Any information provided on this Website is for informational purposes only. How do I contact PHCS? ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. Remember you will only need your registration code this one time to set up your account. 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. 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. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. Testing that exceeds this maximum is the members responsibility. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. If you want a paper copy of this information, you may contact Provider Services at 860-674-5850 or 800-828-3407. 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. Box 450978 Westlake, OH 44145. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. I called in with several medical bills to go over and their staff was extremely helpful. (214) 436 8882 The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Your providers must explain things in a way that you can understand. They will be clearly distinguishable by their ID cards. To pre-notify or to check member or service eligibility, use our provider portal. View sample member ID cards forcopayandhigh-deductibleplans for details. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. Some plans may have deductible requirements. If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. 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. Performance Health Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Giving your doctor and other providers the information they need to care for you, and following the treatment plans and instructions that you and your doctors agree upon. UHSM is always eager and ready to assist. 410 Capitol Avenue These members may have a different copayment and/or benefit package. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? 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. Pay applicable copayments, deductibles or coinsurance. Provider Portal - 90 Degree Benefits PDF PHCS Network and Limited Benefit Plans - MultiPlan If you do, please call Member Services. You have the right to be told about any risks involved in your care. Nutritionist and social worker visit These services are covered under the Option Plan nationwide. You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. 100 Garden City Plaza, Suite 110 Garden City, NY 11530. sales@ibatpa.com. We must investigate and try to resolve all complaints. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . CT scans (all diagnostic exams) Check with our Customer Service Team to find out if your plan accesses Health Coaching. ConnectiCare cannot reverse CMS' determination. The member loses entitlement to Medicare Parts A and/or B. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. Members have an in-network deductible for some covered services. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. Question 1. Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. Paying your co-payments/coinsurance for your covered services. Life Insurance *. Some plans may have deductible and coinsurance requirements. That goes for you, our providers, as much as it does for our members. Participate with practitioners in decision-making regarding your health care. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. abnormal arthrogram. Clinical Review Prior Authorization Request Form.