You have the right to timely access to your prescriptions at any network pharmacy. Prior Authorizations are for professional and institutional services only. 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 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. How do I know if I qualify for PHCS insurance? 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. Call Automated Phone Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. This includes information about our financial condition and about our network pharmacies. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. The member engages in disruptive behavior. New members may use a copy of their enrollment form. Hartford, CT 06134-0308 (214) 436 8882 P.O. Members pay a copayment as cost-share for most covered health services at the time services are rendered. 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. Regardless of where you get this form, keep in mind that it is a legal document. What services are available to me that could save me money? Pay applicable copayments, deductibles or coinsurance. After the deductible is met, benefits will be covered according to the Plan. You may also use the ConnectiCare Eligibility and Referral Line. 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. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. Eligibility Claims Eligibility Fields marked with * are required. Nutritionist and social worker visit If you need more information, please call Member Services. Employer group enrollment will be the result of employers electing to offer benefits to retirees through ConnectiCare. Refractions are not covered by ConnectiCare Medicare Advantage plans. The ID card lists the following information: ConnectiCare member ID number 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. plan. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. Question 4. Requests may be made by either the physician or the member. Box 340308 (More information appears later in this section.). Member satisfaction information is updated and posted annually and is made available on our website atconnecticare.com. your current benefits ID card upon arrival at your appointment. To pre-notify or to check member or service eligibility, use our provider portal. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. Paying your co-payments/coinsurance for your covered services. UHSM Health Share and WeShare All rights reserved. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. Limited to a maximum of $315 every two (2) calendar years for: 1.) PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO 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. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. PCP name and telephone number Participate with practitioners in decision-making regarding your health care. Information is protected as stated in ConnectiCares policies. 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. 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. The provider must agree to accept network rates for the defined period of time. 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. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. ConnectiCare's service area includes all counties. UHSM is excellent, friendly, and very competent. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. 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. 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. Provider Portal - 90 Degree Benefits The sample ID cards are for demonstration only. Be considerate of our providers, and their staff and property, and respect the rights of other patients. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. Were here to help! A sample of the ConnectiCare ID cards appear below. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. This means the PHCS Savility network offers the same quality for which PHCS Network has been recognized since 2001. We protect your personal health information under these laws. 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. For non-portal inquiries, please call 1-800-950-7040 . ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. You have the right under law to have a written/binding advance coverage determination made for the service, even if you obtain this service from a provider not affiliated with our organization. Click Here to go to the PHCS / Multiplan Provider Search. Your Registration Code is the Alternate ID number on your ID card plus a suffix of 01 for the subscriber, 02, 03, 04, 05, etc for spouse and/or dependents. Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. You have the right to get information from us about our plan. Information is protected as outlined in ConnectiCare's policies. To get any of this information, call Member Services. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. 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. Treatment Programs we offer and in which you may participate. Documents called "living will" and "power of attorney for health care" are examples of advance directives. What to do if you think you have been treated unfairly or your rights are not being respected? If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. Members have an in-network deductible for some covered services. On a customer service rating I would give her 5 golden stars for the assistance I received. Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. Claims or Benefits questions will not be answered here. 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) The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Your right to be treated with dignity, respect and fairness Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. Pleasant and provided correct information in a timely manner. You may want to give copies to close friends or family members as well. Pelvic exam Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. Medicare Advantage or Medicaid call 1-866-971-7427. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. Answer 2. All routine laboratory services must be obtained from participating laboratories. Members must reside in the service area. 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. 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. 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. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. Please call Member Services if you have any questions. Initial chiropractic assessment 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. Really good service. 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. 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. 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. Register for an account For No Surprises Act First time visitor? Examples of qualifying medical conditions can be found below. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. This includes information about our financial condition, and how our Plan compares to other health plans. To verify eligibility for services, request to see the member's current ID card. Once your account has been created you will only need your login and password. You have the right to get your questions answered. PHCS Health Insurance - Health Insurance Providers According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Oops, there was an error sending your message. The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. 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. Monitoring includes member satisfaction with physicians. Provider Portal For example, you have the right to look at medical records held at the plan, and to get a copy of your records. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. If you have any concerns about your health, please contact your health care provider's office. Keep scheduled appointments or give sufficient advance notice of cancellation. 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. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. Member race, language, ethnicity, gender orientation, and sexual identity cannot be used to perform underwriting, rate setting, and benefit determinations (specifically denial of coverage and benefits), and cannot be disclosed to unauthorized users. 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. Documents called a "living will" and "power of attorney for health care" are examples of advance directives. ConnectiCare cannot reverse CMS' determination. Stress echocardiograms 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! Letting us know if you have additional health insurance coverage. Nuclear cardiology ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Browse the list to see where your plan is accepted. Coverage for medical emergencies without preauthorization. Blue Cross Providers: 800 . 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. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Enrollee satisfaction with ConnectiCare is very important. Additionally, ConnectiCaremaydisenroll a member if: Premiums are not paid on a timely basis. Your responsibilities as a member of our plan. View sample member ID cards forcopayandhigh-deductibleplans for details. 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. Provide, to the extent possible, information providers need to render care. These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (medical coverage) and may offer extra benefits too. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. All Practitioners:Please notify ConnectiCare in advance prior to taking any action to remove a specific member from your practice for any reason. To get any of this information, call Member Services. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. My rep did an awesome job. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). Your right to get information about our network pharmacies and/or providers Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. To verify or determine patient eligibility, call 1-800-222-APWU (2798). For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. In addition, MultiPlan is not liable for the payment of services under plans. Best of all, it's free- no downloads required or software to install. 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. It is not medical advice and should not be substituted for regular consultation with your health care provider. You may want to give copies to close friends or family members as well. Access to any Medicare-approved doctor or hospital in the United States. If you have any questions please review your formulary website or call Member Services. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Some preventive services are covered at 100% and are exempt from the deductible requirement. There are different types of advance directives and different names for them. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. Balance Bill defense is available for all members with a Reference Based Pricing Plan. Initial mental health consultation ConnectiCare takes all complaints from members seriously. 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). Call us and tell us you would like a decision if the service or item will be covered. Member Services can also help if you need to file a complaint about access (such as wheel chair access). 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. ConnectiCare members may directly access care through self-referral to a participating clinician for covered services and certain Medicare-covered services at designated frequencies and ages, including: Annual routine eye exam (Prime and Custom Plans only) Prostate cancer screening (age restrictions apply) Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. 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. Members receive out-of-network level of benefits when they see non-participating providers. 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. Remember you will only need your registration code this one time to set up your account. 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. Your Explanation of Payment (EOP) will specify member responsibility. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407. 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. They will be clearly distinguishable by their ID cards. Our plan must obey laws that protect you from discrimination or unfair treatment. Benefits - Penn Medicine Princeton Health If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. Additional term life coverage can be elected in increments of $10,000 to a maximum of $500,000 or 5 times your salary, whichever is less; paid for through payroll deductions. (SeeOther Benefit Information). Influenza and pneumococcal vaccinations 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. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. ConnectiCare provides each member with a statement of member rights and responsibilities. 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) Medicare members may disenroll from the plan when the guidelines, as set forth bythe Centers for Medicare & Medicaid Services (CMS), are met. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. 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. 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. It includes services and supplies furnished to a member who has a medical condition that is chronic or non-acute and which, at our discretion, either: Are furnished primarily to assist the patient in maintaining activities of daily living, whether or not the member is disabled, including, but not limited to, bathing, dressing, walking, eating, toileting and maintaining personal hygiene or. 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. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. ConnectiCare will communicate to your patients how they may select a new PCP. What insurance carrier is PHCS? - InsuredAndMore.com 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. Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . The plan contract is terminated. PDF PHCS Network and Limited Benefit Plans - MultiPlan In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Note: Some services require preauthorization. You can sometimes get advance directive forms from organizations that give people information about Medicare. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. Members pay a copayment as cost-share for most covered health services at the time services are rendered. Your right to get information about our plan and our network pharmacies Provider Portal Eligibility inquiry Claims inquiry. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Although not a provider of health insurance, PHCS is a provider of PPO (Preferred Provider Organization) networks. It is critical that the members eligibility be checked at each visit. Performance Health All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. 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.
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