phcs eligibility and benefits

. If authorization is not obtained, payment for the service may be denied. Any personal information that you give us when you enroll in this plan is protected. However, the majority of PHCS plans offer members . The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. 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. 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. A voluntary termination initiated by a practitioner should be communicated to ConnectiCare verbally or in writing, in accordance with the terms set forth in the contract, but no less than sixty (60) days before the effective date. 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. Its affordable, alternative health care. While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. 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) Note: The list of covered DME and disposable supplies is reviewed periodically and subject to change at the sole discretion of ConnectiCare. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. Balance Bill defense is available for all members with a Reference Based Pricing Plan. Life Insurance *. Remember you will only need your registration code this one time to set up your account. UHSM is NOT an insurance company nor is the membership offered through an insurance company. Blue Cross Providers: 800 . For non-portal inquiries, please call 1-800-950-7040 . Your right to get information about our plan and our network pharmacies You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. 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. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. Emergency care is covered. 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. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. You can easily: Verify member eligibility status; . Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. You may want to give copies to close friends or family members as well. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. Members have the responsibility to: Members rights and our obligations are limited to our ability to make a good faith effort in regard to: Each time a member receives services, you should confirm eligibility. Letting us know if you have additional health insurance coverage. ConnectiCare reserves the right to terminate coverage for members who repeatedly fail to make the required copayments, coinsurance or deductibles, subject to the terms outlined in the applicableMember Agreement, Evidence of Coverage, or other governing contract. MultiPlan uses technology-enabled provider network, negotiation, claim pricing and payment accuracy services as building blocks for medical payors to customize the healthcare cost management programs that work best for them. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. I really appreciate the service I received from UHSM. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. 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. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. We protect your personal health information under these laws. Examples of covered medical conditions can be found below. 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. This includes the right to stop taking your medication. Coverage follows Original Medicare guidelines. Box 340308 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. United Faith Ministries, Inc. is a 501(c)(3) nonprofit corporation, dba Unite Health Share Ministries or UHSM Health Share, that facilitates member-to-member sharing of medical bills. To verify or determine patient eligibility, call 1-800-222-APWU (2798). We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. If you admit a member to a SNF on a weekend or holiday, ConnectiCare will automatically authorize payment for SNF services from the day of admission through the next business day. TTY users should call 877-486-2048. While you may contact us by telephone, you will be asked to place your concerns in writing. ConnectiCare enrolls individual members into the ConnectiCare plan. 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. 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. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. You and your administrative staff can quickly and easily access member eligibility and claims status information anytime, on demand. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. Providers are also required to contact ConnectiCares Notification Line at 888-261-2273 to advise ConnectiCare of the transport. That goes for you, our providers, as much as it does for our members. Testing that exceeds this maximum is the members responsibility. A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. SeeAutomated and Online Featuresfor additional information. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. SeeGlossaryfor definitions of emergency and urgent care. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who isnt providing your care or paying for your care. When performed out-of-network, these procedures do require preauthorization. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. Some plans may have deductible requirements. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. Browse the list to see where your plan is accepted. Answer 1. We also cover additional benefits beyond Original Medicare alone. Just like we shop for everything else! 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. Be treated with respect and recognition of your dignity and right to privacy. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. Some plans may have a copayment requirement for radiology services. Lifetime maximums apply to certain services. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. You may want to give copies to close friends or family members as well. Devices can include but not be limited to diskettes, CDs, tapes, mobile applications, portable drives, desktops, laptops, secure portals, and hardware. 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. ConnectiCare takes all complaints from members seriously. 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. Services or supplies that are new or recently emerged uses of existing services and supplies, are not covered benefits, unless and until we determine to cover them. The bill of service for these members must be submitted to Medicaid for reimbursement. All oral medication requests must go through members' pharmacy benefits. Broker benefits Get in touch. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. 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). You are now leavinga ConnectiCare website. You have chosen PHCS (Private Healthcare Systems, Inc.). Choose "Click here if you do not have an account" for self-registration options. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. 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. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Coverage for skilled nursing facility (SNF) admissions with preauthorization. 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. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Your plan does require According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. In these cases, you must request an initial decision called an organization determination or a coverage determination. You have the right to know how your health information has been given out and used for non-routine purposes. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions 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. In addition, MultiPlan is not liable for the payment of services under plans. How do I contact PHCS? Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. All oral medication requests must go through members' pharmacy benefits. PPM/10.16 Overview of Plans Overview of products Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. Hartford, CT 06134-0308 If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. To inquire about an existing authorization - (phone) 800-562-6833 Prospective members must properly complete and sign an enrollment application and submit it to ConnectiCare. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. Go > For Medicaid managed These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. Members receive in-network level of benefits when they see participating providers. Your right to use advance directives (such as a living will or a power of attorney) 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. Letting us know if you have any questions, concerns, problems, or suggestions. 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). ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. For emergency care received outside the U.S. there is a $100,000 limit. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. Members are encouraged to actively participate in decision-making with regard to managing their health care. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. Premier Health Solutions, LLC operates as a Third-Party Administrator in the state of California under the name PHSI Administrators, LLC and does business under the name PremierHS, LLC in Kentucky, Ohio, Pennsylvania, South Carolina and Utah. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. This includes information about our financial condition and about our network pharmacies. 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. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. Check with our Customer Service Team to find out if your plan accesses Health Coaching. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. (214) 436 8882 Be considerate of our providers, and their staff and property, and respect the rights of other patients. Really good service. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. gabbai aliyah cards,

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