Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. Provider Quick Reference Guide - MultiPlan 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. You can reference your plan document for the complete list. What does Transition of Care and Continuity of Care mean? Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. This includes the right to stop taking your medication. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. If you need help with communication, such as help from a language interpreter, please call Medicare Member Services. There are different types of advance directives and different names for them. Submit a Coverage Information Form. When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. Click Here to go to the PHCS / Multiplan Provider Search. 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. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. Pharmacy cost-share, if applicable. All oral medication requests must go through members' pharmacy benefits. Question 1. Call Automated Phone Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. I'm a Broker. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Refuse treatment and to receive information regarding the consequences of such action. PPM/10.16 Overview of Plans Overview of products A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. If you are admitted to the hospital, they will ask you whether you have signed an advance directive form and whether you have it with you. Answer 4. How do I contact PHCS? The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. SeeMedical Management. UHSM is always eager and ready to assist. 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. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. 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. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! If authorization is not obtained, payment for the service may be denied. 410 Capitol Avenue (SeeOther Benefit Information). Blue Cross Providers: 800 . These services are covered under the Option Plan nationwide. Were here to help! Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. Letting us know if you have any questions, concerns, problems, or suggestions. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. Use your member subscriber ID to access the pricing tool using the link below. Eligibility Claims Eligibility Fields marked with * are required. 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. precertification on certain services. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. Supporting evidence, which may be required includes: 1.) All participating providers agree to certify that all information submitted to ConnectiCare is accurate, complete, truthful, and shall comply with applicable CMS standards. This video explains it. Your right to use advance directives (such as a living will or a power of attorney) 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. You may also use the ConnectiCare Eligibility and Referral Line. Oops, there was an error sending your message. This would also include chronic ventilator care. I really appreciate the service I received from UHSM. 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). See preauthorization list for DME that requires pre-authorization. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. In these cases, you must request an initial decision called an organization determination or a coverage determination. Coverage follows Original Medicare guidelines. You are now leavinga ConnectiCare website. Please note: The benefit information provided is not a comprehensive list and is subject to change. 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. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. Note: Presentation of a member ID card is not a guarantee of a member's eligibility. ConnectiCare, in compliance with advance directives regulations, must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care. 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. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). Some preventive services are covered at 100% and are exempt from the deductible requirement. Once you have completed the Registration form you will be emailed a link to confirm your Registration. The sample ID cards are for demonstration only. Best of all, it's free- no downloads required or software to install. Please review the member's ID card to confirm the appropriate phone number. 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. Answer 5. Follow the rules of this Plan, and assume financial responsibility for not following the rules. 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. HPI | Provider Resources | Patient Benefits & Eligibility ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. This includes the right to know about the different Medication Management. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. ConnectiCare also makes available to members printable, temporary ID cards via our website. Question 5. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. 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 877-224-8230. Your plan does require 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. Keep scheduled appointments or give sufficient advance notice of cancellation. This information is not used in contracting or credentialing decisions or for any discriminatory purpose. Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. 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. We must investigate and try to resolve all complaints. PDF PHCS Network and Limited Benefit Plans - MultiPlan . ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. Provider Portal Eligibility inquiry Claims inquiry. If you have difficulty obtaining information from your plan based on language or a disability, call 1-800-MEDICARE (800-633-4227). PHCS www.multiplan.com (Please select the provider network listed on your ID card) ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. To find a participating provider outside of Oklahoma, follow the steps listed below. You and your administrative staff can quickly and easily access member eligibility and claims status information anytime, on demand. Get coverage information. Members are no longer eligible for coverage after their 40th birthday. Some plans may have deductible and coinsurance requirements. 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.
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