If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. As always, confirm benefits by contacting Provider Services at 877-224-8230. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. You have the right to refuse treatment. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. abnormal arthrogram. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. MultiPlan - Delivering affordability, efficiency and fairness to the US Members are required to see participating providers, except in emergencies. All genetic testing requires preauthorization, with the exception of the following: Routine chromosomal analysis (e.g., peripheral blood, tissue culture, chorionic villous sampling, amniocentesis) - CPT 83890 - 83914, billed withModifier 8A or ICD-9 diagnosis codes V77.6 or V83.81, DNA testing for cystic fibrosis - CPT 88271 - 88275; 88291, billed withModifier 2A - 2Z or ICD-9 codes V10.6x or V10.7x, FISH (fluorescent in situ hybridization) for the diagnosis of lymphoma or leukemia - CPT 88230 - 88269; 88280 - 88289; 88291; 88299. Popular Questions. 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. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. Your benefits, claims and/or eligibility are available 24/7 via our member portal. To begin the precertification process, your provider(s) should contact Life Insurance *. For a specific listing of services and procedures that require pre-authorization refer to the Appendices within this manual. Provider - SisCo It is critical that the members eligibility be checked at each visit. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. Register for an account For No Surprises Act First time visitor? You have the right to get full information from your providers when you go for medical care, and the right to participate fully in decisions about your health care. Call us and tell us you would like a decision if the service or item will be covered. Describe the range or medical conditions or procedures affected by the conscience objection; The Evidence of Coverage (EOC) will instruct them to call their PCP. 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. 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. How do I know if I qualify for PHCS insurance? To inquire about an existing authorization - (phone) 800-562-6833 Question 3. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. You are now leavinga ConnectiCare website. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. Just like we shop for everything else! 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. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Choose "Click here if you do not have an account" for self-registration options. Asking at the time of each visit if he/she is still enrolled in a ConnectiCare plan. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. This feature is meant to assist members who need additional copies of their ID card. What services are available to me that could save me money? Member Services can also help if you need to file a complaint about access (such as wheel chair access). 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. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare 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. However, the majority of PHCS plans offer members . Your right to get information about your prescription drugs, Part C medical care or services, and costs 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 sample ID cards are for demonstration only. New users to the Provider Portal can create an account by selecting the Provider Access Link on the portal login page. You should consider having a lawyer help you prepare it. You have the right to an explanation from us about any prescription drugs or Part C medical care or service not covered by our plan. You must pay for services that arent covered. 2. Members pay a copayment as cost-share for most covered health services at the time services are rendered. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. Provider Portal Info > MultiPlan Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. Members pay a copayment cost-share for most covered health services at the time the services are rendered. 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. Influenza and pneumococcal vaccinations To pre-notify or to check member or service eligibility, use our provider portal. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. 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. 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. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. TTY users should call 877-486-2048. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. 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. This information is not used in contracting or credentialing decisions or for any discriminatory purpose. 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. 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. Read the Membership Agreement, Evidence of Coverage, or other Plan document that describes the Plans benefits and rules. To get this information, call Member Services. Simplifying the benefits experience, so you can focus on patient care. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. (SeeOther Benefit Information). 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. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. If you need more information, please call Member Services. UHSM is NOT an insurance company nor is the membership offered through an insurance company. 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. Any information provided on this Website is for informational purposes only. They are collected via enrollment information, self-disclosure, and the member portal. Note: These procedures are covered procedures, but do not require preauthorization in network. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? 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. In addition, MultiPlan is not liable for the payment of services under plans. You can reference your plan document for the complete list. This line is available twenty-four (24) hours a day, seven days a week. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. The plan contract is terminated. Your plan does require 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. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. Were here to help! You have the right to know how your health information has been given out and used for non-routine purposes. 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. 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. What can you doif you think you have been treated unfairly or your rights arent being respected? Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Coverage follows Original Medicare guidelines. Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. Provider Portal 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. Information is protected as outlined in ConnectiCare's policies. Coverage for medical emergencies without preauthorization. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who isnt providing your care or paying for your care. A new web site will open up in a new window. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. Use your member subscriber ID to access the pricing tool using the link below. Claims or Benefits questions will not be answered here. Some plans may have a copayment requirement for radiology services. Nutritionist and social worker visit Bone mass measurement ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. If you have any questions please review your formulary website or call Member Services. 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. What to do if you think you have been treated unfairly or your rights are not being respected? faq. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. PCP name and telephone number Colorectal screening (age restrictions apply) If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. For non-portal inquiries, please call 1-800-950-7040. 410 Capitol Avenue Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 We will make sure that unauthorized people dont see or change your records. Once you have completed the Registration form you will be emailed a link to confirm your Registration. Regardless of where you get this form, keep in mind that it is a legal document. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. SeeAutomated and Online Featuresfor additional information. The service area includes all counties in Connecticut. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. 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 Following is the statement in its entirety. PDF PHCS Network and Limited Benefit Plans - MultiPlan Actual copayment information and other benefit information will vary. 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. If you have questions or concerns about your rights and protections, please call Member Services. 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. Screening pap test. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button Keep scheduled appointments or give sufficient advance notice of cancellation. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. The following are samples of each type of ID card that ConnectiCare issues to members. The admitting physician is responsible for pre-authorizing elective admissions five (5) working days in advance. Members > MultiPlan Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. 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. Follow the plans and instructions for care that they have agreed on with practitioners. We must investigate and try to resolve all complaints. If you are calling to verify your patient's benefits*, please have a copy Clinical Review Prior Authorization Request Form. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. Coverage for skilled nursing facility (SNF) admissions with preauthorization. Portal Training for Provider Groups ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. Members have an in-network deductible for some covered services. 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. Benefit Type* Subscriber SSN or Card ID* Patient First Name Patient Gender* Male Female Patient Date of Birth* Provider TIN or SSN*(used in billing) 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. Members must reside in the service area. 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. Browse the list to see where your plan is accepted. CT scans (all diagnostic exams) Long Term Care Insurance. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Optional Life Insurance *. Yes, PHCS provides coverage for therapy services. Answer 4. 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. Please Note: When searching for providers, the results presented are for reference only; as participating physicians, hospitals, and/or healthcare providers may have changed since the online directory was last updated. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. Follow the rules of this Plan, and assume financial responsibility for not following the rules. Members are encouraged to actively participate in decision-making with regard to managing their health care. These members may have a different copayment and/or benefit package. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. 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. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. 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. 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. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. Members are no longer eligible for coverage after their 40th birthday. This includes the right to leave a hospital or other medical facility, even if your doctor advises you not to leave. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO If you have any concerns about your health, please contact your health care provider's office. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. Physicians may make referrals to participating specialists without entering them into the telephonic referral system. Network providers and practitioners are also contractually obligated to protect the confidentiality of members information. PHCS (Private Healthcare Systems, Inc.) - PPO - Sutter Health We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. Benefits - Penn Medicine Princeton Health Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Your right to get information about your drug coverage and costs