Letting us know if you have any questions, concerns, problems, or suggestions. This includes information about our financial condition, and how our Plan compares to other health plans. 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. These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (optional medical coverage) coverage and offer extra benefits too. 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. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Benefits - Penn Medicine Princeton Health After the deductible is met, benefits will be covered according to the Plan. including benefit designs and Sutter provider participation in your provider network. Screening pap test. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. Members are required to see participating providers, except in emergencies. 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. Influenza and pneumococcal vaccinations 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. Paying your co-payments/coinsurance for your covered services. Be considerate of our providers, and their staff and property, and respect the rights of other patients. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. 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. To get this information, call Member Services. Call us and tell us you would like a decision if the service or item will be covered. UHSM Health Share and WeShare All rights reserved. Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Once your account has been created you will only need your login and password. UHSM is excellent, friendly, and very competent. Referrals must be signed in ConnectiCares referral system viaProvider Connection. You have chosen PHCS (Private Healthcare Systems, Inc.). 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. Covered at participating urgent care providers. PHCS Network | AvMed Answer 5. Your right to know your treatment options and participate in decisions about your health care (SeeOther Benefit Information). Providers | Gmr All oral medication requests must go through members' pharmacy benefits. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. 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. 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. MedAvant Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). The bill of service for these members must be submitted to Medicaid for reimbursement. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. abnormal arthrogram. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. Members pay a copayment as cost-share for most covered health services at the time services are rendered. 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! Your right to get information about your drug coverage and costs When performed out-of-network, these procedures do require preauthorization. Enrollee satisfaction with ConnectiCare is very important. ConnectiCare reserves the right to terminate coverage for members who repeatedly fail to make the required copayments, coinsurance or deductibles, subject to the terms outlined in the applicableMember Agreement, Evidence of Coverage, or other governing contract. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. 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. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. I really appreciate the service I received from UHSM. After the deductible has been met, coinsurance will apply to the covered benefits. providers - IBA TPA Read the Membership Agreement, Evidence of Coverage, or other Plan document that describes the Plans benefits and rules. To inquire about an existing authorization - (phone) 800-562-6833 Pelvic exam ConnectiCare enrolls individual members into the ConnectiCare plan. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. You must pay for services that arent covered. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. Acting in a way that supports the care given to other patients and helps the smooth running of your doctors office, hospitals, and other offices. 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. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). Emergency care is covered. 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. Claims or Benefits questions will not be answered here. Healthcare Provider FAQs > MultiPlan To verify eligibility for services, request to see the member's current ID card. MultiPlan can help you find the provider of your choice. Customer Service number: 877-585-8480. . You are now leavinga ConnectiCare website. 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. ThriveHealth STM - Health Depot Association They should be informed of any health care needs that require follow-up, as well as self-care training. 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. Its affordable, alternative health care. 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. Your plan does require What to do if you think you have been treated unfairly or your rights are not being respected? You have the right to receive a detailed explanation from us if you believe that a provider has denied care that you believe you were entitled to receive or care you believe you should continue to receive. The provider must agree to accept network rates for the defined period of time. Your responsibilities as a member of our plan. From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Click on the link and you will then have immediate access to the Member portal. Choose "Click here if you do not have an account" for self-registration options. Note: These procedures are covered procedures, but do not require preauthorization in network. We protect your personal health information under these laws. A sample of the ConnectiCare ID cards appear below. This would also include chronic ventilator care. While you may contact us by telephone, you will be asked to place your concerns in writing. TTY users should call 877-486-2048. 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. 877-585-8480. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. CT scans (all diagnostic exams) Access to any Medicare-approved doctor or hospital in the United States. You have the right to refuse treatment. To get any of this information, call Member Services. Covered according to Massachusetts state mandate. PDF PHCS Network and Limited Benefit Plans - MultiPlan Members receive in-network level of benefits when they see participating providers. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. 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. PHCS (Private Healthcare Systems, Inc.) - PPO. The member loses entitlement to Medicare Parts A and/or B. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. 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. Really good service. UHSM Providers - PHCS PPO Network Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. Note: The list of covered DME and disposable supplies is reviewed periodically and subject to change at the sole discretion of ConnectiCare. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! All participating providers agree to certify that all information submitted to ConnectiCare is accurate, complete, truthful, and shall comply with applicable CMS standards. Physicians may make referrals to participating specialists without entering them into the telephonic referral system. ConnectiCare will communicate to your patients how they may select a new PCP. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). 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. 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. To verify or determine patient eligibility, call 1-800-222-APWU (2798). As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. PDF PHCS Network Bringing Greater Choice and Savings to the Employees 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). They will be clearly distinguishable by their ID cards. UHSM is not insurance. Submit a Coverage Information Form. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. 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. Use our online Provider Portal or call 1-800-950-7040. 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 Limited Benefit plans. ConnectiCare involuntary disenrollment Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. (800) 557-5471. ConnectiCare takes all complaints from members seriously. 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. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. Following is the statement in its entirety. 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. 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. Members are no longer eligible for coverage after their 40th birthday. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. We also cover additional benefits beyond Original Medicare alone. No prior authorization requirements. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. Pharmacy cost-share, if applicable. 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. Note: Some services require preauthorization. However, the majority of PHCS plans offer members . The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. Box 450978 Westlake, OH 44145. Our plan must obey laws that protect you from discrimination or unfair treatment. The sample ID cards are for demonstration only. Limited to a maximum of $315 every two (2) calendar years for: 1.) See preauthorization list for DME that requires pre-authorization. Life Insurance *. ConnectiCare, in coordination with participating providers, will maintain and monitor the network of participating providers to ensure that members have adequate access to PCPs, specialists, hospitals, and other health care providers, and that through the network of providers their care needs may be met. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. (More information appears later in this section.). 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. The plan contract is terminated. ConnectiCare will communicate to your patients how they may select a new PCP. When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. Provider Portal Info > MultiPlan What can you doif you think you have been treated unfairly or your rights arent being respected? Please review our formulary website or call Member Services for more information. Member satisfaction with ConnectiCare is very important. Provider Portal Eligibility inquiry Claims inquiry. 100 Garden City Plaza, Suite 110 Garden City, NY 11530. [email protected]. Provider Quick Reference Guide - MultiPlan 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. There are different types of advance directives and different names for them. Transition of Care allows new members and/or members whose plan has experienced a recent provider network change to continue to receive services for specified medical and behavioral conditions, with health care professionals that are not participating in the plans designated provider network, until the safe transfer of care to a participating provider and/or facility can be arranged. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. 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. New members may use a copy of their enrollment form. Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). Box 340308 Members pay a copayment as cost-share for most covered health services at the time services are rendered. Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. Please check the privacy statement of the website where this link takes you. Oops, there was an error sending your message. Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 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. This includes the right to stop taking your medication. For non-portal inquiries, please call 1-800-950-7040 . If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. This video explains it. The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. faq. 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. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. Check with our Customer Service Team to find out if your plan accesses Health Coaching. Use your member subscriber ID to access the pricing tool using the link below. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare
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