You may want to give copies to close friends or family members as well. 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). Providers are also reminded that dual eligible members who are designated as Qualified Medicare Beneficiaries (QMB or QMB+) cannot be billed for any Medicare cost-share. Accessing PHCS Savility PHCS Savility is available to insurers and benefit plan administrators meeting certain benefit design 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. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. Follow the plans and instructions for care that they have agreed on with practitioners. High Deductible Health Plan (Health Savings Account [HSA] Compatible). 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. Covered at participating urgent care providers. 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. Wondering how member-to-member health sharing works in a Christian medical health share program? 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. 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. The plan cannot and will not disenroll a member because of the amount or cost of services used. UHSM is always eager and ready to assist. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. 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. These services are covered under the Option Plan nationwide. To verify or determine patient eligibility, call 1-800-222-APWU (2798). Visit Performance Health HealthworksWellness Portal. (SeeOther Benefit Information). 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 your current benefits ID card upon arrival at your appointment. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. 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 you do not inform ConnectiCare according to these guidelines, the SNF may not receive payment for any additional days of the member's stay. Identify the state legal authority permitting such objection; UHSM is excellent, friendly, and very competent. No out-of-network coverage unless pre-authorized in writing by ConnectiCare. Note: Presentation of a member ID card is not a guarantee of a member's eligibility. part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. For a specific listing of services and procedures that require preauthorization please refer to the preauthorization lists found within this manual. Members are no longer eligible for coverage after their 40th birthday. You have the right to make a complaint if you have concerns or problems related to your coverage or care. Answer 1. Pharmacy cost-share, if applicable. P.O. In addition, MultiPlan is not liable for the payment of services under plans. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. Please call Member Services if you have any questions. How do I contact PHCS? 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. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Click Here to go to the PHCS / Multiplan Provider Search. Customer Service number: 877-585-8480. . Register for an account For No Surprises Act First time visitor? To get this information, call Member Services. TTY users should call 877-486-2048. 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. 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. 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. In this section, we explain your Medicare rights and protections as a member of our plan and, we explain what you can do if you think you are being treated unfairly or your rights are not being respected. Keep scheduled appointments or give sufficient advance notice of cancellation. 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. Hartford, CT 06134-0308 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. Providers are also required to contact ConnectiCares Notification Line at 888-261-2273 to advise ConnectiCare of the transport. Your right to use advance directives (such as a living will or a power of attorney) ConnectiCare provides each member with a statement of member rights and responsibilities. CommunityCare Life and Health Insurance Company provides an in-network level of benefits for services delivered outside of Oklahoma through a national PPO network, PHCS. PHCS is the leading PPO provider network and the largest in the nation. For non-portal inquiries, please call 1-800-950-7040. allergenic extracts (or RAST allergen specific testing); 2.) abnormal arthrogram. faq. Question 5. Testing that exceeds this maximum is the members responsibility. 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. Member Services can also help if you need to file a complaint about access (such as wheel chair access). Simplifying the benefits experience, so you can focus on patient care. . Prospective members must properly complete and sign an enrollment application and submit it to ConnectiCare. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. 860-509-8000, (TTY) 860-509-7191. It is not medical advice and should not be substituted for regular consultation with your health care provider. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407. 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. Product and plan details are outlined in the product and coverage section on this page. Yes, PHCS provides coverage for therapy services. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. Answer 4. Eligibility Claims Eligibility Fields marked with * are required. 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. Below are the additional benefits covered by ConnectiCare. Members are encouraged to actively participate in decision-making with regard to managing their 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. What should I do if I get a bill from a healthcare provider? Prostate cancer screening (age restrictions apply) The provider must agree to accept network rates for the defined period of time. Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. This includes information about our financial condition, and how our Plan compares to other health plans. You may also use the ConnectiCare Eligibility and Referral Line. Requests may be made by either the physician or the member. Note: Some plans may vary. A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. Pleasant and provided correct information in a timely manner. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. This includes the right to know about the different Medication Management. For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. ConnectiCare involuntary disenrollment 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). Best of all, it's free- no downloads required or software to install. 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. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. This includes, but is not limited to, an enrollee's medical condition (including mental as well as physical illness), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), disability or on any other basis otherwise prohibited by state or federal law. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. We must investigate and try to resolve all complaints. Your right to know your treatment options and participate in decisions about your health care I really appreciate the service I received from UHSM. To verify eligibility for services, request to see the member's current ID card. Members receive in-network level of benefits when they see participating providers. You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. 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. Some preventive services are covered at 100% and are exempt from the deductible requirement. A sample of the ConnectiCare ID cards appear below. You have the right to get information from us about our plan. Prior Authorizations are for professional and institutional services only. If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother process and overall cost savings. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. Our plan must obey laws that protect you from discrimination or unfair treatment. You can sometimes get advance directive forms from organizations that give people information about Medicare. This video explains it. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. 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. You have the right to find out from us how we pay our doctors. abnormal MRI; and 2.) If you need assistance with the shopping tool or with obtaining pricing please contact our Customer Service Team at 877-585-8480, View the video below for additional information on the MyMedicalShopper pricing tool:. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. 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. 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). If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). In these cases, you must request an initial decision called an organization determination or a coverage determination. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." PHCS www.multiplan.com (Please select the provider network listed on your ID card) We must investigate and try to resolve all complaints. The bill of service for these members must be submitted to Medicaid for reimbursement. 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. They are collected via enrollment information, self-disclosure, and the member portal. You have the right to get information from us about our plan. PHCS (Private Healthcare Systems, Inc.) - PPO. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. 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. Eligibility Claims Eligibility Fields marked with * are required. PPM/10.16 Overview of Plans Overview of products Make recommendations regarding our members rights and responsibilities policies. Glaucoma screening If you are calling to verify your patient's benefits*, please have a copy Limited to a maximum of $315 every two (2) calendar years for: 1.) Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. Use our online Provider Portal or call 1-800-950-7040. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. Customer Service at 800-337-4973 There are different types of advance directives and different names for them. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. 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. You have the right to know how your health information has been given out and used for non-routine purposes. These members may have a different copayment and/or benefit package. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. 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. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. They should be informed of any health care needs that require follow-up, as well as self-care training. Influenza and pneumococcal vaccinations It is generally available between 7 a.m. and 9:30 p.m., Monday through Friday, and from 7 a.m. to 2 p.m. on Saturday. drug, biological or venom sensitivity. (More information appears later in this section.). Participate with practitioners in decision-making regarding your health care. Once submitted, ConnectiCare will verify the eligibility of the member with the Centers for Medicare & Medicaid Services (CMS) as they are the sole arbiter of eligibility for Medicare. Copyright 2022 Unite Health Share Ministries. 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. If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. Referrals must be signed in ConnectiCares referral system viaProvider Connection. Asking at the time of each visit if he/she is still enrolled in a ConnectiCare plan. Refuse treatment and to receive information regarding the consequences of such action. Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. We request your cooperation in investigating and resolving these complaints. For non-portal inquiries, please call 1-800-950-7040 . No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. 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.