* ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. Your right to get information about our plan and our network pharmacies Information is protected as outlined in ConnectiCare's policies. PPM/10.16 Overview of Plans Overview of products Members are no longer eligible for coverage after their 40th birthday. We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. Additionally, ConnectiCaremaydisenroll a member if: Premiums are not paid on a timely basis. Wondering how member-to-member health sharing works in a Christian medical health share program? Contact the pre-notification line at 866-317-5273. Remember, it is your choice whether you want to fill out an advance directive (including whether you want to sign one if you are in the hospital). info@healthdepotassociation.com, Copyright © 2023 Health Depot Association, All Rights Reserved, Supplemental Accident and/or Critical Illness, Follow the prompts to enter your search criteria. A new web site will open up in a new window. While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. 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. Participate with practitioners in decision-making regarding your health care. Remember, it is your choice whether you want to fill out an advance directive (including whether you want to sign one if you are in the hospital). The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. plan. Phcs Insurance Provider Phone Number | TheWebster Miami Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Visit our other websites for Medicaid and Medicare Advantage. Access to any Medicare-approved doctor or hospital in the United States. We conduct routine, focused surveys to monitor satisfaction using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and implement quality improvement activities when opportunities are identified. This video explains it. The sample ID cards are for demonstration only. including benefit designs and Sutter provider participation in your provider network. (SeeOther Benefit Information). Product and plan details are outlined in the product and coverage section on this page. You also have the right to this explanation even if you obtain the prescription drug, or Part C medical care or service from a pharmacy and/or provider not affiliated with our organization. Provider Portal Info > MultiPlan We must investigate and try to resolve all complaints. For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. ConnectiCare requires all of its participating practitioners and providers to treat member medical records and other protected health information as confidential and to assure that the use, maintenance, and disclosure of such protected health information complies with all applicable state and federal laws governing the security and privacy of medical records and other protected health information. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. Provider Quick Reference Guide - MultiPlan ConnectiCare provides each member with a statement of member rights and responsibilities. (SeeOther Benefit Information). Premier Health Solutions, LLC operates as a Third-Party Administrator in the state of California under the name PHSI Administrators, LLC and does business under the name PremierHS, LLC in Kentucky, Ohio, Pennsylvania, South Carolina and Utah. After the deductible has been met, coinsurance will apply to the covered benefits. Member satisfaction information is updated and posted annually and is made available on our website atconnecticare.com. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. ConnectiCare's service area includes all counties. Answer 3. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. The member engages in disruptive behavior. Answer 5. For non-portal inquiries, please call 1-800-950-7040. For the PHCS Network, 1-800-922-4362 For PHCS Healthy Directions, 1-800-678-7427 For the MultiPlan Network, 1-888-342-7427 For the HealthEOS Network, 1-800-279-9776 For language assistance, please call 1-866-981-7427 For TTY/TTD service, please call 1-866-918-7427 Search for a provider > This system requires that you have a touch-tone phone and know your ConnectiCare provider ID number, as well as the member's identification number, to verify eligibility. Simply call (888) 371-7427 Monday through Friday from 8 a.m. to 8 p.m. (Eastern Standard Time) and identify yourself as a health plan participant accessing PHCS Network for Limited Benefit plans. What insurance carrier is PHCS? - InsuredAndMore.com According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. 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. You have the right to make a complaint if you have concerns or problems related to your coverage or care. Emergency care is covered. 877-585-8480. 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. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. To get this information, call Member Services. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. All routine laboratory services must be obtained from participating laboratories. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. Your right to get information in other formats Below are the additional benefits covered by ConnectiCare. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Your plan does require For benefit-related questions, call Provider Services at 877-224-8230. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . Visit www.uhsm.com/preauth Download and print the PDF form Fax the preauth form to (888) 317-9602 GET PREAUTH FORM member-to-member health sharing How Healthshare Works with UHSM, it's Awesome! By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother process and overall cost savings. The plan will release your information, including your prescription drug event data, to Medicare, which may release it for research and other purposes that follow all applicable Federal statutes and regulations. UHSM is not insurance. Member Services can also help if you need to file a complaint about access (such as wheel chair access). Please call Member Services if you have any questions. If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. Incorrect Email or Password - MultiPlan Portal Training for Provider Groups Benefits - Penn Medicine Princeton Health Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. That goes for you, our providers, as much as it does for our members. If you need more information, please call Member Services. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. Go to the Client Portal > Provider directories Create a customized listing of facilities and/or practitioners participating in the network services offered by MultiPlan. If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. PROVIDER PORTAL LOGIN REGISTER NOW Electronic Options: EDI # 59355 Eligibility (270/271) Bill Status (276) Bill Submission (837) For technical assistance with EDI transactions, please contact Change Healthcare at 1-800-845-6592. TTY users should call 877-486-2048. 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. You also have the right to receive an explanation from us about any utilization-management requirements, such as step therapy or prior authorization, which may apply to your plan. If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. Actual copayment information and other benefit information will vary. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO Eligibility Claims Eligibility Fields marked with * are required. Eligibility and Benefits | ConnectiCare Provider Page | Medi-Share You also have the right to receive an explanation from us of any utilization management requirements, such as step therapy or prior authorization that may apply to your plan. No prior authorization requirements. You have the right to refuse treatment. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Box 450978 Westlake, OH 44145. Services or supplies that are new or recently emerged uses of existing services and supplies, are not covered benefits unless and until we determine to cover them. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. High Deductible Health Plan (Health Savings Account [HSA] Compatible). PHCS is the leading PPO provider network and the largest in the nation. To get this information, call Member Services. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! See preauthorization list for DME that requires pre-authorization. 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. Physicians may make referrals to participating specialists without entering them into the telephonic referral system. ConnectiCare, in compliance with advance directives regulations, must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care. To verify or determine patient eligibility, call 1-800-222-APWU (2798). You have the right to get a summary of information about the appeals and grievances that members have filed against our plan in the past. Yes, PHCS provides coverage for therapy services. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. Submit a Coverage Information Form. They are collected via enrollment information, self-disclosure, and the member portal. Pay applicable copayments, deductibles or coinsurance. Paying your co-payments/coinsurance for your covered services. UHSM Health Share and WeShare All rights reserved. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections Letting us know if you have additional health insurance coverage. This includes, but is not limited to, an enrollee's medical condition (including mental as well as physical illness), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), disability or on any other basis otherwise prohibited by state or federal law. UHSM is excellent, friendly, and very competent. If you are calling to verify your patient's benefits*, please have a copy Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. On a customer service rating I would give her 5 golden stars for the assistance I received. Influenza and pneumococcal vaccinations PHCS is the leading PPO provider network and the largest in the nation. Use your member subscriber ID to access the pricing tool using the link below. In this section, we explain your Medicare rights and protections as a member of our plan and, we explain what you can do if you think you are being treated unfairly or your rights are not being respected. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. Customer Service at 800-337-4973 You have the right to ask someone such as a family member or friend to help you with decisions about your health care. SeeAutomated and Online Featuresfor additional information. Screening pap test. precertification on certain services. You have the right to get your questions answered. It is not medical advice and should not be substituted for regular consultation with your health care provider. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. You have the right to find out from us how we pay our doctors. For a specific listing of services and procedures that require preauthorization please refer to the preauthorization lists found within this manual. Note: Some services require preauthorization. UHSM Providers - PHCS PPO Network 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. No referrals needed for network specialists. Performance Health You have the right to timely access to your prescriptions at any network pharmacy. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. UHSM is a different kind of healthcare, called health sharing. HPI | Provider Resources | Patient Benefits & Eligibility For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). ConnectiCare reserves the right to terminate coverage for members who repeatedly fail to make the required copayments, coinsurance or deductibles, subject to the terms outlined in the applicableMember Agreement, Evidence of Coverage, or other governing contract. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. All oral medication requests must go through members' pharmacy benefits. 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. ConnectiCare will communicate to your patients how they may select a new PCP. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. The provider must agree to accept network rates for the defined period of time. Describe the range or medical conditions or procedures affected by the conscience objection; Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. PCPs:Advise your patients to contact ConnectiCare's Member Services at 800-224-2273 to designate a new PCP, even if your practice is being assumed by another physician. Initial chiropractic assessment If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. I called in with several medical bills to go over and their staff was extremely helpful. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. 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) What does Transition of Care and Continuity of Care mean? We must tell you in writing why we will not pay for or approve a prescription drug or Part C medical care or service, and how you can file an appeal to ask us to change this decision. Your right to know your treatment options and participate in decisions about your health care ConnectiCare also makes available to members printable, temporary ID cards via our website. Enrollee satisfaction with ConnectiCare is very important. Contact us. If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. 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. Be treated with respect and recognition of your dignity and right to privacy.