Claims or Benefits questions will not be answered here. To begin the precertification process, your provider(s) should contact PDF PHCS Network and Limited Benefit Plans - MultiPlan Pharmacy cost-share, if applicable. 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. If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. Out of network benefits will apply when receiving care from non-participating providers. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. Portal Training for Provider Groups If you need help with communication, such as help from a language interpreter, please call Medicare Member Services. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. Call Automated Phone Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. To get any of this information, call Member Services. To get this information, call 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. 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. You can reference your plan document for the complete list. These services are covered under the Option Plan nationwide. 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. 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. Solutions. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. Best of all, it's free- no downloads required or software to install. 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. Check with our Customer Service Team to find out if your plan accesses Health Coaching. ConnectiCare will also notify members of the change thirty (30) days prior to the effective date of the change, or as soon as possible after we become aware of the change. ConnectiCare will communicate to your patients how they may select a new PCP. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. Prior Authorizations are for professional and institutional services only. Since you have Medicare, you have certain rights to help protect you. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. 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. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. Performance Health You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. You may want to give copies to close friends or family members as well. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). You also have the right to get information from us about our plan. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections 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. It includes services and supplies furnished to a member who has a medical condition that is chronic or non-acute and which, at our discretion, either: Are furnished primarily to assist the patient in maintaining activities of daily living, whether or not the member is disabled, including, but not limited to, bathing, dressing, walking, eating, toileting and maintaining personal hygiene or. Your right to use advance directives (such as a living will or a power of attorney) Paying your co-payments/coinsurance for your covered services. . How do I know if I qualify for PHCS insurance? See the preauthorization section for a listing of DME that requires preauthorization. If you have any other kind of concern or problem related to your Medicare rights and protections described in this section, you can also get help from CHOICES. Letting us know if you have any questions, concerns, problems, or suggestions. Answer 3. TTY users should call 877-486-2048. Your right to get information about our network pharmacies and/or providers Go > For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. Our goal is to be the best healthcare sharing program on the planet and to provide. UHSM is always eager and ready to assist. Members must reside in the service area. Note: The list of covered DME and disposable supplies is reviewed periodically and subject to change at the sole discretion of ConnectiCare. Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. No referrals needed for network specialists. 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. Access to any Medicare-approved doctor or hospital in the United States. Describe the range or medical conditions or procedures affected by the conscience objection; Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. Life Insurance *. 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. This line is available twenty-four (24) hours a day, seven days a week. If authorization is not obtained, payment for the service may be denied. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Supporting evidence, which may be required includes: 1.) 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. If you have questions or concerns about your rights and protections, please call Member Services. For non-portal inquiries, please call 1-800-950-7040 . To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. This includes information about our financial condition, and how our Plan compares to other health plans. That goes for you, our providers, as much as it does for our members. What does Transition of Care and Continuity of Care mean? Eligibility Claims Eligibility Fields marked with * are required. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. Monitoring includes member satisfaction with physicians. 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. Member satisfaction with ConnectiCare is very important. View sample member ID cards forcopayandhigh-deductibleplans for details. PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. This feature is meant to assist members who need additional copies of their ID card. It is critical that the members eligibility be checked at each visit. How do I contact PHCS? This video explains it. ConnectiCare also makes available to members printable, temporary ID cards via our website. All requests to initiate or extend a mental health or substance abuse authorization should be directed to our Behavioral Health Program at 800-349-5365. Additionally, ConnectiCaremaydisenroll a member if: Premiums are not paid on a timely basis. 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. 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. 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. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. ThriveHealth STM - Health Depot Association Our plan must obey laws that protect you from discrimination or unfair treatment. Use our online Provider Portal or call 1-800-950-7040. Members pay a copayment cost-share for most covered health services at the time the services are rendered. This would also include chronic ventilator care. ConnectiCare takes all complaints from members seriously. 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. 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. For benefit-related questions, call Provider Services at 877-224-8230. Contact the pre-notification line at 866-317-5273. Nutritionist and social worker visit 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). Members who develop ESRD after enrollment may remain with a ConnectiCare plan. Member satisfaction information is updated and posted annually and is made available on our website atconnecticare.com. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). Go to the Client Portal > Provider directories Create a customized listing of facilities and/or practitioners participating in the network services offered by MultiPlan. For Medicaid managed These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. If you want a paper copy of this information, you may contact Provider Services at 860-674-5850 or 800-828-3407. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. Once you have completed the Registration form you will be emailed a link to confirm your Registration. drug, biological or venom sensitivity. Continuity of Care allows members the option to apply to receive services at in-network coverage levels for specified medical and behavioral conditions, from their current health care provider if the provider is or is soon to be out-of-network. Covered according to Massachusetts state mandate. 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. On a customer service rating I would give her 5 golden stars for the assistance I received. 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. A sample of the ConnectiCare ID cards appear below. 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. To find a participating provider outside of Oklahoma, follow the steps listed below. plan. Were here to help! 860-509-8000, (TTY) 860-509-7191. Provider Portal Info > MultiPlan 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. You have the right to be treated with dignity, respect, and fairness at all times. Provider Portal 877-585-8480. When performed out of network, these procedures do require preauthorization. Your right to get information about your prescription drugs, Part C medical care or services, and costs Mail Paper HCFAs or UBs: Medi-Share These members may have a different copayment and/or benefit package. Members are no longer eligible for coverage after their 40th birthday. Provider. PDF PHCS Network and Limited Benefit Plans - MultiPlan Acting in a way that supports the care given to other patients and helps the smooth running of your doctors office, hospitals, and other offices. CT scans (all diagnostic exams) 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. Remember you will only need your registration code this one time to set up your account. To verify or determine patient eligibility, call 1-800-222-APWU (2798). The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. While you may contact us by telephone, you will be asked to place your concerns in writing. 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. For non-portal inquiries, please call 1-800-950-7040. MultiPlan can help you find the provider of your choice. (214) 436 8882 The sample ID cards are for demonstration only. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. Providers - INSURANCE BENEFIT ADMINISTRATORS Your right to get information about your drug coverage and costs ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Box 340308 If you have any questions please review your formulary website or call Member Services. PHCS (Private Healthcare Systems, Inc.) - PPO - Sutter Health Use your member subscriber ID to access the pricing tool using the link below. Colorectal screening (age restrictions apply) You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). Call us and tell us you would like a decision if the service or item will be covered. Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. You can easily: Verify member eligibility status; . The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. 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. Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. UHSM is excellent, friendly, and very competent. Clinical Review Prior Authorization Request Form. I really appreciate the service I received from UHSM. Your responsibilities as a member of our plan. Please call Member Services if you have any questions. 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. You may want to give copies to close friends or family members as well. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Medicare Advantage or Medicaid call 1-866-971-7427. Emergency care is covered. (800) 557-5471. 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. Identify the state legal authority permitting such objection; Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. Your right to be treated with dignity, respect and fairness Some plans cover preventive dental services: Receive information about us, our services, our participating providers, and "Members Rights and Responsibilities.". ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. 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. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button Really good service. Members receive out-of-network level of benefits when they see non-participating providers. Initial mental health consultation (SeeOther Benefit Information). If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. To inquire about an existing authorization - (phone) 800-562-6833 As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. Lifetime maximums apply to certain services. If you need more information, please call our Member Services. Box 450978 Westlake, OH 44145. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. The member loses entitlement to Medicare Parts A and/or B. Quality - MultiPlan applies rigorous criteria when credentialing providers for participation in the PHCSNetwork, so you can be assured you are choosing your healthcare provider from a high-quality network. Devices can include but not be limited to diskettes, CDs, tapes, mobile applications, portable drives, desktops, laptops, secure portals, and hardware. After the deductible is met, benefits will be covered according to the Plan. Popular Questions. For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. We must investigate and try to resolve all complaints. PHCS PPO Network - Health Depot Association 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. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. ConnectiCare takes all complaints from members seriously. P.O. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. 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. After the Plan deductible is met, benefits will be covered according to the Plan. Actual copayment information and other benefit information will vary. 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 must investigate and try to resolve all complaints. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." abnormal arthrogram. Note: These procedures are covered procedures, but do not require preauthorization in network. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. ConnectiCare will communicate to your patients how they may select a new PCP. Contact us. Once your account has been created you will only need your login and password. A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who isnt providing your care or paying for your care. Regardless of where you get this form, keep in mind that it is a legal document. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. As always, confirm benefits by contacting Provider Services at 877-224-8230. 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. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. What to do if you think you have been treated unfairly or your rights are not being respected? 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). A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. Incorrect Email or Password - MultiPlan Below are the additional benefits covered by ConnectiCare. 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. 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. We also cover additional benefits beyond Original Medicare alone. Letting us know if you have additional health insurance coverage. Covered at participating urgent care providers. All genetic testing requires preauthorization, with the exception of the following: Routine chromosomal analysis (e.g., peripheral blood, tissue culture, chorionic villous sampling, amniocentesis) - CPT 83890 - 83914, billed withModifier 8A or ICD-9 diagnosis codes V77.6 or V83.81, DNA testing for cystic fibrosis - CPT 88271 - 88275; 88291, billed withModifier 2A - 2Z or ICD-9 codes V10.6x or V10.7x, FISH (fluorescent in situ hybridization) for the diagnosis of lymphoma or leukemia - CPT 88230 - 88269; 88280 - 88289; 88291; 88299.
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phcs eligibility and benefits