phcs eligibility and benefits

Claims or Benefits questions will not be answered here. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). The provider must agree to accept network rates for the defined period of time. Providers | Gmr PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. However, the majority of PHCS plans offer members . 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. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. 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. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. Browse the list to see where your plan is accepted. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. 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. Your benefits, claims and/or eligibility are available 24/7 via our member portal. You have the right to get a summary of information about the appeals and grievances that members have filed against our plan in the past. Portal Training for Provider Groups Members receive in-network level of benefits when they see participating providers. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. 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. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. 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. 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. For a specific listing of services and procedures that require pre-authorization refer to the Appendices within this manual. Members > MultiPlan We must investigate and try to resolve all complaints. Once your account has been created you will only need your login and password. 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. Although not a provider of health insurance, PHCS is a provider of PPO (Preferred Provider Organization) networks. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. UHSM is NOT an insurance company nor is the membership offered through an insurance company. You also have the right to get information from us about our plan. There are different types of advance directives and different names for them. 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. Documents called "living will" and "power of attorney for health care" are examples of advance directives. To inquire about an existing authorization - (phone) 800-562-6833 Multiplan or PHCS | Mental Health Coverage | Zencare Zencare We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. 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. Renal dialysis services for members temporarily outside the service area. Prior Authorizations are for professional and institutional services only. To get this information, call Member Services. Physicians may make referrals to participating specialists without entering them into the telephonic referral system. Your Registration Code is the Alternate ID number on your ID card plus a suffix of 01 for the subscriber, 02, 03, 04, 05, etc for spouse and/or dependents. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. Long Term Care Insurance. PHCS is the leading PPO provider network and the largest in the nation. 410 Capitol Avenue For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). 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. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. 2. Your right to make complaints You have the right to find out from us how we pay our doctors. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. MRI/MRA (all examinations) If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. Member Services can also help if you need to file a complaint about access (such as wheel chair access). MedAvant Contact us. 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. Christian Health Sharing State Specific Notices. PDF PHCS Network Bringing Greater Choice and Savings to the Employees Eligibility and Benefits | ConnectiCare Oops, there was an error sending your message. You can sometimes get advance directive forms from organizations that give people information about Medicare. Our contract with you for participation in the ConnectiCare program requires you to provide coverage 24-hours, seven days a week, including weekends and holidays. 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. This includes the right to know about the different Medication Management. Your right to get information in other formats Yes, PHCS provides coverage for therapy services. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. If there are unusual and extraordinary circumstances, or the enrollees PCP is unavailable or inaccessible, the enrollee may seek urgent care treatment at the nearest facility. Reference the below Performance Health Open Negotiation Notice for details on the process your provider must follow for disputing the allowable rate used on your claim. Answer 3. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. 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. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. Coverage for medical emergencies without preauthorization. Really good service. Treatment Programs we offer and in which you may participate. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. including benefit designs and Sutter provider participation in your provider network. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. ConnectiCare's service area includes all counties. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. This line is available twenty-four (24) hours a day, seven days a week. Please check the privacy statement of the website where this link takes you. Refuse treatment and to receive information regarding the consequences of such action. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. Question 5. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Members can print temporary ID cards by visiting the secure portion of our member website. ConnectiCare provides each member with a statement of member rights and responsibilities. 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. A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. When scheduling your appointment, specify that you have access to the PHCS Network throughthe HD Protection Plus Plan, confirm the providers current participation in the PHCS Network, their address and thatthey are accepting new patients. 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. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). A 3-day covered hospital stay is not required prior to being admitted. 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. PHCS PPO Network - WeShare Healthcare Be considerate of our providers, and their staff and property, and respect the rights of other patients. We protect your personal health information under these laws. ConnectiCare offers both employer-sponsored plans and individual insurance plans. Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. How to get more information about your rights 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.

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