Contact the pre-notification line at 866-317-5273. On a customer service rating I would give her 5 golden stars for the assistance I received. ConnectiCare cannot reverse CMS' determination. The following are samples of each type of ID card that ConnectiCare issues to members. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. 860-509-8000, (TTY) 860-509-7191. PHCS is the leading PPO provider network and the largest in the nation. 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. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. Members receive in-network level of benefits when they see participating providers. Question 4. Simply call (888) 371-7427 Monday through Friday from 8 a.m. to 8 p.m. (Eastern Standard Time) and identify yourself as a health plan participant accessing PHCS Network for Limited Benefit plans. Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. 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! 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) Members pay a copayment cost-share for most covered health services at the time the services are rendered. These members may have a different copayment and/or benefit package. However, the majority of PHCS plans offer members . After the deductible is met, benefits will be covered according to the 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. 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. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? No referrals needed for network specialists. 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. SeeGlossaryfor definitions of emergency and urgent care. Remember you will only need your registration code this one time to set up your account. If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. 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. Wondering how member-to-member health sharing works in a Christian medical health share program? Documents called "living will" and "power of attorney for health care" are examples of advance directives. 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. Letting us know if you have any questions, concerns, problems, or suggestions. 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. If you do, please call Member Services. ConnectiCare's policies must show evidence of respecting the implementation of their rights, including a clear and precise statement of limitation if ConnectiCare and its network of participating providers cannot implement an advance directive as a matter of conscience. We also cover additional benefits beyond Original Medicare alone. abnormal MRI; and 2.) Your plan does require Keep scheduled appointments or give sufficient advance notice of cancellation. 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. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. If you have any concerns about your health, please contact your health care provider's office. 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. Your Explanation of Payment (EOP) will specify member responsibility. 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. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. We will make sure that unauthorized people dont see or change your records. To find a participating provider outside of Oklahoma, follow the steps listed below. P.O. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. UHSM is always eager and ready to assist. 877-585-8480. Medicare members who elect to become members of ConnectiCare must meet the following qualifications: Members must be eligible for Medicare Part A and be enrolled in and continue to pay for Medicare Part B. If you have any questions please review your formulary website or call Member Services. You have the right to timely access to your prescriptions at any network pharmacy. Influenza and pneumococcal vaccinations We must investigate and try to resolve all complaints. (SeeOther Benefit Information). 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. You can also visit www.medicare.gov on the Web to view or download the publication Your Medicare Rights & Protections. Under Search Tools, select Find a Medicare Publication. Or, call 1-800-MEDICARE (800-633-4227). 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. 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). You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments. When performed out-of-network, these procedures do require preauthorization. Members can print temporary ID cards by visiting the secure portion of our member website. To verify or determine patient eligibility, call 1-800-222-APWU (2798). You have the right to refuse treatment. You have chosen PHCS (Private Healthcare Systems, Inc.). 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. Referrals must be signed in ConnectiCares referral system viaProvider Connection. You have the right to get information from us about our plan. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). Life Insurance *. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. 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. (214) 436 8882 Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections All oral medication requests must go through members' pharmacy benefits. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. Get coverage information. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. This line is available twenty-four (24) hours a day, seven days a week. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! Follow the rules of this Plan, and assume financial responsibility for not following the rules. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. Regardless of where you get this form, keep in mind that it is a legal document. If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. You have the right to find out from us how we pay our doctors. To get this information, call Member Services. There are different types of advance directives and different names for them. 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. Broker benefits Get in touch. 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. abnormal arthrogram. Identify the state legal authority permitting such objection; For more information regarding complaint resolution, contact Provider Services at 877-224-8230. No referrals needed for network specialists. 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. 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. The member provides fraudulent information on the application or permits abuse of an enrollment card. 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. 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) It is not medical advice and should not be substituted for regular consultation with your health care provider. You can reference your plan document for the complete list. PCP name and telephone number We must investigate and try to resolve all complaints. Optional Life Insurance *. allergenic extracts (or RAST allergen specific testing); 2.) It is important to note that not all of the Sutter Health network . 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. 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. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. Coverage for receipt of blood and for autologous blood transfusions for the following procedures, when the procedures are covered benefits: Custodial care is not a covered benefit. When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. PCPs:Advise your patients to contact ConnectiCare's Member Services at 800-224-2273 to designate a new PCP, even if your practice is being assumed by another physician. ConnectiCare will communicate to your patients how they may select a new PCP. Your providers must explain things in a way that you can understand. If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. UHSM is a different kind of healthcare, called health sharing. The provider must agree to accept network rates for the defined period of time. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. Go > You can sometimes get advance directive forms from organizations that give people information about Medicare. Examples of qualifying medical conditions can be found below. 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. 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. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. PPM/10.16 Overview of Plans Overview of products Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. 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. Information is protected as stated in ConnectiCares policies. Emergency care is covered. High Deductible Health Plan (Health Savings Account [HSA] Compatible). 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. 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. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. They will be clearly distinguishable by their ID cards. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. Contact us. Were here to help! A 3-day covered hospital stay is not required prior to being admitted. If you are calling to verify your patient's benefits*, please have a copy Call us and tell us you would like a decision if the service or item will be covered. We request your cooperation in investigating and resolving these complaints. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. If you want a paper copy of this information, you may contact Provider Services at 860-674-5850 or 800-828-3407. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. TTY users should call 877-486-2048. Members are encouraged to actively participate in decision-making with regard to managing their health care. Below are the additional benefits covered by ConnectiCare. Members have the responsibility to: Members rights and our obligations are limited to our ability to make a good faith effort in regard to: Each time a member receives services, you should confirm eligibility. Ask to see the member's ConnectiCare member identification (ID) card. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. Pleasant and provided correct information in a timely manner. For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. What can you doif you think you have been treated unfairly or your rights arent being respected? 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. See preauthorization list for DME that requires pre-authorization. Check with our Customer Service Team to find out if your plan accesses Health Coaching. I'm a Broker. Your right to get information about our plan and our network pharmacies To inquire about an existing authorization - (phone) 800-562-6833 Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. Some plans may have deductible and coinsurance requirements. 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. If you need more information, please call our Member Services. Your right to get information about your drug coverage and costs Answer 5. Eligibility and Referral Line 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. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. The bill of service for these members must be submitted to Medicaid for reimbursement. Provider Portal - Claims & Eligibility If authorization is not obtained, payment for the service may be denied. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. Make recommendations regarding our members rights and responsibilities policies. The admitting physician is responsible for pre-authorizing elective admissions five (5) working days in advance. Examples of covered medical conditions can be found below. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. The ConnectiCare Medicare Advantage network. 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. 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. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. Please call Member Services if you have any questions. New Century Health - Medical Oncology Policies, Provider resource: 2020 changes to Medicare Advantage plans, Dual special needs plan member information available through provider website, Reminders about caring for our Medicare Advantage members, Changes to claims payment for Medicare Advantage inpatient stays, Update on Medicare Beneficiary Identifiers (MBIs), Clinical Review Prior Authorization Request Form.
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