phcs eligibility and benefits

PDF PHCS Savility - MultiPlan Your right to make complaints 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) It is important to sign this form and keep a copy at home. Clinical Review Prior Authorization Request Form. The provider must agree to accept network rates for the defined period of time. If authorization is not obtained, payment for the service may be denied. Can be provided safely by persons who are not medically skilled, with a reasonable amount of instruction, including, but not limited to, supervision in taking medication, homemaking, supervision of the patient who is unsafe to be left alone, and maintenance of bladder catheters, tracheotomies, colostomies/ileostomies and intravenous infusions (such as TPN) and oral or nasal suctioning. 2. 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. To pre-notify or to check member or service eligibility, use our provider portal. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Long Term Care Insurance. Note: Some plans may vary. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. 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. Your right to get information about our plan and our network pharmacies To verify eligibility for services, request to see the member's current ID card. Members have an in-network deductible for some covered services before coverage for the benefits will apply. Provider Portal Eligibility inquiry Claims inquiry. Note: Presentation of a member ID card is not a guarantee of a member's eligibility. 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). You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. If you do, please call Member Services. Best of all, it's free- no downloads required or software to install. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. Your right to get information about your drug coverage and costs Regardless of where you get this form, keep in mind that it is a legal document. Click on the link and you will then have immediate access to the Member portal. 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 DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Actual copayment information and other benefit information will vary. Prospective members must properly complete and sign an enrollment application and submit it to ConnectiCare. HPI | Provider Resources | Patient Benefits & Eligibility To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. Your right to get information about your prescription drugs, Part C medical care or services, and costs ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. 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. 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. 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. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Life Insurance *. These members may have a different copayment and/or benefit package. ConnectiCare also makes available to members printable, temporary ID cards via our website. PET scans Browse the list to see where your plan is accepted. 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. 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! You may also use the ConnectiCare Eligibility and Referral Line. 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 Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections Use your member subscriber ID to access the pricing tool using the link below. It is not medical advice and should not be substituted for regular consultation with your health care provider. Member Services can also help if you need to file a complaint about access (such as wheel chair access). The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. Provide, to the extent possible, information providers need to render care. ConnectiCare members will receive an identification (ID) card when they enroll in the plan. Covered at participating urgent care providers. Pharmacy cost-share, if applicable. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. Be considerate of our providers, and their staff and property, and respect the rights of other patients. Christian Health Sharing State Specific Notices. Coverage for skilled nursing facility (SNF) admissions with preauthorization. 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. You have the right to refuse treatment. 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. What should I do if I get a bill from a healthcare provider? Covered according to Massachusetts state mandate. These services are covered under the Option Plan nationwide. 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. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. providers - IBA TPA Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. What does Transition of Care and Continuity of Care mean? You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. your current benefits ID card upon arrival at your appointment. Please check the privacy statement of the website where this link takes you. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. Advance directives are written instructions, such as living will, durable power of attorney for health care, health care proxy, or do not resuscitate (DNR) request, recognized under state law and relating to the provision of health care when the individual is incapacitated and unable to communicate his/her desires. Members pay a copayment as cost-share for most covered health services at the time services are rendered. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. SeeMedical Management. 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. What can you doif you think you have been treated unfairly or your rights arent being respected? If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement 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. Members must reside in the service area. 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. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. 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. ConnectiCare involuntary disenrollment You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments. PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO 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. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. ThriveHealth STM - Health Depot Association This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. Some preventive services are covered at 100% and are exempt from the deductible requirement. 100 Garden City Plaza, Suite 110 Garden City, NY 11530. sales@ibatpa.com. 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. Your right to get information about our plan You can easily: Verify member eligibility status; . We must tell you in writing why we will not pay for or approve a prescription drug or Part C medical care or service, and how you can file an appeal to ask us to change this decision. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients).
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