This feature is meant to assist members who need additional copies of their ID card. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. Our plan must obey laws that protect you from discrimination or unfair treatment. PDF PHCS Network and Limited Benefit Plans - MultiPlan Member race, language, ethnicity, gender orientation, and sexual identity cannot be used to perform underwriting, rate setting, and benefit determinations (specifically denial of coverage and benefits), and cannot be disclosed to unauthorized users. Incorrect Email or Password - MultiPlan 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. Please check the privacy statement of the website where this link takes you. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. Provider. Transition of Care allows new members and/or members whose plan has experienced a recent provider network change to continue to receive services for specified medical and behavioral conditions, with health care professionals that are not participating in the plans designated provider network, until the safe transfer of care to a participating provider and/or facility can be arranged. PDF PHCS Network and Limited Benefit Plans - MultiPlan If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. You have the right to be treated with dignity, respect, and fairness at all times. See preauthorization list for DME that requires pre-authorization. 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 Treatment Programs we offer and in which you may participate. You have the right to get information from us about our plan. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. All Practitioners:Please notify ConnectiCare in advance prior to taking any action to remove a specific member from your practice for any reason. If you need more information, please call Member Services. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. How do I contact PHCS? Your right to know your treatment options and participate in decisions about your health care Provider - SisCo In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Covered at participating urgent care providers. Monitoring includes member satisfaction with physicians. If you have questions or concerns about your rights and protections, please call Member Services. Screening pap test. 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. When performed out-of-network, these procedures do require preauthorization. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Visit our other websites for Medicaid and Medicare Advantage. TTY users should call 877-486-2048. Balance Bill defense is available for all members with a Reference Based Pricing Plan. Question 3. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. PCP name and telephone number The bill of service for these members must be submitted to Medicaid for reimbursement. However, the majority of PHCS plans offer members . It is important to note that not all of the Sutter Health network . Members receive in-network level of benefits when they see participating providers. PDF PHCS Network Bringing Greater Choice and Savings to the Employees What services are available to me that could save me money? These services are covered under the Option Plan nationwide. All oral medication requests must go through members' pharmacy benefits. These members may have a different copayment and/or benefit package. A 3-day covered hospital stay is not required prior to being admitted. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. Were here to help! We protect your personal health information under these laws. We may enroll employer group members as well. PHCS www.multiplan.com (Please select the provider network listed on your ID card) Members are required to see participating providers, except in emergencies. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. We also cover additional benefits beyond Original Medicare alone. PHCS (Private Healthcare Systems, Inc.) - Sutter Health You have the right to ask someone such as a family member or friend to help you with decisions about your health care. PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Letting us know if you have additional health insurance coverage. Go to the Client Portal > Provider directories Create a customized listing of facilities and/or practitioners participating in the network services offered by MultiPlan. ConnectiCare involuntary disenrollment Benefit Type* Subscriber SSN or Card ID* Patient First Name Patient Gender* Male Female Patient Date of Birth* Provider TIN or SSN*(used in billing) 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. Performance Health Please review the member's ID card to confirm the appropriate phone number. This would also include chronic ventilator care. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. If you dont know the member's ID number, contact Provider Services during regular business hours to verify eligibility and benefits. 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. For non-portal inquiries, please call 1-800-950-7040 . You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. What to do if you think you have been treated unfairly or your rights are not being respected? 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. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who isnt providing your care or paying for your care. Prospective members must properly complete and sign an enrollment application and submit it to ConnectiCare. precertification on certain services. Requests may be made by either the physician or the member. High Deductible Health Plan (Health Savings Account [HSA] Compatible). After the Plan deductible is met, benefits will be covered according to the Plan. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. Documents called "living will" and "power of attorney for health care" are examples of advance directives. 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. 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.