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UHSM is NOT an insurance company nor is the membership offered through an insurance company. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions To inquire about an existing authorization - (phone) 800-562-6833 For example, you have the right to look at medical records held at the plan, and to get a copy of your records. PDF PHCS Network and Limited Benefit Plans - MultiPlan You have the right to get information from us about our plan. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. Hartford, CT 06134-0308 ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. 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. We also cover additional benefits beyond Original Medicare alone. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Eligibility Claims Eligibility Fields marked with * are required. This includes the right to stop taking your medication. Wondering how member-to-member health sharing works in a Christian medical health share program? 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. We may enroll employer group members as well. Medicare Advantage or Medicaid call 1-866-971-7427. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. 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. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (medical coverage) and may offer extra benefits too. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. Your right to get information about our network pharmacies and/or providers 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. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. Copyright 2022 Unite Health Share Ministries. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! 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. Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. 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. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. Please check the privacy statement of the website where this link takes you. Members must reside in the service area. abnormal arthrogram. 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. What insurance carrier is PHCS? - InsuredAndMore.com Identify the state legal authority permitting such objection; If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. It is important to note that not all of the Sutter Health network . Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. 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. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. This includes the right to know about the different Medication Management. 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. There are federal and state laws that protect the privacy of your medical records and personal health information. 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. Our goal is to be the best healthcare sharing program on the planet and to provide. 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. Members can print temporary ID cards by visiting the secure portion of our member website. . You have the right to make a complaint if you have concerns or problems related to your coverage or care. Following is the statement in its entirety. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. Eligibility and Referral Line MultiPlan - Delivering affordability, efficiency and fairness to the US If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. To find a participating provider outside of Oklahoma, follow the steps listed below. There are different types of advance directives and different names for them. What services are available to me that could save me money? Coverage for medical emergencies without preauthorization. You must apply for Continuity of Care within 30 days of your health care providers termination date (this is the date your provider is leaving the network) using the request form below. ConnectiCare will communicate to your patients how they may select a new PCP. Monitoring includes member satisfaction with physicians. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. 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. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. Question 3. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. 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. Performance Health at If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive, take a copy with you to the hospital. 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. Check with our Customer Service Team to find out if your plan accesses Health Coaching. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. Regardless of where you get this form, keep in mind that it is a legal document. Be treated with respect and recognition of your dignity and right to privacy. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. Information is protected as stated in ConnectiCares policies. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. Asking at the time of each visit if he/she is still enrolled in a ConnectiCare plan. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. Nuclear cardiology Eligibility Claims Eligibility Fields marked with * are required. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. Provider. Supporting evidence, which may be required includes: 1.) The provider must agree to accept network rates for the defined period of time. New users to the Provider Portal can create an account by selecting the Provider Access Link on the portal login page. Postoperative physical therapy for TMJ surgery is limited to ninety (90) days from the date of surgery when pre-authorized as part of surgical procedure. PHCS (Private Healthcare Systems, Inc.) - PPO. If you have difficulty obtaining information from your plan based on language or a disability, call 1-800-MEDICARE (800-633-4227). Physicians may make referrals to participating specialists without entering them into the telephonic referral system. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. Prospective members must properly complete and sign an enrollment application and submit it to ConnectiCare. PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. Note: Some plans may vary. Influenza and pneumococcal vaccinations If you have any concerns about your health, please contact your health care provider's office. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Please review our formulary website or call Member Services for more information. Employer group enrollment will be the result of employers electing to offer benefits to retirees through ConnectiCare. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Accessing PHCS Savility PHCS Savility is available to insurers and benefit plan administrators meeting certain benefit design Make recommendations regarding our members rights and responsibilities policies. Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. 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 > The sample ID cards are for demonstration only. You should consider having a lawyer help you prepare it. MRI/MRA (all examinations) You have the right to find out from us how we pay our doctors. See preauthorization list for DME that requires pre-authorization. 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) The member engages in disruptive behavior. You can also get free help and information from CHOICES - your SHIP. How to get more information about your rights According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. 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 Health Insurance - Health Insurance Providers 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. New members may use a copy of their enrollment form. 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. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. You have the right to get information from us about our plan. 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. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections Welcome to the MultiPlan Provider PortalThe portal lets you view and update your network-related information, manage tasks such as credentialing and track your customer service case history. Initial chiropractic assessment Multiplan or PHCS | Mental Health Coverage | Zencare Zencare (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). Limited to a maximum of $315 every two (2) calendar years for: 1.) We request your cooperation in investigating and resolving these complaints. 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. MultiPlan can help you find the provider of your choice. Provider Portal - Claims & Eligibility abnormal MRI; and 2.) 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. Members receive in-network level of benefits when they see participating providers. Pharmacy cost-share, if applicable. If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. That goes for you, our providers, as much as it does for our members. 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. Your right to know your treatment options and participate in decisions about your health care Referrals must be signed in ConnectiCares referral system viaProvider Connection. 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. faq. You have the right to refuse treatment. Oops, there was an error sending your message. Information is protected as outlined in ConnectiCare's policies. Once you have completed the Registration form you will be emailed a link to confirm your Registration. ConnectiCare cannot reverse CMS' determination. We conduct routine, focused surveys to monitor satisfaction using the Consumer Assessment of Health Plan Satisfaction (CAHPS) survey and implement quality improvement activities when opportunities are identified. It is important to sign this form and keep a copy at home. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. Please review the member's ID card to confirm the appropriate phone number. Our plan must obey laws that protect you from discrimination or unfair treatment. Christian Health Sharing State Specific Notices. When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. Register for an account For No Surprises Act First time visitor? 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. In addition, information is protected by information systems security, and authentication and authorization procedures, such as but not limited to: password-protected files; storage, data disposal, and reuse of media and devices; and transmission and physical security requirements using company-protected equipment including access to devices and media that contain individual-level data. 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. 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. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? PHCS (Private Healthcare Systems, Inc.) - PPO - Sutter Health Claims or Benefits questions will not be answered here. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. This video explains it. Pay applicable copayments, deductibles or coinsurance. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Blue Cross Providers: 800 . All routine laboratory services must be obtained from participating laboratories. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. We protect your personal health information under these laws. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. Your right to get information about your drug coverage and costs 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 reference your plan document for the complete list. Provider Portal Eligibility inquiry Claims inquiry. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. That goes for you, our providers, as much as it does for our members. To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. If you need more information, please call Member Services. Prostate cancer screening (age restrictions apply) Your right to the privacy of your medical records and personal health information. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; If authorization is not obtained, payment for the service may be denied. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Benefit Type* Subscriber SSN or Card ID* Subscriber Group #* Patient First Name Patient Gender* Male Female Patient Date of Birth* Provider TIN or SSN*(used in billing) Its affordable, alternative health care. You must pay for services that arent covered. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. Follow the plans and instructions for care that they have agreed on with practitioners. Click on the link and you will then have immediate access to the Member portal. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. 410 Capitol Avenue Your right to get information in other formats Admission to a SNF for rehabilitation, in the absence of a hospitalization or acute episode of illness, requires preauthorization and is subject to medical necessity review. 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) ConnectiCare enrolls individual members into the ConnectiCare plan. 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.