Stress echocardiograms For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. They are collected via enrollment information, self-disclosure, and the member portal. You will now leave the AvMed web site once you click the "I agree" button. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). 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. Contact the pre-notification line at 866-317-5273. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. You have the right to find out from us how we pay our doctors. If you do not inform ConnectiCare according to these guidelines, the SNF may not receive payment for any additional days of the member's stay. New members may use a copy of their enrollment form. PPM/10.16 Overview of Plans Overview of products If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. Once submitted, ConnectiCare will verify the eligibility of the member with the Centers for Medicare & Medicaid Services (CMS) as they are the sole arbiter of eligibility for Medicare. Go to the Client Portal > Provider directories Create a customized listing of facilities and/or practitioners participating in the network services offered by MultiPlan. PHCS PPO Network - WeShare Healthcare What can you doif you think you have been treated unfairly or your rights arent being respected? You must pay for services that arent covered. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and pre-authorization must be obtained through ConnectiCare. Initial chiropractic assessment Payors > MultiPlan Refuse treatment and to receive information regarding the consequences of such action. Below are the additional benefits covered by ConnectiCare. Benefit Type* Subscriber SSN or Card ID* Subscriber Group #* Patient First Name Patient Gender* Male Female Patient Date of Birth* Provider TIN or SSN*(used in billing) 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. Monitoring includes member satisfaction with physicians. The Evidence of Coverage (EOC) will instruct them to call their PCP. Any personal information that you give us when you enroll in this plan is protected. 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. Your right to get information about our plan and our network pharmacies In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. You have the right to be told about any risks involved in your care. Preferred Provider Organization Questions? ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. 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. Referrals must be signed in to ConnectiCaresProvider Connection. Renal dialysis services for members temporarily outside the service area. Browse the list to see where your plan is accepted. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Call us and tell us you would like a decision if the service or item will be covered. UHSM is a different kind of healthcare, called health sharing. For Medicaid managed Get coverage information. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. Members are required to see participating providers, except in emergencies. Our goal is to be the best healthcare sharing program on the planet and to provide. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. 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. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. Routine hearing tests covered up to 1 every year, Routine eye exams covered up to 1 every year, Discounts are available on lenses, contacts and frames. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. 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. To verify or determine patient eligibility, call 1-800-222-APWU (2798). If you are calling to verify your patient's benefits*, please have a copy 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) If so, they will follow up to recruit the provider. If you do, please call Member Services. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. Bone Mineral Density exams ordered more frequently than every twenty-three (23) months 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. We will make sure that unauthorized people dont see or change your records. They should be informed of any health care needs that require follow-up, as well as self-care training. The ID card lists the following information: ConnectiCare member ID number 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. 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. Yes, PHCS provides coverage for therapy services. Question 4. You have the right to timely access to your prescriptions at any network pharmacy. 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. 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. The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. There are different types of advance directives and different names for them. This means the PHCS Savility network offers the same quality for which PHCS Network has been recognized since 2001. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. Coverage follows Original Medicare guidelines. To get any of this information, call Member Services. ConnectiCare enrolls individual members into the ConnectiCare plan. To find a participating provider outside of Oklahoma, follow the steps listed below. 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 admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. 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. Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. Actual copayment information and other benefit information will vary. Some applicable copayments PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. If you think you have been treated unfairly or your rights have not been respected, you may call Member Services or: If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, you can call the Office for Civil Rights at 800-368-1019 or TTY 800-537-7697, or call your local Office for Civil Rights. This feature is meant to assist members who need additional copies of their ID card. 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. Accessing PHCS Savility PHCS Savility is available to insurers and benefit plan administrators meeting certain benefit design Provider Portal Info > MultiPlan Make recommendations regarding our members rights and responsibilities policies. For non-portal inquiries, please call 1-800-950-7040. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. The member provides fraudulent information on the application or permits abuse of an enrollment card. Use your member subscriber ID to access the pricing tool using the link below. High Deductible Health Plan (Health Savings Account [HSA] Compatible). By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . What services are available to me that could save me money? Lifetime maximums apply to certain services. 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. 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. Members can print temporary ID cards by visiting the secure portion of our member website. I called in with several medical bills to go over and their staff was extremely helpful. (SeeOther Benefit Information). P.O. Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. MRI/MRA (all examinations) Giving your doctor and other providers the information they need to care for you, and following the treatment plans and instructions that you and your doctors agree upon. You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. 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. 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. Regardless of where you get this form, keep in mind that it is a legal document. You can also get free help and information from CHOICES - your SHIP. My rep did an awesome job. 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. Popular Questions. Member satisfaction with ConnectiCare is very important. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. Use our online Provider Portal or call 1-800-950-7040. plan. Healthcare Provider FAQs > MultiPlan 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. Were here to help! 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). 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. If you dont know the member's ID number, contact Provider Services during regular business hours to verify eligibility and benefits. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. You may want to give copies to close friends or family members as well. 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. 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. There are federal and state laws that protect the privacy of your medical records and personal health information. Medicare members may disenroll from the plan when the guidelines, as set forth bythe Centers for Medicare & Medicaid Services (CMS), are met. 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. Prior Authorizations are for professional and institutional services only. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. Be considerate of our providers, and their staff and property, and respect the rights of other patients. If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement Describe the range or medical conditions or procedures affected by the conscience objection; Your right to know your treatment options and participate in decisions about your health care 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. Note: Some plans may vary. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. ConnectiCare eligible members shall not be discriminated against with respect to the availability or provision of health services based on an enrollee's race, sex, age, religion, place of residence, HIV status, source of payment, ConnectiCare membership, color, sexual orientation, marital status, or any factor related to an enrollee's health status. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. Nutritionist and social worker visit The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. 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) To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. Note: Presentation of a member ID card is not a guarantee of a member's eligibility. For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. TTY users should call 877-486-2048. ConnectiCare members will receive an identification (ID) card when they enroll in the plan. You can sometimes get advance directive forms from organizations that give people information about Medicare. Members receive in-network level of benefits when they see participating providers. Provider Portal - 90 Degree Benefits ConnectiCare's service area includes all counties. 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 You have chosen PHCS (Private Healthcare Systems, Inc.). Please review the member's ID card to confirm the appropriate phone number. Balance Bill defense is available for all members with a Reference Based Pricing Plan. Covered at participating urgent care providers. PHCS (Private Healthcare Systems, Inc.) - PPO - Sutter Health Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. PDF PHCS Network Bringing Greater Choice and Savings to the Employees Oops, there was an error sending your message. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. This video explains it. 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. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. If you have difficulty obtaining information from your plan based on language or a disability, call 1-800-MEDICARE (800-633-4227). Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. 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. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. Our plan must have individuals and translation services available to answer questions from non-English speaking beneficiaries, and must provide information about our benefits that is accessible and appropriate for persons eligible for Medicare because of disability. If authorization is not obtained, payment for the service may be denied. The ConnectiCare Medicare Advantage network. If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. Out of network benefits will apply when receiving care from non-participating providers. TTY users should call 877-486-2048. Letting us know if you have additional health insurance coverage. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. New users to the Provider Portal can create an account by selecting the Provider Access Link on the portal login page. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. 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. This includes information about our financial condition and about our network pharmacies. Eligibility Claims Eligibility Fields marked with * are required. Access to any Medicare-approved doctor or hospital in the United States. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button Your right to get information about your drug coverage and costs Network providers and practitioners are also contractually obligated to protect the confidentiality of members information. Members pay a copayment cost-share for most covered health services at the time the services are rendered. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. What does Transition of Care and Continuity of Care mean? To get any of this information, call Member Services. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. We request your cooperation in investigating and resolving these complaints. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. 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. Follow the plans and instructions for care that they have agreed on with practitioners. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). Blue Cross Providers: 800 . 860-509-8000, (TTY) 860-509-7191. You may want to give copies to close friends or family members as well. 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. A new web site will open up in a new window. ConnectiCare members may directly access care through self-referral to a participating clinician for covered services and certain Medicare-covered services at designated frequencies and ages, including: Annual routine eye exam (Prime and Custom Plans only)
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