Use our online Provider Portal or call 1-800-950-7040. 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. No out-of-network coverage unless preauthorized in writing by ConnectiCare. Provider Page | Medi-Share You have the right to timely access to your providers and to see specialists when care from a specialist is needed. Question 4. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. Answer 5. drug, biological or venom sensitivity. Your Explanation of Payment (EOP) will specify member responsibility. 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. Once you have completed the Registration form you will be emailed a link to confirm your Registration. You will get most or all of your care from plan providers, that is, from doctors and other health providers who are part of our plan. Glaucoma screening Member Services can also help if you need to file a complaint about access (such as wheel chair access). For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. 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. Eligibility Claims Eligibility Fields marked with * are required. Referrals must be signed in ConnectiCares referral system viaProvider Connection. Follow the plans and instructions for care that they have agreed on with practitioners. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Question 3. Monitoring includes member satisfaction with physicians. Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. To verify or determine patient eligibility, call 1-800-222-APWU (2798). It is important to sign this form and keep a copy at home. There are different types of advance directives and different names for them. 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. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. 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. Your right to use advance directives (such as a living will or a power of attorney) Refractions are not covered by ConnectiCare Medicare Advantage plans. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. 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. Just like we shop for everything else! Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. Limited to a maximum of $315 every two (2) calendar years for: 1.) 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. 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. To verify eligibility for services, request to see the member's current ID card. We must tell you in writing why we will not pay for or approve a service, and how you can file an appeal to ask us to change this decision. Follow the rules of this Plan, and assume financial responsibility for not following the rules. Be sure to ask your doctors and other providers if you have any questions and have them explain your treatment in a way you can understand. How to manage the front desk when they ask who you are insured with? What can you doif you think you have been treated unfairly or your rights arent being respected? 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. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. You have the right to make a complaint if you have concerns or problems related to your coverage or care. We hope that our members are satisfied and decide to stay with ConnectiCare; however, should you learn that a member plans to disenroll, you may avoid payment delays by: 1. Provider Portal TTY users should call 877-486-2048. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. Note: The list of covered DME and disposable supplies is reviewed periodically and subject to change at the sole discretion of ConnectiCare. That goes for you, our providers, as much as it does for our members. If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. 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. 877-585-8480. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. UHSM Health Share and WeShare All rights reserved. Coverage follows Original Medicare guidelines. 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. 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. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. To get this information, call Member Services. To find a participating provider outside of Oklahoma, follow the steps listed below. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. TTY users should call 877-486-2048. (214) 436 8882 Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. 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. Actual copayment information and other benefit information will vary. MedAvant Employer group enrollment will be the result of employers electing to offer benefits to retirees through ConnectiCare. 410 Capitol Avenue Your rights include knowing about all of the treatment options that are recommended for your condition, no matter what they cost or whether they are covered by our plan. All routine laboratory services must be obtained from participating laboratories. PDF PHCS Savility - MultiPlan By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother process and overall cost savings. That goes for you, our providers, as much as it does for our members. Out of network benefits will apply when receiving care from non-participating providers. PHCS (Private Healthcare Systems, Inc.) - PPO. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. A 3-day covered hospital stay is not required prior to being admitted. Asking at the time of each visit if he/she is still enrolled in a ConnectiCare plan. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. See the preauthorization section for a listing of DME that requires preauthorization. ConnectiCare enrolls individual members into the ConnectiCare plan. Be considerate of our providers, and their staff and property, and respect the rights of other patients. Click on the link and you will then have immediate access to the Member portal. 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. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions A new web site will open up in a new window. Members receive in-network level of benefits when they see participating providers. The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. 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. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Your benefits, claims and/or eligibility are available 24/7 via our member portal. We also cover additional benefits beyond Original Medicare alone. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. 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) 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. All oral medication requests must go through members' pharmacy benefits. I'm a Broker. Hartford, CT 06134-0308 It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. 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. Members > MultiPlan DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. High Deductible Health Plan (Health Savings Account [HSA] Compatible). You will now leave the AvMed web site once you click the "I agree" button. Member race, language, ethnicity, gender orientation, and sexual identity cannot be used to perform underwriting, rate setting, and benefit determinations (specifically denial of coverage and benefits), and cannot be disclosed to unauthorized users. 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. The member provides fraudulent information on the application or permits abuse of an enrollment card. Mail Paper HCFAs or UBs: Medi-Share Some plans may have a copayment requirement for radiology services. PHCS Health Insurance - Health Insurance Providers Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. It is not medical advice and should not be substituted for regular consultation with your health care provider. Make recommendations regarding our members rights and responsibilities policies. 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. ConnectiCare takes all complaints from members seriously. Call us and tell us you would like a decision if the service or item will be covered. 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. Contact us. What should I do if I get a bill from a healthcare provider? These services are covered under the Option Plan nationwide. Bone mass measurement We may enroll employer group members as well. Answer 1. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Question 1. You can also visit www.medicare.gov on the Web to view or download the publication Your Medicare Rights & Protections. Under Search Tools, select Find a Medicare Publication. Or, call 1-800-MEDICARE (800-633-4227). 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. ConnectiCare members may directly access care through self-referral to a participating clinician for covered services and certain Medicare-covered services at designated frequencies and ages, including: Annual routine eye exam (Prime and Custom Plans only)
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