phcs eligibility and benefits

You also have the right to get information from us about our plan. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. 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. Your benefits, claims and/or eligibility are available 24/7 via our member portal. 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. Some applicable copayments To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. Our plan must obey laws that protect you from discrimination or unfair treatment. Letting us know if you have additional health insurance coverage. Get coverage information. What should I do if I get a bill from a healthcare provider? Nuclear cardiology For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Optional Life Insurance *. My rep did an awesome job. ConnectiCare offers both employer-sponsored plans and individual insurance plans. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. . To pre-notify or to check member or service eligibility, use our provider portal. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. The plan cannot and will not disenroll a member because of the amount or cost of services used. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. This feature is meant to assist members who need additional copies of their ID card. 877-585-8480. 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. (More information appears later in this section.). 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. When performed out of network, these procedures do require preauthorization. TTY users should call 877-486-2048. ConnectiCare provides each member with a statement of member rights and responsibilities. Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. 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. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. 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. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. You have chosen PHCS (Private Healthcare Systems, Inc.). 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. Note: The list of covered DME and disposable supplies is reviewed periodically and subject to change at the sole discretion of ConnectiCare. 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). Glaucoma screening 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. UHSM is not insurance. (800) 557-5471. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. To begin the precertification process, your provider(s) should contact The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. You have the right to timely access to your prescriptions at any network pharmacy. Although not a provider of health insurance, PHCS is a provider of PPO (Preferred Provider Organization) networks. ConnectiCare takes all complaints from members seriously. Claims or Benefits questions will not be answered here. Click on the link and you will then have immediate access to the Member portal. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. Box 340308 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. Christian Health Sharing State Specific Notices. Remember you will only need your registration code this one time to set up your account. Please note: The benefit information provided is not a comprehensive list and is subject to change. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. 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. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. Popular Questions. I really appreciate the service I received from UHSM. Your right to use advance directives (such as a living will or a power of attorney) Your responsibilities include the following: Getting familiar with your coverage and the rules you must follow to get care as a member. Copyright 2022 Unite Health Share Ministries. Use our online Provider Portal or call 1-800-950-7040. No prior authorization requirements. (SeeOther Benefit Information). If you have any questions please review your formulary website or call Member Services. Click Here to go to the PHCS / Multiplan Provider Search. You have the right to be told about any risks involved in your care. Question 2. 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. The temporary card is a valid form of ConnectiCare member identification. If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. No referrals needed for network specialists. Bone mass measurement 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. Performance Health at Provider Portal - Claims & Eligibility If you have difficulty obtaining information from your plan based on language or a disability, call 1-800-MEDICARE (800-633-4227). If you admit a member to a SNF on a weekend or holiday, ConnectiCare will automatically authorize payment for SNF services from the day of admission through the next business day. Pleasant and provided correct information in a timely manner. Examples of qualifying medical conditions can be found below. 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. Your right to make complaints Referrals must be signed in ConnectiCares referral system viaProvider Connection. 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. For a specific listing of services and procedures that require preauthorization please refer to the preauthorization lists found within this manual. Your right to get information about your drug coverage and costs We must investigate and try to resolve all complaints. 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. Eligibility, Benefits & Claims Assistance, If you dont see the network listed on your ID card please contact our Customer Service at, Please be sure to verify your providers network access with your provider's office directly prior to receiving services. Prospective members must properly complete and sign an enrollment application and submit it to ConnectiCare. The member loses entitlement to Medicare Parts A and/or B. 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. Question 3. 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. For the PHCS Network, 1-800-922-4362 For PHCS Healthy Directions, 1-800-678-7427 For the MultiPlan Network, 1-888-342-7427 For the HealthEOS Network, 1-800-279-9776 For language assistance, please call 1-866-981-7427 For TTY/TTD service, please call 1-866-918-7427 Search for a provider > SeeAutomated and Online Featuresfor additional information. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). Asking at the time of each visit if he/she is still enrolled in a ConnectiCare plan. MultiPlan can help you find the provider of your choice. Initial chiropractic assessment If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. 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. Testing that exceeds this maximum is the members responsibility. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button Since you have Medicare, you have certain rights to help protect you. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. Members pay a copayment as cost-share for most covered health services at the time services are rendered. This includes information about our financial condition, and how our Plan compares to other health plans. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. 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. The provider must agree to accept network rates for the defined period of time. The service area includes all counties in Connecticut. Covered at participating urgent care providers. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. We request your cooperation in investigating and resolving these complaints. Nutritionist and social worker visit 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. They will be clearly distinguishable by their ID cards. 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. You have the right to get information from us about our plan. No referrals needed for network specialists. 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. If you do, please call Member Services. You have the right to refuse treatment. All oral medication requests must go through members' pharmacy benefits. If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. 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. You can easily: Verify member eligibility status; . Notifying providers when seeking care (unless it is an emergency) that you are enrolled in our plan and you must present your plan enrollment card to the provider. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. (SeeOther Benefit Information). You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. 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. (SeeOther Benefit Information). Coverage for medical emergencies without preauthorization. Provide, to the extent possible, information providers need to render care. Reminding the patient to notify ConnectiCare; and Follow the plans and instructions for care that they have agreed on with practitioners. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. 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) High Deductible Health Plan (Health Savings Account [HSA] Compatible). However, the majority of PHCS plans offer members . ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Renal dialysis services for members temporarily outside the service area. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. Your responsibilities as a member of our plan. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. Documents called "living will" and "power of attorney for health care" are examples of advance directives. Your plan does require Your right to use advance directives (such as a living will or a power of attorney) Please call Member Services if you have any questions. Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. 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. Its affordable, alternative health care. UHSM is NOT an insurance company nor is the membership offered through an insurance company. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. How do I contact PHCS? Coverage for skilled nursing facility (SNF) admissions with preauthorization. Some plans cover preventive dental services: Receive information about us, our services, our participating providers, and "Members Rights and Responsibilities.". For a specific listing of services and procedures that require pre-authorization refer to the Appendices within this manual. Provider. You also have the right to this explanation even if you obtain the prescription drug, or Part C medical care or service from a pharmacy and/or provider not affiliated with our organization. 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. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? You may want to give copies to close friends or family members as well. ConnectiCare will communicate to your patients how they may select a new PCP. You can sometimes get advance directive forms from organizations that give people information about Medicare. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. When performed out-of-network, these procedures do require preauthorization. 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. 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. 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. You can also get free help and information from CHOICES - your SHIP. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). 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. Members must reside in the service area. No out-of-network coverage unless pre-authorized in writing by ConnectiCare. Long Term Care Insurance. Medicare members may disenroll from the plan when the guidelines, as set forth bythe Centers for Medicare & Medicaid Services (CMS), are met. As always, confirm benefits by contacting Provider Services at 877-224-8230. PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. 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. 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). Prior Authorizations are for professional and institutional services only. While other insurance companies and TPAs make you go through numerous frustrating prompts and then hold for an extensive period, our approach is to take the call as soon as possible so that you can move on with your day. part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. 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. 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. PPM/10.16 Overview of Plans Overview of products You have the right to know how your health information has been given out and used for non-routine purposes. 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. 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. Identify the state legal authority permitting such objection; plan. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. MRI/MRA (all examinations) This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. Lifetime maximums apply to certain services. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. Examples of covered medical conditions can be found below. Wondering how member-to-member health sharing works in a Christian medical health share program? UHSM is excellent, friendly, and very competent. 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. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. View sample member ID cards forcopayandhigh-deductibleplans for details. Answer 2. The ID card lists the following information: ConnectiCare member ID number In addition, MultiPlan is not liable for the payment of services under plans. Call us and tell us you would like a decision if the service or item will be covered. Eligibility Claims Eligibility Fields marked with * are required. ConnectiCare takes all complaints from members seriously. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. For non-portal inquiries, please call 1-800-950-7040 . Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. Solutions. Answer 3. info@healthdepotassociation.com, Copyright © 2023 Health Depot Association, All Rights Reserved, Supplemental Accident and/or Critical Illness, Follow the prompts to enter your search criteria. elizabeth police department records, doug sauder salary,

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