Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. Our plan must obey laws that protect you from discrimination or unfair treatment. To get this information, call Member Services. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. Timely access means that you can get appointments and services within a reasonable amount of time. Letting us know if you have any questions, concerns, problems, or suggestions. Really good service. You should consider having a lawyer help you prepare it. If you have questions or concerns about your rights and protections, please call Member Services. (800) 557-5471. PHCS PPO Network - WeShare Healthcare This feature is meant to assist members who need additional copies of their ID card. 877-585-8480. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. Please check the privacy statement of the website where this link takes you. What insurance carrier is PHCS? - InsuredAndMore.com 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. 860-509-8000, (TTY) 860-509-7191. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. Members have an in-network deductible for some covered services. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. 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. 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. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. faq. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. No referrals needed for network specialists. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. 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. Your Explanation of Payment (EOP) will specify member responsibility. Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. TTY users should call 877-486-2048. 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. See the preauthorization section for a listing of DME that requires preauthorization. We may enroll employer group members as well. The member loses entitlement to Medicare Parts A and/or B. Influenza and pneumococcal vaccinations If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. Claims or Benefits questions will not be answered here. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. 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. We request your cooperation in investigating and resolving these complaints. 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. Your right to get information about our network pharmacies and/or providers If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). ConnectiCare members will receive an identification (ID) card when they enroll in the plan. Your right to get information in other formats Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Yes, PHCS provides coverage for therapy services. Question 5. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Colorectal screening (age restrictions apply) Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. Please Note: When searching for providers, the results presented are for reference only; as participating physicians, hospitals, and/or healthcare providers may have changed since the online directory was last updated. These services are covered under the Option Plan nationwide. ConnectiCare also makes available to members printable, temporary ID cards via our website. If you dont know the member's ID number, contact Provider Services during regular business hours to verify eligibility and benefits. A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. Can be provided safely by persons who are not medically skilled, with a reasonable amount of instruction, including, but not limited to, supervision in taking medication, homemaking, supervision of the patient who is unsafe to be left alone, and maintenance of bladder catheters, tracheotomies, colostomies/ileostomies and intravenous infusions (such as TPN) and oral or nasal suctioning. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Go > Question 1. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. 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. 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. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! 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:. You will get most or all of your care from plan providers, that is, from doctors and other health providers who are part of our plan. UHSM is a different kind of healthcare, called health sharing. PHCS www.multiplan.com (Please select the provider network listed on your ID card) * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. They are collected via enrollment information, self-disclosure, and the member portal. Describe the range or medical conditions or procedures affected by the conscience objection; part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. CT scans (all diagnostic exams) Any personal information that you give us when you enroll in this plan is protected. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Provider Portal UHSM is NOT an insurance company nor is the membership offered through an insurance company. Prior Authorizations are for professional and institutional services only. Answer 4. Your right to make complaints Documents called "living will" and "power of attorney for health care" are examples of advance directives. Below are the additional benefits covered by ConnectiCare. If you are calling to verify your patient's benefits*, please have a copy 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. 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. Examples of covered medical conditions can be found below. Screening pap test. Providers - INSURANCE BENEFIT ADMINISTRATORS To get this information, call Member Services. What to do if you think you have been treated unfairly or your rights are not being respected? Refuse treatment and to receive information regarding the consequences of such action. This includes the right to stop taking your medication. PHCS is the leading PPO provider network and the largest in the nation. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. How to manage the front desk when they ask who you are insured with? You have the right to timely access to your prescriptions at any network pharmacy. A sample of the ConnectiCare ID cards appear below. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. PHCS (Private Healthcare Systems, Inc.) - Sutter Health 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. Question 3. Product and plan details are outlined in the product and coverage section on this page. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. Actual copayment information and other benefit information will vary. CommunityCare Life and Health Insurance Company provides an in-network level of benefits for services delivered outside of Oklahoma through a national PPO network, PHCS. 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. 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. PHCS is the leading PPO provider network and the largest in the nation. 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. Participate with practitioners in decision-making regarding your health care. However, the majority of PHCS plans offer members . providers - IBA TPA Covered at participating urgent care providers. Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. ConnectiCare must provide written information to those individuals, including their rights under the law of the State to make decisions concerning their medical care, such as the right to accept or refuse medical or surgical treatment and the right to formulate advance directives. 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. Call Automated Phone Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. ConnectiCare, in coordination with participating providers, will maintain and monitor the network of participating providers to ensure that members have adequate access to PCPs, specialists, hospitals, and other health care providers, and that through the network of providers their care needs may be met. While you may contact us by telephone, you will be asked to place your concerns in writing. That goes for you, our providers, as much as it does for our members. Your right to get information about our plan and our network pharmacies Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. All oral medication requests must go through members' pharmacy benefits. Make recommendations regarding our members rights and responsibilities policies. Your right to be treated with dignity, respect and fairness Visit Performance Health HealthworksWellness Portal. 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. 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. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. It is not medical advice and should not be substituted for regular consultation with your health care provider. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. You have chosen PHCS (Private Healthcare Systems, Inc.). Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. That goes for you, our providers, as much as it does for our members. UHSM is not insurance. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. ConnectiCare will communicate to your patients how they may select a new PCP. Performance Health at In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. 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. P.O. 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. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. Limited to a maximum of $315 every two (2) calendar years for: 1.) You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. Clinical Review Prior Authorization Request Form. Bone Mineral Density exams ordered more frequently than every twenty-three (23) months The bill of service for these members must be submitted to Medicaid for reimbursement. Provider Portal Eligibility inquiry Claims inquiry. Its affordable, alternative health care. When scheduling your appointment, specify that you have access to the PHCS Network throughthe HD Protection Plus Plan, confirm the providers current participation in the PHCS Network, their address and thatthey are accepting new patients. Testing that exceeds this maximum is the members responsibility. Register for an account For No Surprises Act First time visitor? A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. Regardless of where you get this form, keep in mind that it is a legal document. 100 Garden City Plaza, Suite 110 Garden City, NY 11530. [email protected]. 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 410 Capitol Avenue, P.O. Regardless of where you get this form, keep in mind that it is a legal document. precertification on certain services. Click Here to go to the PHCS / Multiplan Provider Search. It is important to note that not all of the Sutter Health network . If you need help with communication, such as help from a language interpreter, please call Medicare Member Services. Optional Life Insurance *. Preferred Provider Organization Questions? The ID card lists the following information: ConnectiCare member ID number 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. They will be clearly distinguishable by their ID cards. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. SeeAutomated and Online Featuresfor additional information. The member engages in disruptive behavior. See preauthorization list for DME that requires pre-authorization. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. Get coverage information. PDF PHCS Network Bringing Greater Choice and Savings to the Employees 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. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Answer 2. I called in with several medical bills to go over and their staff was extremely helpful. They are used to assess health care disparities, design intervention programs, and design and direct outreach materials, and they inform health care practitioners and providers about individuals needs. Keep scheduled appointments or give sufficient advance notice of cancellation. If you have any concerns about your health, please contact your health care provider's office. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. PET scans The plan contract is terminated. If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement
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