PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. Choose "Click here if you do not have an account" for self-registration options. Your right to get information about your prescription drugs, Part C medical care or services, and costs The plan cannot and will not disenroll a member because of the amount or cost of services used. Simplifying the benefits experience, so you can focus on patient care. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. 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. You also have the right to ask us to make additions or corrections to your medical records (if you ask us to do this, we will review your request and figure out whether the changes are appropriate). Actual copayment information and other benefit information will vary. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. PHCS PPO Network - WeShare Healthcare If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. Solutions. Remember you will only need your registration code this one time to set up your account. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. You have the right to make a complaint if you have concerns or problems related to your coverage or care. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. 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. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. Members pay a copayment as cost-share for most covered health services at the time services are rendered. 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. If you have any other kind of concern or problem related to your Medicare rights and protections described in this section, you can also get help from CHOICES. Limited to a maximum of $315 every two (2) calendar years for: 1.) Follow the rules of this Plan, and assume financial responsibility for not following the rules. Requests may be made by either the physician or the member. Make recommendations regarding our members rights and responsibilities policies. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. 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. We must investigate and try to resolve all complaints. Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. The member provides fraudulent information on the application or permits abuse of an enrollment card. Your responsibilities as a member of our plan. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. Once your account has been created you will only need your login and password. 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. (SeeOther Benefit Information). UHSM is excellent, friendly, and very competent. No out-of-network coverage unless pre-authorized in writing by ConnectiCare. 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. Members pay a copayment cost-share for most covered health services at the time the services are rendered. Examples of covered medical conditions can be found below. Member satisfaction with ConnectiCare is very important. 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. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. PDF PHCS Network and Limited Benefit Plans - MultiPlan 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. 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) Performance Health at Provider Portal - Claims & Eligibility The member engages in disruptive behavior. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. PHCS (Private Healthcare Systems, Inc.) - PPO. Pleasant and provided correct information in a timely manner. You may want to give copies to close friends or family members as well. Our plan must obey laws that protect you from discrimination or unfair treatment. ConnectiCare must provide written information to those individuals, including their rights under the law of the State to make decisions concerning their medical care, such as the right to accept or refuse medical or surgical treatment and the right to formulate advance directives. Your responsibilities include the following: Getting familiar with your coverage and the rules you must follow to get care as a member. They will be clearly distinguishable by their ID cards. To verify or determine patient eligibility, call 1-800-222-APWU (2798). Advance directives are written instructions, such as living will, durable power of attorney for health care, health care proxy, or do not resuscitate (DNR) request, recognized under state law and relating to the provision of health care when the individual is incapacitated and unable to communicate his/her desires. You are now leavinga ConnectiCare website. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. 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. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. 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. 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. Your Registration Code is the Alternate ID number on your ID card plus a suffix of 01 for the subscriber, 02, 03, 04, 05, etc for spouse and/or dependents. You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. Long Term Care Insurance. PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. Be treated with respect and recognition of your dignity and right to privacy. New members may use a copy of their enrollment form. Benefits - Penn Medicine Princeton Health your current benefits ID card upon arrival at your appointment. See preauthorization list for DME that requires pre-authorization. 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. Customer Service number: 877-585-8480. . PPM/10.16 Overview of Plans Overview of products Prostate cancer screening (age restrictions apply) Please review our formulary website or call Member Services for more information. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). All Practitioners:Please notify ConnectiCare in advance prior to taking any action to remove a specific member from your practice for any reason. The provider must agree to accept network rates for the defined period of time. It is important to sign this form and keep a copy at home. We have partnered with TALON to bring you access to MyMedicalShopper; which provides you the ability to shop for healthcare services based on price, quality, and location. Voice complaints or appeals/grievances about us or the care you are provided. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. For benefit-related questions, call Provider Services at 877-224-8230. This includes the right to leave a hospital or other medical facility, even if your doctor advises you not to leave. While other insurance companies and TPAs make you go through numerous frustrating prompts and then hold for an extensive period, our approach is to take the call as soon as possible so that you can move on with your day. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. 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. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. Your right to make complaints Member Services can also help if you need to file a complaint about access (such as wheel chair access). We request your cooperation in investigating and resolving these complaints. 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). How do I know if I qualify for PHCS insurance? What should I do if I get a bill from a healthcare provider? These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. 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. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! 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. Referrals must be signed in to ConnectiCaresProvider Connection. Member satisfaction information is updated and posted annually and is made available on our website atconnecticare.com. Eligibility and Benefits | ConnectiCare precertification on certain services. Members pay a copayment as cost-share for most covered health services at the time services are rendered. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! Browse the list to see where your plan is accepted. You also have the right to receive an explanation from us of any utilization management requirements, such as step therapy or prior authorization that may apply to your plan. Please call Member Services if you have any questions. The plan contract is terminated. What insurance carrier is PHCS? - InsuredAndMore.com 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 If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. After the deductible has been met, coinsurance will apply to the covered benefits. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. 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. You have the right to know how your health information has been given out and used for non-routine purposes. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. (800) 557-5471. Monitoring includes member satisfaction with physicians. Members > MultiPlan Enrollee satisfaction with ConnectiCare is very important. 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. 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. PHCS www.multiplan.com (Please select the provider network listed on your ID card) You and your administrative staff can quickly and easily access member eligibility and claims status information anytime, on demand. ConnectiCare involuntary disenrollment Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. Really good service. No referrals needed for network specialists. 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. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. Employer group enrollment will be the result of employers electing to offer benefits to retirees through ConnectiCare. 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. Performance Health Multiplan or PHCS | Mental Health Coverage | Zencare Zencare ConnectiCare offers both employer-sponsored plans and individual insurance plans. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. faq. 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. Documents called a "living will" and "power of attorney for health care" are examples of advance directives. Out of network benefits will apply when receiving care from non-participating providers. Product and plan details are outlined in the product and coverage section on this page. Members receive out-of-network level of benefits when they see non-participating providers. PET scans Nutritionist and social worker visit ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. 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. All oral medication requests must go through members' pharmacy benefits. Some plans may have deductible requirements. Testing that exceeds this maximum is the members responsibility. Eligibility and Referral Line A 3-day covered hospital stay is not required prior to being admitted. ConnectiCare will communicate to your patients how they may select a new PCP. 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. P.O. Customer Service at 800-337-4973 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. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407. Question 5. Screening pap test. This includes information about our financial condition, and how our Plan compares to other health plans. Box 340308 MultiPlan - Delivering affordability, efficiency and fairness to the US Life Insurance *. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. 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) PDF PHCS Network Bringing Greater Choice and Savings to the Employees 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. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. 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. To find a participating provider outside of Oklahoma, follow the steps listed below. Monitoring includes member satisfaction with physicians. Call us and tell us you would like a decision if the service or item will be covered. The provider must agree to accept network rates for the defined period of time. UHSM is not insurance. 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. 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.