phcs eligibility and benefits

Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. Broker benefits Get in touch. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. Your providers must explain things in a way that you can understand. 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 make complaints Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. 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. 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. Regardless of where you get this form, keep in mind that it is a legal document. Visit our other websites for Medicaid and Medicare Advantage. 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) Screening pap test. To get this information, call Member Services. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. What services are available to me that could save me money? All participating providers agree to certify that all information submitted to ConnectiCare is accurate, complete, truthful, and shall comply with applicable CMS standards. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. Healthcare Provider FAQs > MultiPlan We may enroll employer group members as well. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. They are collected via enrollment information, self-disclosure, and the member portal. We believe there is no such thing as a standard cost management approach. 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. No prior authorization requirements. Members can print temporary ID cards by visiting the secure portion of our member website. 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. Wondering how member-to-member health sharing works in a Christian medical health share program? Coverage follows Original Medicare guidelines. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. To pre-notify or to check member or service eligibility, use our provider portal. Members are no longer eligible for coverage after their 40th birthday. your current benefits ID card upon arrival at your appointment. 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. For a specific listing of services and procedures that require preauthorization please refer to the preauthorization lists found within this manual. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; 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. If you need more information, please call Member Services. PCPs:Advise your patients to contact ConnectiCare's Member Services at 860-674-5757 or 800-251-7722 to designate a new PCP, even if your practice is being assumed by another physician. Your right to use advance directives (such as a living will or a power of attorney) The member engages in disruptive behavior. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. including benefit designs and Sutter provider participation in your provider network. Solutions. Your right to get information about your drug coverage and costs We must investigate and try to resolve all complaints. Use your member subscriber ID to access the pricing tool using the link below. That goes for you, our providers, as much as it does for our members. Portal Training for Provider Groups Refractions are not covered by ConnectiCare Medicare Advantage plans. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Giving your doctor and other providers the information they need to care for you, and following the treatment plans and instructions that you and your doctors agree upon. If you do, please call Member Services. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. 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 Please review our formulary website or call Member Services for more information. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. The provider must agree to accept network rates for the defined period of time. 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. Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. Provider Page | Medi-Share For emergency care received outside the U.S. there is a $100,000 limit. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time You may also call the Office for Civil Rights at 800-368-1019 or TTY:800-537-7697, or your local Office for Civil Rights. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. Popular Questions. Customer Service number: 877-585-8480. . You have the right to be told about any risks involved in your care. Emergency care is covered. You should give a copy of the form to your doctor and to the person you name on the form as the one to make decisions for you if you cant. Click on the link and you will then have immediate access to the Member portal. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. How do I contact PHCS? A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections 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. 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:. Your responsibilities as a member of our plan. SeeGlossaryfor definitions of emergency and urgent care. 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. These members may have a different copayment and/or benefit package. This includes information about our financial condition and about our network pharmacies. Members must reside in the service area. ThriveHealth STM - Health Depot Association Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. Medicare Advantage or Medicaid call 1-866-971-7427. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. PHCS is the leading PPO provider network and the largest in the nation. Treatment Programs we offer and in which you may participate. allergenic extracts (or RAST allergen specific testing); 2.) 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. Providers | Gmr PHCS PPO Network - WeShare Healthcare Stress echocardiograms Members receive out-of-network level of benefits when they see non-participating providers. For non-portal inquiries, please call 1-800-950-7040. Note: Some plans may vary. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. drug, biological or venom sensitivity. You are now leavinga ConnectiCare website. You can easily: Verify member eligibility status; . Please check the privacy statement of the website where this link takes you. 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. In addition, the ID card also includes emergency instructions and a toll-free telephone number for out-of-area and after-hours notifications, the Member Services phone number, and the claims submission address. 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) Your right to get information about our plan You should consider having a lawyer help you prepare it. You may also use the ConnectiCare Eligibility and Referral Line. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. Blue Cross Providers: 800 . 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. Regardless of where you get this form, keep in mind that it is a legal document. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. You have the right to find out from us how we pay our doctors. Copyright 2022 Unite Health Share Ministries. Your right to use advance directives (such as a living will or a power of attorney)

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