phcs eligibility and benefits

PCPs:Advise your patients to contact ConnectiCare's Member Services at 860-674-5757 or 800-251-7722 to designate a new PCP, even if your practice is being assumed by another physician. Eligibility and Benefits | ConnectiCare Welcome to the MultiPlan Provider PortalThe portal lets you view and update your network-related information, manage tasks such as credentialing and track your customer service case history. Members can print temporary ID cards by visiting the secure portion of our member website. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. 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! Clinical Review Prior Authorization Request Form. You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. That goes for you, our providers, as much as it does for our members. This includes information about our financial condition and about our network pharmacies. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; What services are available to me that could save me money? precertification on certain services. Advance directives are written instructions, such as living will, durable power of attorney for health care, health care proxy, or do not resuscitate (DNR) request, recognized under state law and relating to the provision of health care when the individual is incapacitated and unable to communicate his/her desires. 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. You have the right to get information from us about our plan. Your benefits, claims and/or eligibility are available 24/7 via our member portal. Members are required to see participating providers, except in emergencies. We hope that our members are satisfied and decide to stay with ConnectiCare; however, should you learn that a member plans to disenroll, you may avoid payment delays by: 1. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. Get coverage information. Please call Member Services if you have any questions. This feature is meant to assist members who need additional copies of their ID card. Members receive out-of-network level of benefits when they see non-participating providers. If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. The member loses entitlement to Medicare Parts A and/or B. The member engages in disruptive behavior. You can also get free help and information from CHOICES - your SHIP. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. Customer Service at 800-337-4973 ConnectiCare members will receive an identification (ID) card when they enroll in the plan. With the PHCS Network in your cost management strategy, you give your health plan participants the choice of over 4,100 hospitals, 70,000 ancillary care facilities and 630,000 healthcare professionals nationwide, whether they seek care in their home town or across the country. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. To pre-notify or to check member or service eligibility, use our provider portal. Glaucoma screening When performed out of network, these procedures do require preauthorization. Billing and Claims Eligibility and Benefits Commercial Medicare Product & Coverage Information Overview of Plan Types Overview of plan types The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. ConnectiCare also makes available to members printable, temporary ID cards via our website. To verify benefits and eligibility - (phone) 800-828-3407, To inquire about an existing authorization -800-562-6833, To request a continuation of authorization for home health care or IV therapy (seeForms, to obtain a copy of the applicable form) - fax 860-409-2437. 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. You also have the right to give your doctors written instructions about how you want them to handle your medical care if you become unable to make decisions for yourself. Members are no longer eligible for coverage after their 40th birthday. Some plans may have deductible requirements. Your right to use advance directives (such as a living will or a power of attorney) Admission to a SNF for rehabilitation, in the absence of a hospitalization or acute episode of illness, requires preauthorization and is subject to medical necessity review. The plan contract is terminated. For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. (800) 557-5471. Note: Some services require preauthorization. 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. It is important to sign this form and keep a copy at home. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Yes, PHCS provides coverage for therapy services. On a customer service rating I would give her 5 golden stars for the assistance I received. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. Providers are also required to contact ConnectiCares Notification Line at 888-261-2273 to advise ConnectiCare of the transport. 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. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. The admitting physician is responsible for pre-authorizing elective admissions five (5) working days in advance. ConnectiCare cannot reverse CMS' determination. Visit Performance Health HealthworksWellness Portal. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. That goes for you, our providers, as much as it does for our members. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. You have the right to be told about any risks involved in your care. 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. allergenic extracts (or RAST allergen specific testing); 2.) Members receive in-network level of benefits when they see participating providers. UHSM is not insurance. Once your account has been created you will only need your login and password. Pharmacy cost-share, if applicable. Members > MultiPlan Provider - SisCo There are different types of advance directives and different names for them. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. This means the PHCS Savility network offers the same quality for which PHCS Network has been recognized since 2001. Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. 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). If so, they will follow up to recruit the provider. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. For emergency care received outside the U.S. there is a $100,000 limit. Use your member subscriber ID to access the pricing tool using the link below. Be treated with respect and recognition of your dignity and right to privacy. 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 LimitedBenefit plans. Phcs Insurance Provider Phone Number | TheWebster Miami Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. ConnectiCare takes all complaints from members seriously. The following information was provided by the Connecticut Office of Attorney General for the Department of Public Health and Addiction Services and the Department of Social Services. 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. You must apply for Continuity of Care within 30 days of your health care providers termination date (this is the date your provider is leaving the network) using the request form below. 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. ConnectiCare will disclose to the Centers of Medicare & Medicaid Services (CMS) all information that is necessary to evaluate and administer our Medicare Advantage plans, and to establish and facilitate a process for current and prospective members to exercise choice in obtaining Medicare services. Providers | Gmr Note: Presentation of a member ID card is not a guarantee of a member's eligibility. If you need assistance with the shopping tool or with obtaining pricing please contact our Customer Service Team at 877-585-8480, View the video below for additional information on the MyMedicalShopper pricing tool:. Keep scheduled appointments or give sufficient advance notice of cancellation. How do I contact PHCS? We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. ConnectiCare, in coordination with participating providers, will maintain and monitor the network of participating providers to ensure that members have adequate access to PCPs, specialists, hospitals, and other health care providers, and that through the network of providers their care needs may be met. What can you doif you think you have been treated unfairly or your rights arent being respected? (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). Documents called "living will" and "power of attorney for health care" are examples of advance directives. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. PET scans Regardless of where you get this form, keep in mind that it is a legal document. 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. (More information appears later in this section.). You have the right to know how your health information has been given out and used for non-routine purposes. Provider Portal Eligibility inquiry Claims inquiry. For a specific listing of services and procedures that require pre-authorization refer to the Appendices within this manual. The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. ConnectiCare will communicate to your patients how they may select a new PCP. Member eligibility Medicaid managed care and Medicare Advantage plan effective dates Note: MultiPlan does not have access to payment records and does not make determinations with respect to ben-efits or eligibility. Wondering how member-to-member health sharing works in a Christian medical health share program? Our goal is to be the best healthcare sharing program on the planet and to provide. It is important to sign this form and keep a copy at home. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. Your right to make complaints Claims or Benefits questions will not be answered here. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. Out of network benefits will apply when receiving care from non-participating providers. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. For a specific listing of services and procedures that require preauthorization please refer to the preauthorization lists found within this manual. If you want to have an advance directive, you can get a form from your lawyer, from a social worker, or from some office supply stores. This line is available twenty-four (24) hours a day, seven days a week. All Practitioners:Please notify ConnectiCare in advance prior to taking any action to remove a specific member from your practice for any reason. Provider Quick Reference Guide - MultiPlan Paying your co-payments/coinsurance for your covered services. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Box 340308 You must apply for Transition of Care no later than 30 days after the date your coverage becomes effective or after the effective date of the network change using the request form below. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. To get any of this information, call Member Services. If you need more information, please call our Member Services. Preferred Provider Organization Questions? Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. Your right to get information in other formats ConnectiCare's service area includes all counties. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. 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. abnormal MRI; and 2.) Information is protected as stated in ConnectiCares policies. 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. Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. Prostate cancer screening (age restrictions apply) 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. 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. Initial chiropractic assessment If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. drug, biological or venom sensitivity. 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. As always, confirm benefits by contacting Provider Services at 877-224-8230. You have chosen PHCS (Private Healthcare Systems, Inc.). In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. Benefit Type* Subscriber SSN or Card ID* Patient First Name Patient Gender* Male Female Patient Date of Birth* Provider TIN or SSN*(used in billing) Go to the Client Portal > Provider directories Create a customized listing of facilities and/or practitioners participating in the network services offered by MultiPlan. 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. We may enroll employer group members as well. Your right to get information about your prescription drugs, Part C medical care or services, and costs Your plan does require For more information regarding complaint resolution, contact Provider Services at 877-224-8230. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. 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. The sample ID cards are for demonstration only. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407. 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 have the right to an explanation from us about any bills you may get for services not covered by our plan. Your right to use advance directives (such as a living will or a power of attorney) If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. 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. View the video below for additional information on the MyMedicalShopper pricing tool: The Member Resource Document includes details for your reference on: You can reference your plan document for the complete list. Copyright 2022 Unite Health Share Ministries. We must tell you in writing why we will not pay for a drug, and how you can file an appeal to ask us to change this decision. Please Note: When searching for providers, the results presented are for reference only; as participating physicians, hospitals, and/or healthcare providers may have changed since the online directory was last updated. Reminding the patient to notify ConnectiCare; and 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. What does Transition of Care and Continuity of Care mean? Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. Once you have completed the Registration form you will be emailed a link to confirm your Registration. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. Best of all, it's free- no downloads required or software to install. Coverage for medical emergencies without preauthorization. Performance Health For Medicaid managed To verify eligibility for services, request to see the member's current ID card. 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. 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. PHCS PPO Network - WeShare Healthcare Some plans may have a copayment requirement for radiology services. You can sometimes get advance directive forms from organizations that give people information about Medicare. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. Monitoring includes member satisfaction with physicians. All participating providers agree to certify that all information submitted to ConnectiCare is accurate, complete, truthful, and shall comply with applicable CMS standards. 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). Balance Bill defense is available for all members with a Reference Based Pricing Plan. A voluntary termination initiated by a practitioner should be communicated to ConnectiCare verbally or in writing, in accordance with the terms set forth in the contract, but no less than sixty (60) days before the effective date. Call Automated Phone Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. The ID card lists the following information: ConnectiCare member ID number (SeeOther Benefit Information). You should consider having a lawyer help you prepare it. Were here to help! For non-portal inquiries, please call 1-800-950-7040 . If you have any concerns about your health, please contact your health care provider's office. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. P.O. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. Question 4. Broker benefits Get in touch. You also have the right to give your doctors written instructions about how you want them to handle your medical care if you become unable to make decisions for yourself. You have the right under law to have a written/binding advance coverage determination made for the service, even if you obtain this service from a provider not affiliated with our organization. View sample member ID cards forcopayandhigh-deductibleplans for details. It is critical that the members eligibility be checked at each visit. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. Go > After the deductible has been met, coinsurance will apply to the covered benefits. Following is the statement in its entirety. Members who do not have an ID card should not be denied medical services without contacting ConnectiCare first to determine the member's enrollment status. Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and 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. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. Describe the range or medical conditions or procedures affected by the conscience objection; After the deductible is met, benefits will be covered according to the Plan. Below are the additional benefits covered by ConnectiCare. 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. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. Register for an account For No Surprises Act First time visitor? This would also include chronic ventilator care. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. To begin the precertification process, your provider(s) should contact If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. ConnectiCare will communicate to your patients how they may select a new PCP. Your right to get information about our plan and our network pharmacies Call us and tell us you would like a decision if the service or item will be covered. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. TTY users should call 877-486-2048. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. Actual copayment information and other benefit information will vary. Its affordable, alternative health care. 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. 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. Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. We must investigate and try to resolve all complaints. TTY users should call 877-486-2048. PHCS (Private Healthcare Systems, Inc.) - PPO. Physicians may make referrals to participating specialists without entering them into the telephonic referral system. I'm a Broker. MultiPlan uses technology-enabled provider network, negotiation, claim pricing and payment accuracy services as building blocks for medical payors to customize the healthcare cost management programs that work best for them. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). 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 Health Share and WeShare All rights reserved. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. PHCS (Private Healthcare Systems, Inc.) - Sutter Health If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. your current benefits ID card upon arrival at your appointment. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. Covered according to Massachusetts state mandate. This video explains it. PHCS is the leading PPO provider network and the largest in the nation. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. It is important to note that not all of the Sutter Health network .

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