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. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. Nuclear cardiology 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! This includes information about our financial condition, and how our Plan compares to other health plans. 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. 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. Prior Authorizations are for professional and institutional services only. Answer 1. The member loses entitlement to Medicare Parts A and/or B. Nutritionist and social worker visit 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 have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. We also cover additional benefits beyond Original Medicare alone. 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. 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. Documents called a "living will" and "power of attorney for health care" are examples of advance directives. 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. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. Use your member subscriber ID to access the pricing tool using the link below. Provider Portal Info > MultiPlan You have chosen PHCS (Private Healthcare Systems, Inc.). Broker benefits Get in touch. You have the right to get your questions answered. Visit our other websites for Medicaid and Medicare Advantage. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. 877-585-8480. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. 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 providers must explain things in a way that you can understand. (214) 436 8882 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. They will be clearly distinguishable by their ID cards. HPI | Provider Resources | Patient Benefits & Eligibility For benefit-related questions, call Provider Services at 877-224-8230. 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. Note: Some plans may vary. Members pay a copayment as cost-share for most covered health services at the time services are rendered. In addition, MultiPlan is not liable for the payment of services under plans. If you want to have an advance directive, you can get a form from your lawyer, from a social worker, or from some office supply stores. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. 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. Eligibility Claims Eligibility Fields marked with * are required. The ConnectiCare Medicare Advantage network. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. Accessing PHCS Savility PHCS Savility is available to insurers and benefit plan administrators meeting certain benefit design 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. Question 2. Members can print temporary ID cards by visiting the secure portion of our member website. PPM/10.16 Overview of Plans Overview of products To begin the precertification process, your provider(s) should contact If you have questions or concerns about your rights and protections, please call Member Services. What to do if you think you have been treated unfairly or your rights are not being respected? Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. The following are samples of each type of ID card that ConnectiCare issues to members. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. 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. 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. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. Prior Authorizations are for professional and institutional services only. You have the right to be treated with dignity, respect, and fairness at all times. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. Check with our Customer Service Team to find out if your plan accesses Health Coaching. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button 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. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. PHCS PPO Network - WeShare Healthcare Documents called "living will" and "power of attorney for health care" are examples of advance directives. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. The member provides fraudulent information on the application or permits abuse of an enrollment card. That goes for you, our providers, as much as it does for our members. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. Enrollee satisfaction with ConnectiCare is very important. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. Your right to use advance directives (such as a living will or a power of attorney) part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. 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. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare Timely access means that you can get appointments and services within a reasonable amount of time. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. 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. I called in with several medical bills to go over and their staff was extremely helpful. A 3-day covered hospital stay is not required prior to being admitted. Your responsibilities as a member of our plan. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time TTY users should call 877-486-2048, or visit www.medicare.govto view or download the publication Your Medicare Rights & Protections. Under Search Tools, select find a Medicare Publication. If you have any questions whether our plan will pay for a service, including inpatient hospital services, and including services obtained from providers not affiliated with our plan, you have the right under law to have a written/binding advance coverage determination made for the service. PHCS Network | AvMed The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. including benefit designs and Sutter provider participation in your provider network. 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. PROVIDER PORTAL LOGIN REGISTER NOW Electronic Options: EDI # 59355 Eligibility (270/271) Bill Status (276) Bill Submission (837) For technical assistance with EDI transactions, please contact Change Healthcare at 1-800-845-6592. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. If authorization is not obtained, payment for the service may be denied. Your right to make complaints MRI/MRA (all examinations) 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). This includes the right to know about the different Medication Management. CT scans (all diagnostic exams) PDF PHCS Savility - MultiPlan What can you doif you think you have been treated unfairly or your rights arent being respected? No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. All oral medication requests must go through members' pharmacy benefits. ConnectiCare takes all complaints from members seriously. How to manage the front desk when they ask who you are insured with? Answer 4. Balance Bill defense is available for all members with a Reference Based Pricing Plan. Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. 100 Garden City Plaza, Suite 110 Garden City, NY 11530. sales@ibatpa.com. TTY users should call 877-486-2048. Stress echocardiograms Provider Portal Eligibility inquiry Claims inquiry. Testing that exceeds this maximum is the members responsibility. UHSM is always eager and ready to assist. Use our online Provider Portal or call 1-800-950-7040. Colorectal screening (age restrictions apply) Members are required to see participating providers, except in emergencies. 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. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. PHCS PPO Network - Health Depot Association What services are available to me that could save me money? Information is protected as outlined in ConnectiCare's policies. Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. UHSM is excellent, friendly, and very competent. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. Providers | Gmr Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. abnormal MRI; and 2.) It is critical that the members eligibility be checked at each visit. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. 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. 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. My rep did an awesome job. P.O. Popular Questions. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Provide, to the extent possible, information providers need to render care. All oral medication requests must go through members' pharmacy benefits. We may enroll employer group members as well. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Paying your co-payments/coinsurance for your covered services. MultiPlan can help you find the provider of your choice. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). 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). Members are encouraged to actively participate in decision-making with regard to managing their health care. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. View sample member ID cards forcopayandhigh-deductibleplans for details. 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. The service area includes all counties in Connecticut. If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. Keep scheduled appointments or give sufficient advance notice of cancellation. To inquire about an existing authorization - (phone) 800-562-6833 For example, you have the right to look at medical records held at the plan, and to get a copy of your records. We request your cooperation in investigating and resolving these complaints. Monitoring includes member satisfaction with physicians. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. (SeeOther Benefit Information). 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. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. To get any of this information, call Member Services. If you are calling to verify your patient's benefits*, please have a copy Additionally, ConnectiCaremaydisenroll a member if: Premiums are not paid on a timely basis. If you have any questions please review your formulary website or call Member Services. Best of all, it's free- no downloads required or software to install. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. You have the right to get information from us about our plan. 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. You are now leavinga ConnectiCare website. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). New users to the Provider Portal can create an account by selecting the Provider Access Link on the portal login page. Provider Page | Medi-Share 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. 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. PHCS (Private Healthcare Systems, Inc.) - Sutter Health For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Bone Mineral Density exams ordered more frequently than every twenty-three (23) months 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. 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. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Members receive in-network level of benefits when they see participating providers. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. All oral medication requests must go through members' pharmacy benefits. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. . The temporary card is a valid form of ConnectiCare member identification. Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. Your plan does require Examples of covered medical conditions can be found below. Remember, it is your choice whether you want to fill out an advance directive (including whether you want to sign one if you are in the hospital). Blue Cross Providers: 800 . Supporting evidence, which may be required includes: 1.) 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. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. Pelvic exam Healthcare Provider FAQs > MultiPlan Medicare Advantage or Medicaid call 1-866-971-7427. Incorrect Email or Password - MultiPlan Members receive out-of-network level of benefits when they see non-participating providers. If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. All participating providers agree to certify that all information submitted to ConnectiCare is accurate, complete, truthful, and shall comply with applicable CMS standards. Initial chiropractic assessment PET scans The admitting physician is responsible for pre-authorizing elective admissions five (5) working days in advance. The plan contract is terminated. Members > MultiPlan If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. Visit Performance Health HealthworksWellness Portal. 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 have the right to know how your health information has been given out and used for non-routine purposes. Member satisfaction information is updated and posted annually and is made available on our website atconnecticare.com. We believe there is no such thing as a standard cost management approach. ConnectiCare will communicate to your patients how they may select a new PCP. Your responsibilities include the following: Getting familiar with your coverage and the rules you must follow to get care as a member. 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 more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. Your Explanation of Payment (EOP) will specify member responsibility. Participate with practitioners in decision-making regarding your health care. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. Any information provided on this Website is for informational purposes only. PHCS (Private Healthcare Systems, Inc.) - PPO. You may also call the Office for Civil Rights at 800-368-1019 or TTY:800-537-7697, or your local Office for Civil Rights. Note: These procedures are covered procedures, but do not require preauthorization in network. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. However, the majority of PHCS plans offer members . 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. 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. Your right to use advance directives (such as a living will or a power of attorney) Bone mass measurement The plan cannot and will not disenroll a member because of the amount or cost of services used. Reminding the patient to notify ConnectiCare; and You have the right to timely access to your providers and to see specialists when care from a specialist is needed.

Defenses To Declaratory Judgment Action Texas, Cards Like Cathars' Crusade, Articles P