If you have difficulty obtaining information from your plan based on language or a disability, call 1-800-MEDICARE (800-633-4227). A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and The Evidence of Coverage (EOC) will instruct them to call their PCP. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Visit our other websites for Medicaid and Medicare Advantage. You have the right to be told about any risks involved in your care. No out-of-network coverage unless pre-authorized in writing by ConnectiCare. Nuclear cardiology 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. Members pay a copayment as cost-share for most covered health services at the time services are rendered. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. abnormal arthrogram. 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. 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. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. It is critical that the members eligibility be checked at each visit. PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO Browse the list to see where your plan is accepted. Your right to get information about our plan Regardless of where you get this form, keep in mind that it is a legal document. Click on the link and you will then have immediate access to the Member portal. Pharmacy cost-share, if applicable. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. Provider Quick Reference Guide - MultiPlan PHCS (Private Healthcare Systems, Inc.) - PPO. Optional Life Insurance *. They should be informed of any health care needs that require follow-up, as well as self-care training. Following is the statement in its entirety. A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. Covered according to Massachusetts state mandate. Some plans may have deductible requirements. You have the right to make a complaint if you have concerns or problems related to your coverage or care. ConnectiCare takes all complaints from members seriously. We may enroll employer group members as well. Please review our formulary website or call Member Services for more information. You also have the right to get information from us about our plan. For non-portal inquiries, please call 1-800-950-7040 . 410 Capitol Avenue 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. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Question 4. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. This includes information about our financial condition and about our network pharmacies. Customer Service at 800-337-4973 This includes the right to leave a hospital or other medical facility, even if your doctor advises you not to leave. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Some applicable copayments No referrals needed for network specialists. Best of all, it's free- no downloads required or software to install. Continuity of Care allows members the option to apply to receive services at in-network coverage levels for specified medical and behavioral conditions, from their current health care provider if the provider is or is soon to be out-of-network. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. UHSM is always eager and ready to assist. 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). DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Please call Member Services if you have any questions. The following are samples of each type of ID card that ConnectiCare issues to members. That goes for you, our providers, as much as it does for our members. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. Healthcare Provider FAQs > MultiPlan 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. 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. Phcs Insurance Provider Phone Number | TheWebster Miami Claims or Benefits questions will not be answered here. faq. Medicare members may disenroll from the plan when the guidelines, as set forth bythe Centers for Medicare & Medicaid Services (CMS), are met. In addition, MultiPlan is not liable for the payment of services under plans. You have the right to get your questions answered. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. For non-portal inquiries, please call 1-800-950-7040. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). ConnectiCare takes all complaints from members seriously. You can also get free help and information from CHOICES - your SHIP. 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. Regardless of where you get this form, keep in mind that it is a legal document. Go to the Client Portal > Provider directories Create a customized listing of facilities and/or practitioners participating in the network services offered by MultiPlan. We must investigate and try to resolve all complaints. 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. Coverage for medical emergencies without preauthorization. Our plan must obey laws that protect you from discrimination or unfair treatment. Note: Some services require preauthorization. ConnectiCare will communicate to your patients how they may select a new PCP. Members are no longer eligible for coverage after their 40th birthday. Box 340308 The member provides fraudulent information on the application or permits abuse of an enrollment card. You have the right to refuse treatment. 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. 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. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. 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. 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. To verify or determine patient eligibility, call 1-800-222-APWU (2798). UHSM Providers - PHCS PPO Network Monitoring includes member satisfaction with physicians. PDF PHCS Savility - MultiPlan Initial mental health consultation Eligibility Claims Eligibility Fields marked with * are required. To verify eligibility for services, request to see the member's current ID card. ConnectiCare cannot reverse CMS' determination. Yes, PHCS provides coverage for therapy services. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. A new web site will open up in a new window. Choose "Click here if you do not have an account" for self-registration options. Your right to make complaints 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). 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. I really appreciate the service I received from UHSM. ConnectiCare offers both employer-sponsored plans and individual insurance plans. Prior Authorizations are for professional and institutional services only. You must apply for Transition of Care no later than 30 days after the date your coverage becomes effective or after the effective date of the network change using the request form below. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. (SeeOther Benefit Information). If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive, take a copy with you to the hospital. Clinical Review Prior Authorization Request Form. You have the right to be treated with dignity, respect, and fairness at all times. To get this information, call Member Services. Your right to get information about your drug coverage and costs We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. MultiPlan uses technology-enabled provider network, negotiation, claim pricing and payment accuracy services as building blocks for medical payors to customize the healthcare cost management programs that work best for them. Describe the range or medical conditions or procedures affected by the conscience objection; You can easily: Verify member eligibility status; . For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. Members can print temporary ID cards by visiting the secure portion of our member website. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. It is important to note that not all of the Sutter Health network . Enrollee satisfaction with ConnectiCare is very important. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. 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). To pre-notify or to check member or service eligibility, use our provider portal. 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. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. Balance Bill defense is available for all members with a Reference Based Pricing Plan. All participating providers agree to certify that all information submitted to ConnectiCare is accurate, complete, truthful, and shall comply with applicable CMS standards. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. We also cover additional benefits beyond Original Medicare alone. If you need help with communication, such as help from a language interpreter, please call Medicare Member Services. This includes the right to stop taking your medication. Benefits - Penn Medicine Princeton Health When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. These members may have a different copayment and/or benefit package. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare However, the majority of PHCS plans offer members . If authorization is not obtained, payment for the service may be denied. Answer 2. Your right to be treated with dignity, respect and fairness Ask to see the member's ConnectiCare member identification (ID) card. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. 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. 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! View the video below for additional information on the MyMedicalShopper pricing tool: The Member Resource Document includes details for your reference on: You can reference your plan document for the complete list. Your benefits, claims and/or eligibility are available 24/7 via our member portal. You may want to give copies to close friends or family members as well. Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. 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 What services are available to me that could save me money? By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . 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. To inquire about an existing authorization - (phone) 800-562-6833 This video explains it. part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. ConnectiCare's service area includes all counties. Call us and tell us you would like a decision if the service or item will be covered. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. 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. 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.