Providers are also reminded that dual eligible members who are designated as Qualified Medicare Beneficiaries (QMB or QMB+) cannot be billed for any Medicare cost-share. For a specific listing of services and procedures that require preauthorization please refer to the preauthorization lists found within this manual. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. Identify the state legal authority permitting such objection; ConnectiCare takes all complaints from members seriously. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. 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. Pelvic exam To verify or determine patient eligibility, call 1-800-222-APWU (2798). (SeeOther Benefit Information). PCPs:Advise your patients to contact ConnectiCare's Member Services at 800-224-2273 to designate a new PCP, even if your practice is being assumed by another physician. Member satisfaction with ConnectiCare is very important. Follow the plans and instructions for care that they have agreed on with practitioners. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections Your right to the privacy of your medical records and personal health information. Describe the range or medical conditions or procedures affected by the conscience objection; When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. Members are encouraged to actively participate in decision-making with regard to managing their health care. Optional Life Insurance *. Coverage for skilled nursing facility (SNF) admissions with preauthorization. View the video below for additional information on the MyMedicalShopper pricing tool: The Member Resource Document includes details for your reference on: You can reference your plan document for the complete list. This includes the right to stop taking your medication. After the Plan deductible is met, benefits will be covered according to the Plan. ConnectiCare enrolls individual members into the ConnectiCare plan. 2. Eligibility Claims Eligibility Fields marked with * are required. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. Members have an in-network deductible for some covered services before coverage for the benefits will apply. View sample member ID cards forcopayandhigh-deductibleplans for details. 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. Reminding the patient to notify ConnectiCare; and Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). Some plans may have deductible requirements. UHSM is a different kind of healthcare, called health sharing. These services are covered under the Option Plan nationwide. SeeMedical Management. 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. Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. Note: Some services require preauthorization. Coverage for medical emergencies without preauthorization. Box 340308 Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. Question 3. Voice complaints or appeals/grievances about us or the care you are provided. A new web site will open up in a new window. Mail Paper HCFAs or UBs: Medi-Share All Practitioners:Please notify ConnectiCare in advance prior to taking any action to remove a specific member from your practice for any reason. 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). Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. Register for an account For No Surprises Act First time visitor? On a customer service rating I would give her 5 golden stars for the assistance I received. The Evidence of Coverage (EOC) will instruct them to call their PCP. Please check the privacy statement of the website where this link takes you. If you are relocating out of ConnectiCare's network or retiring, please notify your patients at least ten (10) days in advance, in writing, in addition to notifying ConnectiCare and, if applicable, your contracted PHO/IPA in writing sixty (60) days in advance. Your right to make complaints The legal documents that you can use to give your directions in advance in these situations are called "advance directives." 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. Stress echocardiograms Choose "Click here if you do not have an account" for self-registration options. Member Services can also help if you need to file a complaint about access (such as wheel chair access). Oops, there was an error sending your message. Letting us know if you have additional health insurance coverage. (More information appears later in this section.). This includes information about our financial condition, about our plan health care providers and their qualifications, about information on our network pharmacies, and how our plan compares to other health plans. Answer 2. Devices can include but not be limited to diskettes, CDs, tapes, mobile applications, portable drives, desktops, laptops, secure portals, and hardware. Your Explanation of Payment (EOP) will specify member responsibility. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. 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. Paying your co-payments/coinsurance for your covered services. UHSM is not insurance. Question 4. 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) 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. Visit www.uhsm.com/preauth Download and print the PDF form Fax the preauth form to (888) 317-9602 GET PREAUTH FORM member-to-member health sharing How Healthshare Works with UHSM, it's Awesome! faq. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. You may also use the ConnectiCare Eligibility and Referral Line. This includes the right to know about the different Medication Management. You also have the right to get information from us about our plan. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Blue Cross Providers: 800 . Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. 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. Pharmacy cost-share, if applicable. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. Your responsibilities as a member of our plan. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. Asking at the time of each visit if he/she is still enrolled in a ConnectiCare plan. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. Once you have completed the Registration form you will be emailed a link to confirm your Registration. 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. The bill of service for these members must be submitted to Medicaid for reimbursement. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. . Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. We believe there is no such thing as a standard cost management approach. Members can print temporary ID cards by visiting the secure portion of our member website. We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. For the PHCS Network, 1-800-922-4362 For PHCS Healthy Directions, 1-800-678-7427 For the MultiPlan Network, 1-888-342-7427 For the HealthEOS Network, 1-800-279-9776 For language assistance, please call 1-866-981-7427 For TTY/TTD service, please call 1-866-918-7427 Search for a provider > Prospective members must properly complete and sign an enrollment application and submit it to ConnectiCare. No out-of-network coverage unless preauthorized in writing by ConnectiCare. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. Members have an in-network deductible for some covered services. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. Christian Health Sharing State Specific Notices. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. I called in with several medical bills to go over and their staff was extremely helpful. We protect your personal health information under these laws. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. After the deductible has been met, coinsurance will apply to the covered benefits. 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. Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. You have the right to find out from us how we pay our doctors. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. Routine hearing tests covered up to 1 every year, Routine eye exams covered up to 1 every year, Discounts are available on lenses, contacts and frames. ConnectiCare offers both employer-sponsored plans and individual insurance plans. Screening pap test. drug, biological or venom sensitivity. They will be clearly distinguishable by their ID cards. See the preauthorization section for a listing of DME that requires preauthorization. Member eligibility Medicaid managed care and Medicare Advantage plan effective dates Note: MultiPlan does not have access to payment records and does not make determinations with respect to ben-efits or eligibility. Your right to get information about your prescription drugs, Part C medical care or services, and costs Requests may be made by either the physician or the member. The plan cannot and will not disenroll a member because of the amount or cost of services used. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. What should I do if I get a bill from a healthcare provider? ConnectiCare also makes available to members printable, temporary ID cards via our website. allergenic extracts (or RAST allergen specific testing); 2.) All participating providers agree to certify that all information submitted to ConnectiCare is accurate, complete, truthful, and shall comply with applicable CMS standards. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. To verify benefits and eligibility - (phone) 800-828-3407, To inquire about an existing authorization -800-562-6833, To request a continuation of authorization for home health care or IV therapy (seeForms, to obtain a copy of the applicable form) - fax 860-409-2437. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. For non-portal inquiries, please call 1-800-950-7040 . 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. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. Information is protected as outlined in ConnectiCare's policies. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). There are different types of advance directives and different names for them. This includes information about our financial condition, and how our Plan compares to other health plans. Your right to be treated with dignity, respect and fairness If authorization is not obtained, payment for the service may be denied. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. All oral medication requests must go through members' pharmacy benefits. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. That goes for you, our providers, as much as it does for our members. Provide, to the extent possible, information providers need to render care. Nutritionist and social worker visit Please note that your benefits and out of pocket expenses may vary when using PHCS providers. Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. Welcome to the MultiPlan Provider PortalThe portal lets you view and update your network-related information, manage tasks such as credentialing and track your customer service case history. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. How do I know if I qualify for PHCS insurance? 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. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. (SeeOther Benefit Information). According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments. A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. We must investigate and try to resolve all complaints. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. How to manage the front desk when they ask who you are insured with? They should be informed of any health care needs that require follow-up, as well as self-care training. 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). These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (optional medical coverage) coverage and offer extra benefits too. What services are available to me that could save me money? ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. 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). This would also include chronic ventilator care. 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. Claims or Benefits questions will not be answered here. If you have any questions please review your formulary website or call Member Services. 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. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. 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. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Your right to get information about our plan and our network pharmacies The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. 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. Visit our other websites for Medicaid and Medicare Advantage. 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. Prior Authorizations are for professional and institutional services only. Covered according to Massachusetts state mandate. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. UHSM is always eager and ready to assist. Documents called "living will" and "power of attorney for health care" are examples of advance directives. SeeAutomated and Online Featuresfor additional information. For Medicaid managed 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. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. You may also search online at www.multiplan.com: If you are currently seeing a doctor or other healthcare professional who does not participate in the PHCS Network,you may use the Online Provider Referral System in the Patients section of www.multiplan.com, which allows you tonominate the provider in just minutes using an online form. Were here to help! For benefit-related questions, call Provider Services at 877-224-8230. 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. Go > This video explains it. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; 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. They are used to assess health care disparities, design intervention programs, and design and direct outreach materials, and they inform health care practitioners and providers about individuals needs. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. What to do if you think you have been treated unfairly or your rights are not being respected? All requests to initiate or extend a mental health or substance abuse authorization should be directed to our Behavioral Health Program at 800-349-5365. 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) It is important to sign this form and keep a copy at home. Visit Performance Health HealthworksWellness Portal. To get this information, call Member Services. Use your member subscriber ID to access the pricing tool using the link below. New users to the Provider Portal can create an account by selecting the Provider Access Link on the portal login page. 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. You have the right to make a complaint if you have concerns or problems related to your coverage or care. 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. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. High Deductible Health Plan (Health Savings Account [HSA] Compatible). part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. 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. Once submitted, ConnectiCare will verify the eligibility of the member with the Centers for Medicare & Medicaid Services (CMS) as they are the sole arbiter of eligibility for Medicare. You must pay for services that arent covered. Notifying providers when seeking care (unless it is an emergency) that you are enrolled in our plan and you must present your plan enrollment card to the provider. Click Here to go to the PHCS / Multiplan Provider Search. Note: These procedures are covered procedures, but do not require preauthorization in network. 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. Ask to see the member's ConnectiCare member identification (ID) card. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. The temporary card is a valid form of ConnectiCare member identification. (800) 557-5471. 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. You have the right to get information from us about our plan. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission.
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