In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. If there are any questions about the member's eligibility status or PCP/MH assignment, providers can use . Your right to get information about our network pharmacies and/or providers 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. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. ConnectiCare provides each member with a statement of member rights and responsibilities. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. See preauthorization list for DME that requires pre-authorization. Note: Some plans may vary. Nuclear cardiology To inquire about an existing authorization - (phone) 800-562-6833 In this section, we explain your Medicare rights and protections as a member of our plan and, we explain what you can do if you think you are being treated unfairly or your rights are not being respected. please refer to your health plan booklet or contact your Plan Administrator. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). Please review our formulary website or call Member Services for more information. Refuse treatment and to receive information regarding the consequences of such action. Contact PHCS 414.541.5500, 800.236.6623, [email protected] https://www.phcsonline.com/staffing/contact-phcs/ Category: HealthShow Health Phcs Insurance Phone Number TheWebster Miami Health (6 days ago)Simply call (888) 371-7427 Monday through Friday from 8 a.m. to 8 p.m. (Eastern Standard Time) and . ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Some plans may have deductible requirements. If authorization is not obtained, payment for the service may be denied. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). If you have any concerns about your health, please contact your health care provider's office. If you're a PHCS provider please send all claims to: PHCS P.O. Reminding the patient to notify ConnectiCare; and 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. New members may use a copy of their enrollment form. Simply call 800-455-9528 or 740-522-1593 and provide:. Referrals must be signed in ConnectiCares referral system viaProvider Connection. Mail Paper HCFAs or UBs: Medi-Share Pharmacy cost-share, if applicable. 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 have the right to get a summary of information about the appeals and grievances that members have filed against our plan in the past. Initial chiropractic assessment You may also use the ConnectiCare Eligibility and Referral Line. phcs provider phone number for eligibility. (SeeOther Benefit Information). Use our online Provider Portal or call 1-800-950-7040. 2. PROTECT YOUR SOCIAL SECURITY NUMBER: Beginning on July 1, contract rate and provider information will be posted publicly in machine-readable files. Member satisfaction with ConnectiCare is very important. Submit a Coverage Information Form. They should be informed of any health care needs that require follow-up, as well as self-care training. You have the right to know how your health information has been given out and used for non-routine purposes. You may want to give copies to close friends or family members as well. For non-portal inquiries, please call 1-800-950-7040 . You have the right to timely access to your prescriptions at any network pharmacy. ConnectiCare takes all complaints from members seriously. 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. 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). Medicare members who elect to become members of ConnectiCare must meet the following qualifications: Members must be eligible for Medicare Part A and be enrolled in and continue to pay for Medicare Part B. We conduct routine, focused surveys to monitor satisfaction using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and implement quality improvement activities when opportunities are identified. 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. How do I know if I qualify for PHCS insurance? a. drug, biological or venom sensitivity. For Commercial Health Plans: Email registrar@multiplan.com* Fax781-487-8273 Contact Us. Members must meet an in-network Plan deductible that applies to most covered health services, including prescription drug coverage, before coverage of those benefits apply. Most AvMed Members are required to seek covered services from AvMed's participating plan providers. ConnectiCare's service area includes all counties. Some plans may have a copayment requirement for radiology services. Your right to be treated with dignity, respect and fairness The member provides fraudulent information on the application or permits abuse of an enrollment card. The plan contract is terminated. These members may have a different copayment and/or benefit package. To find a participating provider outside of Oklahoma, follow the steps listed below. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). 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. The ConnectiCare Medicare Advantage network. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Claims, Payment Policies and Other Information. Note: These procedures are covered procedures, but do not require preauthorization in network. Changes to any demographic information for providers contracted through a group must be submitted to MultiPlan on the group's letterhead by the group administrator. 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. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. Pharmacy providers Apply to become a Commercial or Medicare pharmacy network provider by contacting Optum Provider Relations at Provider.Relations@optum.com or 877.633.4701. No prior authorization requirements. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. 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. 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. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. For emergency care received outside the U.S. there is a $100,000 limit. Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. abnormal arthrogram. 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. What to do if you think you have been treated unfairly or your rights are not being respected? Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. 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. 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. Colorectal screening (age restrictions apply) 1.888.847.7902 ; Medicare, 1.877. network hospital, the hospital will submit the claim form directly to PHCS . The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. 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. Click here to contact other Allied departments. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. We must tell you in writing why we will not pay for a drug, and how you can file an appeal to ask us to change this decision. If you are a returning user and already have a user id and password then click continue to log in. (800) 557-5471. Emergency care is covered. Some plans may have deductible and coinsurance requirements. ConnectiCare's policies must show evidence of respecting the implementation of their rights, including a clear and precise statement of limitation if ConnectiCare and its network of participating providers cannot implement an advance directive as a matter of conscience. Follow the rules of this Plan, and assume financial responsibility for not following the rules. 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). 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. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. Letting us know if you have any questions, concerns, problems, or suggestions. You can sometimes get advance directive forms from organizations that give people information about Medicare. Enter the information for your search, then click continue to access the search results. Since you have Medicare, you have certain rights to help protect you. Members pay a copayment as cost-share for most covered health services at the time services are rendered. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; The service area includes all counties in Connecticut. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. The PHCS Health Directions is an expanded, lowest cost network designed to provide medical care to members traveling outside of their coverage area. 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. For a specific listing of services and procedures that require preauthorization please refer to the preauthorization lists found within this manual. Your right to know your treatment options and participate in decisions about your health care 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. Nutritionist and social worker visit Other physicians and providers are available in our network. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. If you are calling to verify your patient's benefits*, please have a copy 866-323-2985. ConnectiCare also makes available to members printable, temporary ID cards via our website. A sample of the ConnectiCare ID cards appear below. CommunityCare is here for you. Please note: The benefit information provided is not a comprehensive list and is subject to change. Timely access means that you can get appointments and services within a reasonable amount of time. If you are a returning user and already have a user id and password then click continue to log in. Click Here to go to the PHCS / Multiplan Provider Search. 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. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. Think you have the right to timely access to your prescriptions at network! 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