This would also include chronic ventilator care. Reminding the patient to notify ConnectiCare; and 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. Coverage for receipt of blood and for autologous blood transfusions for the following procedures, when the procedures are covered benefits: Custodial care is not a covered benefit. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. You may want to give copies to close friends or family members as well. For Medicaid managed Medicare members may disenroll from the plan when the guidelines, as set forth bythe Centers for Medicare & Medicaid Services (CMS), are met. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. To verify or determine patient eligibility, call 1-800-222-APWU (2798). 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. Nuclear cardiology Eligibility and Benefits | ConnectiCare Provider. 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. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. For non-portal inquiries, please call 1-800-950-7040. The ConnectiCare Medicare Advantage network. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. HPI | Provider Resources | Patient Benefits & Eligibility SeeGlossaryfor definitions of emergency and urgent care. Members receive out-of-network level of benefits when they see non-participating providers. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. Eligibility Claims Eligibility Fields marked with * are required. After the Plan deductible is met, benefits will be covered according to the Plan. The service area includes all counties in Connecticut. Question 1. Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. The plan cannot and will not disenroll a member because of the amount or cost of services used. Providers | Gmr To inquire about an existing authorization - (phone) 800-562-6833 Devices can include but not be limited to diskettes, CDs, tapes, mobile applications, portable drives, desktops, laptops, secure portals, and hardware. 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. 410 Capitol Avenue In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. Your plan does require 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). To pre-notify or to check member or service eligibility, use our provider portal. 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. Please Note: When searching for providers, the results presented are for reference only; as participating physicians, hospitals, and/or healthcare providers may have changed since the online directory was last updated. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Call us and tell us you would like a decision if the service or item will be covered. 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. (SeeOther Benefit Information). Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. Please review our formulary website or call Member Services for more information. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. United Faith Ministries, Inc. is a 501(c)(3) nonprofit corporation, dba Unite Health Share Ministries or UHSM Health Share, that facilitates member-to-member sharing of medical bills. Ask to see the member's ConnectiCare member identification (ID) card. Some preventive services are covered at 100% and are exempt from the deductible requirement. 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. 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. Your right to use advance directives (such as a living will or a power of attorney) You have the right to get information from us about our plan. It is important to note that not all of the Sutter Health network . Covered according to Massachusetts state mandate. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). Members are encouraged to actively participate in decision-making with regard to managing their health care. There are federal and state laws that protect the privacy of your medical records and personal health information. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Providers - INSURANCE BENEFIT ADMINISTRATORS You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. You must pay for services that arent covered. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. 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. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. To find a participating provider outside of Oklahoma, follow the steps listed below. Your right to get information about our plan and our network pharmacies 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. Provide, to the extent possible, information providers need to render care. No referrals needed for network specialists. 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. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Member satisfaction with ConnectiCare is very important. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. Broker benefits Get in touch. 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. You have the right to get information from us about our plan. allergenic extracts (or RAST allergen specific testing); 2.) Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. TTY users should call 877-486-2048. To get this information, call Member Services. UHSM is not insurance. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. I'm a Broker. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. Prospective members must properly complete and sign an enrollment application and submit it to ConnectiCare. 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. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. Covered at participating urgent care providers. In these cases, you must request an initial decision called an organization determination or a coverage determination.
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