The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. What insurance carrier is PHCS? - InsuredAndMore.com Incorrect Email or Password - MultiPlan Provider - SisCo For Medicaid managed Note: Some services require preauthorization. In these cases, you must request an initial decision called an organization determination or a coverage determination. UHSM Providers - PHCS PPO Network After the deductible has been met, coinsurance will apply to the covered benefits. Treatment Programs we offer and in which you may participate. 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. Answer 3. These services are covered under the Option Plan nationwide. All oral medication requests must go through members' pharmacy benefits. Describe the range or medical conditions or procedures affected by the conscience objection; Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. This includes the right to stop taking your medication. Letting us know if you have any questions, concerns, problems, or suggestions. If you have any concerns about your health, please contact your health care provider's office. Any information provided on this Website is for informational purposes only. A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. I'm a Broker. ConnectiCare involuntary disenrollment 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. 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. Your right to be treated with dignity, respect and fairness Referrals must be signed in to ConnectiCaresProvider Connection. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. The provider must agree to accept network rates for the defined period of time. 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). Colorectal screening (age restrictions apply) 860-509-8000, (TTY) 860-509-7191. Prior Authorizations are for professional and institutional services only. Covered according to Massachusetts state mandate. Customer Service at 800-337-4973 The sample ID cards are for demonstration only. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. Call us and tell us you would like a decision if the service or item will be covered. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. PDF PHCS Network Bringing Greater Choice and Savings to the Employees Best of all, it's free- no downloads required or software to install. ConnectiCare provides each member with a statement of member rights and responsibilities. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. Were here to help! You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. Since you have Medicare, you have certain rights to help protect you. For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. CT scans (all diagnostic exams) How do I contact PHCS? Once your account has been created you will only need your login and password. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. 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) (SeeOther Benefit Information). Our goal is to be the best healthcare sharing program on the planet and to provide. Provider Quick Reference Guide - MultiPlan Regardless of where you get this form, keep in mind that it is a legal document. ConnectiCare eligible members shall not be discriminated against with respect to the availability or provision of health services based on an enrollee's race, sex, age, religion, place of residence, HIV status, source of payment, ConnectiCare membership, color, sexual orientation, marital status, or any factor related to an enrollee's health status. We also cover additional benefits beyond Original Medicare alone. PHCS Network | AvMed We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. 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). To begin the precertification process, your provider(s) should contact Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). 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. Your right to use advance directives (such as a living will or a power of attorney) You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). PHCS is the leading PPO provider network and the largest in the nation. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Testing that exceeds this maximum is the members responsibility. You can easily: Verify member eligibility status; . Wondering how member-to-member health sharing works in a Christian medical health share program? If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! Information is protected as stated in ConnectiCares policies. Supporting evidence, which may be required includes: 1.) Contact the pre-notification line at 866-317-5273. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. This includes the right to leave a hospital or other medical facility, even if your doctor advises you not to leave. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions PHCS Health Insurance - Health Insurance Providers Question 1. On a customer service rating I would give her 5 golden stars for the assistance I received. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). Medicare members who elect to become members of ConnectiCare must meet the following qualifications: Members must be eligible for Medicare Part A and be enrolled in and continue to pay for Medicare Part B. PHCS (Private Healthcare Systems, Inc.) - Sutter Health Click Here to go to the PHCS / Multiplan Provider Search. drug, biological or venom sensitivity. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. You should consider having a lawyer help you prepare it. Members have an in-network deductible for some covered services. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. 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. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. (More information appears later in this section.). If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. 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. Identify the state legal authority permitting such objection; part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. Ask to see the member's ConnectiCare member identification (ID) card. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. 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. That goes for you, our providers, as much as it does for our members. Broker benefits Get in touch. UHSM Health Share and WeShare All rights reserved. You may want to give copies to close friends or family members as well. Initial chiropractic assessment PHCS (Private Healthcare Systems, Inc.) - PPO - Sutter Health You may also use the ConnectiCare Eligibility and Referral Line. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. plan. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). (SeeOther Benefit Information). It is not medical advice and should not be substituted for regular consultation with your health care provider. Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. 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. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. PDF PHCS Network and Limited Benefit Plans - MultiPlan It is critical that the members eligibility be checked at each visit. 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.
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