions please review your formulary website or call Member Services. Get coverage information. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! A sample of the ConnectiCare ID cards appear below. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. PHCS PPO Network - Health Depot Association We will make sure that unauthorized people dont see or change your records. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. Medicare providers under their ConnectiCare contract are required to see all ConnectiCare VIP Medicare Plan members including those who are dual eligible for Medicare and Medicaid. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. No prior authorization requirements. ConnectiCare provides each member with a statement of member rights and responsibilities. PHCS Network | AvMed Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. Eligibility Claims Eligibility Fields marked with * are required. It is critical that the members eligibility be checked at each visit. We conduct routine, focused surveys to monitor satisfaction using the Consumer Assessment of Health Plan Satisfaction (CAHPS) survey and implement quality improvement activities when opportunities are identified. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. 860-509-8000, (TTY) 860-509-7191. ConnectiCare will communicate to your patients how they may select a new PCP. Incorrect Email or Password - MultiPlan ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. Additional term life coverage can be elected in increments of $10,000 to a maximum of $500,000 or 5 times your salary, whichever is less; paid for through payroll deductions. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. Eligibility, Benefits & Claims Assistance, If you dont see the network listed on your ID card please contact our Customer Service at, Please be sure to verify your providers network access with your provider's office directly prior to receiving services. While other insurance companies and TPAs make you go through numerous frustrating prompts and then hold for an extensive period, our approach is to take the call as soon as possible so that you can move on with your day. It is important to sign this form and keep a copy at home. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. No referrals needed for network specialists. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. You have the right to get your questions answered. When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. P.O. You should consider having a lawyer help you prepare it. When scheduling your appointment, specify that you have access to the PHCS Network throughthe HD Protection Plus Plan, confirm the providers current participation in the PHCS Network, their address and thatthey are accepting new patients. Your Explanation of Payment (EOP) will specify member responsibility. Phcs Insurance Provider Phone Number | TheWebster Miami If you want to, you can use a special form to give someone the legal authority to make decisions for you if you ever become unable to make decisions for yourself. Clinical Review Prior Authorization Request Form. Any personal information that you give us when you enroll in this plan is protected. Our contract with you for participation in the ConnectiCare program requires you to provide coverage 24-hours, seven days a week, including weekends and holidays. You should give a copy of the form to your doctor and to the person you name on the form as the one to make decisions for you if you cant. TTY users should call 877-486-2048. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. Transition of Care allows new members and/or members whose plan has experienced a recent provider network change to continue to receive services for specified medical and behavioral conditions, with health care professionals that are not participating in the plans designated provider network, until the safe transfer of care to a participating provider and/or facility can be arranged. Your right to get information about our network pharmacies and/or providers SeeAutomated and Online Featuresfor additional information. They will be clearly distinguishable by their ID cards. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. Provider Portal - 90 Degree Benefits Additionally, ConnectiCaremaydisenroll a member if: Premiums are not paid on a timely basis. To verify or determine patient eligibility, call 1-800-222-APWU (2798). Your right to be treated with dignity, respect and fairness Prior Authorizations are for professional and institutional services only. If so, they will follow up to recruit the provider. Once you have completed the Registration form you will be emailed a link to confirm your Registration. You may also search online at www.multiplan.com: If you are currently seeing a doctor or other healthcare professional who does not participate in the PHCS Network,you may use the Online Provider Referral System in the Patients section of www.multiplan.com, which allows you tonominate the provider in just minutes using an online form. New members may use a copy of their enrollment form. Box 450978 Westlake, OH 44145. Customer Service number: 877-585-8480. . Pleasant and provided correct information in a timely manner. Your right to the privacy of your medical records and personal health information. You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. We may enroll employer group members as well. Contact us. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. You must pay for services that arent covered. Notifying providers when seeking care (unless it is an emergency) that you are enrolled in our plan and you must present your plan enrollment card to the provider. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. My rep did an awesome job. I called in with several medical bills to go over and their staff was extremely helpful. SeeMedical Management. It is generally available between 7 a.m. and 9:30 p.m., Monday through Friday, and from 7 a.m. to 2 p.m. on Saturday. See the preauthorization section for a listing of DME that requires preauthorization. (SeeOther Benefit Information). In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. Providers are also reminded that dual eligible members who are designated as Qualified Medicare Beneficiaries (QMB or QMB+) cannot be billed for any Medicare cost-share. Timely access means that you can get appointments and services within a reasonable amount of time. Reference the below Performance Health Open Negotiation Notice for details on the process your provider must follow for disputing the allowable rate used on your claim. ConnectiCare eligible members shall not be discriminated against with respect to the availability or provision of health services based on an enrollee's race, sex, age, religion, place of residence, HIV status, source of payment, ConnectiCare membership, color, sexual orientation, marital status, or any factor related to an enrollee's health status. Pelvic exam What should I do if I get a bill from a healthcare provider? If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. (SeeOther Benefit Information). To request a continuation of an authorization forhome health careorIV therapyfax 860-409-2437, All infertility services that are subject to the mandate must be preauthorized, including: a) injectible infertility drugs for the purpose of ovulation induction, b) intrauterine insemination with or without the use of oral or injected medications for ovulation induction, and c) all ART procedures. Payors > MultiPlan Yes, PHCS provides coverage for therapy services. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. Supporting evidence, which may be required includes: 1.) These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (optional medical coverage) coverage and offer extra benefits too. Note: The list of covered DME and disposable supplies is reviewed periodically and subject to change at the sole discretion of ConnectiCare. ConnectiCare cannot reverse CMS' determination. (More information appears later in this section.). By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. Your right to get information about our plan Prior Authorizations are for professional and institutional services only. Limited to a maximum of $315 every two (2) calendar years for: 1.) Pharmacy cost-share, if applicable. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. The Evidence of Coverage (EOC) will instruct them to call their PCP. To get any of this information, call Member Services. Answer 5. This video explains it. Read the Membership Agreement, Evidence of Coverage, or other Plan document that describes the Plans benefits and rules. This includes information about our financial condition, about our plan health care providers and their qualifications, about information on our network pharmacies, and how our plan compares to other health plans. plan. Note: These procedures are covered procedures, but do not require preauthorization in network.
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