Provider. Answer 2. You can sometimes get advance directive forms from organizations that give people information about Medicare. ConnectiCare offers both employer-sponsored plans and individual insurance plans. P.O. Submit a Coverage Information Form. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. All Practitioners:Please notify ConnectiCare in advance prior to taking any action to remove a specific member from your practice for any reason. Product and plan details are outlined in the product and coverage section on this page. Eligibility Claims Eligibility Fields marked with * are required. Some plans may have a copayment requirement for radiology services. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Please note that your benefits and out of pocket expenses may vary when using PHCS providers. On a customer service rating I would give her 5 golden stars for the assistance I received. 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. The temporary card is a valid form of ConnectiCare member identification. For a specific listing of services and procedures that require pre-authorization refer to the Appendices within this manual. The member loses entitlement to Medicare Parts A and/or B. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). Providers are also required to contact ConnectiCares Notification Line at 888-261-2273 to advise ConnectiCare of the transport. If so, they will follow up to recruit the provider. Copyright 2022 Unite Health Share Ministries. 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. If you have any questions please review your formulary website or call Member Services. We request your cooperation in investigating and resolving these complaints. Additionally, ConnectiCaremaydisenroll a member if: Premiums are not paid on a timely basis. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. High Deductible Health Plan (Health Savings Account [HSA] Compatible). 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. Following is the statement in its entirety. Limited to a maximum of $315 every two (2) calendar years for: 1.) 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. CT scans (all diagnostic exams) Just like we shop for everything else! You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. Solutions. 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. ThriveHealth STM - Health Depot Association Members pay a copayment cost-share for most covered health services at the time the services are rendered. Members > MultiPlan Claims or Benefits questions will not be answered here. 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. allergenic extracts (or RAST allergen specific testing); 2.) In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). (More information appears later in this section.). 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. Participate with practitioners in decision-making regarding your health care. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. You have the right to an explanation from us about any bills you may get for services not covered by our plan. I called in with several medical bills to go over and their staff was extremely helpful. PDF PHCS Network and Limited Benefit Plans - MultiPlan (SeeOther Benefit Information). SeeMedical Management. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." You have the right to know how your health information has been given out and used for non-routine purposes. 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. Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. 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. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. What insurance carrier is PHCS? - InsuredAndMore.com Paying your co-payments/coinsurance for your covered services. You may also use the ConnectiCare Eligibility and Referral Line. 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. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. You have chosen PHCS (Private Healthcare Systems, Inc.). Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. Supporting evidence, which may be required includes: 1.) Nuclear cardiology Members who do not have an ID card should not be denied medical services without contacting ConnectiCare first to determine the member's enrollment status. Healthcare Provider FAQs > MultiPlan We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. Question 5. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. This line is available twenty-four (24) hours a day, seven days a week. There are different types of advance directives and different names for them. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. You should consider having a lawyer help you prepare 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. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Some preventive services are covered at 100% and are exempt from the deductible requirement. I really appreciate the service I received from UHSM. In addition, the ID card also includes emergency instructions and a toll-free telephone number for out-of-area and after-hours notifications, the Member Services phone number, and the claims submission address. . To begin the precertification process, your provider(s) should contact ConnectiCare's service area includes all counties. Please call Member Services if you have any questions. Documents called "living will" and "power of attorney for health care" are examples of advance directives. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). Prior Authorizations are for professional and institutional services only. 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. Timely access means that you can get appointments and services within a reasonable amount of time. drug, biological or venom sensitivity. Members have an in-network deductible for some covered services before coverage for the benefits will apply. Some plans may have deductible requirements. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. The sample ID cards are for demonstration only. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. 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 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. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. 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. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. Please note: The benefit information provided is not a comprehensive list and is subject to change. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. Prior Authorizations are for professional and institutional services only. Members are required to see participating providers, except in emergencies. 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. Visit Performance Health HealthworksWellness Portal. After the deductible has been met, coinsurance will apply to the covered benefits. 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). 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. SeeAutomated and Online Featuresfor additional information. (SeeOther Benefit Information). To get any of this information, call Member Services. Phcs Insurance Provider Phone Number | TheWebster Miami You also have the right to get information from us about our plan. Providers - INSURANCE BENEFIT ADMINISTRATORS It is important to sign this form and keep a copy at home. Members receive in-network level of benefits when they see participating providers. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. Best of all, it's free- no downloads required or software to install. Your responsibilities as a member of our plan. 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. Clinical Review Prior Authorization Request Form. 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. Question 4. For benefit-related questions, call Provider Services at 877-224-8230. A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. ConnectiCare involuntary disenrollment You will now leave the AvMed web site once you click the "I agree" button. Prostate cancer screening (age restrictions apply) PDF PHCS Network and Limited Benefit Plans - MultiPlan We will make sure that unauthorized people dont see or change your records. 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. 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. Its affordable, alternative health care. Any personal information that you give us when you enroll in this plan is protected. 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. 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. 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. 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. Member satisfaction with ConnectiCare is very important. 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) A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. 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. 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. Provide, to the extent possible, information providers need to render care. Click on the link and you will then have immediate access to the Member portal. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. The plan cannot and will not disenroll a member because of the amount or cost of services used. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. For non-portal inquiries, please call 1-800-950-7040 . 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. 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. When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! ConnectiCare will communicate to your patients how they may select a new PCP. You have the right to get information from us about our plan. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Letting us know if you have additional health insurance coverage. 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. You must pay for services that arent covered. Medicare Advantage or Medicaid call 1-866-971-7427. Information is protected as stated in ConnectiCares policies. Your right to get information about our network pharmacies and/or providers Answer 3. 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). Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 ConnectiCare cannot reverse CMS' determination. 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. Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. If you want a paper copy of this information, you may contact Provider Services at 860-674-5850 or 800-828-3407.
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