Coverage for medical emergencies without preauthorization. Regardless of where you get this form, keep in mind that it is a legal document. 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. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. When performed out of network, these procedures do require preauthorization. Members pay a copayment cost-share for most covered health services at the time the services are rendered. Note: Some services require preauthorization. TTY users should call 877-486-2048. You can sometimes get advance directive forms from organizations that give people information about Medicare. However, the majority of PHCS plans offer members . You have the right to make a complaint if you have concerns or problems related to your coverage or care. You have the right to receive a detailed explanation from us if you believe that a provider has denied care that you believe you were entitled to receive or care you believe you should continue to receive. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. ConnectiCare takes all complaints from members seriously. We must tell you in writing why we will not pay for or approve a service, and how you can file an appeal to ask us to change this decision. How do I contact PHCS? Specialists:Provide continuity and coordination of care by sending a written report to the member's PCP regarding any treatment or consultation provided to the member. 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! The legal documents that you can use to give your directions in advance in these situations are called "advance directives." (800) 557-5471. There are different types of advance directives and different names for them. Yes, PHCS provides coverage for therapy services. Popular Questions. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. It is important to note that not all of the Sutter Health network . Prior Authorizations are for professional and institutional services only. 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 have questions or concerns about privacy of your personal information and medical records, please call Member Services. 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. We request your cooperation in investigating and resolving these complaints. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. That goes for you, our providers, as much as it does for our members. Your right to use advance directives (such as a living will or a power of attorney) Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. Your right to get information about our plan A new web site will open up in a new window. You also have the right to get information from us about our plan. part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. Member Services can also help if you need to file a complaint about access (such as wheel chair access). 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. If you do, please call Member Services. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. That goes for you, our providers, as much as it does for our members. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. abnormal MRI; and 2.) 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. 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. UHSM Health Share and WeShare All rights reserved. They should be informed of any health care needs that require follow-up, as well as self-care training. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. 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. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. All oral medication requests must go through members' pharmacy benefits. This includes information about our financial condition, and how our Plan compares to other health plans. Portal Training for Provider Groups Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. What services are available to me that could save me money? SeeGlossaryfor definitions of emergency and urgent care. 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 Claims Eligibility Fields marked with * are required. To begin the precertification process, your provider(s) should contact You have the right to get information from us about our plan. Our goal is to be the best healthcare sharing program on the planet and to provide. If so, they will follow up to recruit the provider. Colorectal screening (age restrictions apply) Monitoring includes member satisfaction with physicians. Oops, there was an error sending your message. Provider Portal Eligibility inquiry Claims inquiry. Employer group enrollment will be the result of employers electing to offer benefits to retirees through ConnectiCare. The bill of service for these members must be submitted to Medicaid for reimbursement. In addition, information is protected by information systems security, and authentication and authorization procedures, such as but not limited to: password-protected files; storage, data disposal, and reuse of media and devices; and transmission and physical security requirements using company-protected equipment including access to devices and media that contain individual-level data. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. To get this information, call Member Services. Lifetime maximums apply to certain services. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. 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. The temporary card is a valid form of ConnectiCare member identification. See the preauthorization section for a listing of DME that requires preauthorization. Members pay a copayment as cost-share for most covered health services at the time services are rendered. 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 > The sample ID cards are for demonstration only. Balance Bill defense is available for all members with a Reference Based Pricing Plan. Screening pap test. 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. Visit Performance Health HealthworksWellness Portal. Members with End Stage Renal Disease (ESRD) will not qualify, except if they are currently covered by a ConnectiCare benefit plan through an employer or self pay (a commercial member). 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. 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. Really good service. Your right to get information about our plan and our network pharmacies Provide, to the extent possible, information providers need to render care. Follow the plans and instructions for care that they have agreed on with practitioners. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. 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. 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. PHCS (Private Healthcare Systems, Inc.) - PPO. 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 can sometimes get advance directive forms from organizations that give people information about Medicare. Members are no longer eligible for coverage after their 40th birthday. TTY users should call 877-486-2048. Members must meet an in-network Plan deductible that applies to most covered health services, including prescription drug coverage, before coverage of those benefits apply. 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. You will now leave the AvMed web site once you click the "I agree" button. You have the right to find out from us how we pay our doctors. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. You may want to give copies to close friends or family members as well. I'm a Broker. Describe the range or medical conditions or procedures affected by the conscience objection; It is not medical advice and should not be substituted for regular consultation with your health care provider. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). You and your administrative staff can quickly and easily access member eligibility and claims status information anytime, on demand. We believe there is no such thing as a standard cost management approach. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Your right to know your treatment options and participate in decisions about your health care 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. Coverage for skilled nursing facility (SNF) admissions with preauthorization. Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. ConnectiCare offers both employer-sponsored plans and individual insurance plans. Note: Some plans may vary. As always, confirm benefits by contacting Provider Services at 877-224-8230. Reminding the patient to notify ConnectiCare; and If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive, take a copy with you to the hospital. Covered according to Massachusetts state mandate. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. 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. Choose "Click here if you do not have an account" for self-registration options. For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. A 3-day covered hospital stay is not required prior to being admitted. Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. Product and plan details are outlined in the product and coverage section on this page. 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. 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. We request your cooperation in investigating and resolving these complaints. Members receive out-of-network level of benefits when they see non-participating providers. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. 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:. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. In addition, the ID card also includes emergency instructions and a toll-free telephone number for out-of-area and after-hours notifications, the Member Services phone number, and the claims submission address. Blue Cross Providers: 800 . Question 2. Box 450978 Westlake, OH 44145. Regardless of where you get this form, keep in mind that it is a legal document. To verify eligibility for services, request to see the member's current ID card. 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. This means the PHCS Savility network offers the same quality for which PHCS Network has been recognized since 2001. UHSM is excellent, friendly, and very competent. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. Bone mass measurement Your right to get information about your drug coverage and costs How to get more information about your rights Following is the statement in its entirety. How to manage the front desk when they ask who you are insured with? For non-portal inquiries, please call 1-800-950-7040. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. The ID card lists the following information: ConnectiCare member ID number 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. For emergency care received outside the U.S. there is a $100,000 limit. 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. Hartford, CT 06134-0308 Clinical Review Prior Authorization Request Form. To get any of this information, call Member Services. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. 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. Once you have completed the Registration form you will be emailed a link to confirm your Registration. 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. Answer 1. You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. Timely access means that you can get appointments and services within a reasonable amount of time. Enrollee satisfaction with ConnectiCare is very important. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. Members can print temporary ID cards by visiting the secure portion of our member website. Some plans may have deductible requirements. 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. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Members are encouraged to actively participate in decision-making with regard to managing their health care. Member satisfaction information is updated and posted annually and is made available on our website atconnecticare.com. For Medicaid managed Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. After the deductible is met, benefits will be covered according to the Plan. Postoperative physical therapy for TMJ surgery is limited to ninety (90) days from the date of surgery when pre-authorized as part of surgical procedure. 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. United Faith Ministries, Inc. is a 501(c)(3) nonprofit corporation, dba Unite Health Share Ministries or UHSM Health Share, that facilitates member-to-member sharing of medical bills. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. What can you doif you think you have been treated unfairly or your rights arent being respected? Examples of qualifying medical conditions can be found below. From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. (More information appears later in this section.). 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. If you have any concerns about your health, please contact your health care provider's office. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. UHSM is not insurance. 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. No out-of-network coverage unless pre-authorized in writing by ConnectiCare. Members have an in-network deductible for some covered services. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. Initial chiropractic assessment Be sure to ask your doctors and other providers if you have any questions and have them explain your treatment in a way you can understand. MedAvant Physicians may make referrals to participating specialists without entering them into the telephonic referral system. If you have signed an advance directive, and you believe that a doctor or hospital hasnt followed the instructions in it, you may file a complaint with: Connecticut Department of Health This information is not used in contracting or credentialing decisions or for any discriminatory purpose. 410 Capitol Avenue 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. Be treated with respect and recognition of your dignity and right to privacy. 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. In these cases, you must request an initial decision called an organization determination or a coverage determination. Voice complaints or appeals/grievances about us or the care you are provided. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. PHCS is the leading PPO provider network and the largest in the nation. Your right to use advance directives (such as a living will or a power of attorney) Call Automated Phone Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. 877-585-8480. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. Answer 3. Contact the pre-notification line at 866-317-5273. To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. Your right to get information about your prescription drugs, Part C medical care or services, and costs Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. 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. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). Get coverage information. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. You should consider having a lawyer help you prepare it. When performed out-of-network, these procedures do require preauthorization. CT scans (all diagnostic exams) 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.
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