For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. On a customer service rating I would give her 5 golden stars for the assistance I received. Stress echocardiograms 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. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. Member eligibility Medicaid managed care and Medicare Advantage plan effective dates Note: MultiPlan does not have access to payment records and does not make determinations with respect to ben-efits or eligibility. Your right to get information about your drug coverage and costs Your right to get information about our plan and our network pharmacies 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. Go > Monitoring includes member satisfaction with physicians. To get this information, call Member Services. 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. 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. your current benefits ID card upon arrival at your appointment. including benefit designs and Sutter provider participation in your provider network. Your right to make complaints Physicians may make referrals to participating specialists without entering them into the telephonic referral system. See preauthorization list for DME that requires pre-authorization. You also have the right to receive an explanation from us about any utilization-management requirements, such as step therapy or prior authorization, which may apply to your plan. That goes for you, our providers, as much as it does for our members. (More information appears later in this section.). The following information was provided by the Connecticut Office of Attorney General for the Department of Public Health and Addiction Services and the Department of Social Services. This information is not used in contracting or credentialing decisions or for any discriminatory purpose. ConnectiCare takes all complaints from members seriously. Best of all, it's free- no downloads required or software to install. allergenic extracts (or RAST allergen specific testing); 2.) Members are required to see participating providers, except in emergencies. Pelvic exam You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. UHSM Health Share and WeShare All rights reserved. Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. Eligibility and Referral Line Identify the state legal authority permitting such objection; Bone mass measurement ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Prostate cancer screening (age restrictions apply) Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. Simply call (888) 371-7427 Monday through Friday from 8 a.m.to 8 p.m. (Eastern Standard Time) and identify yourself as a health plan participant accessing PHCS Network for LimitedBenefit plans. Optional Life Insurance *. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. MultiPlan uses technology-enabled provider network, negotiation, claim pricing and payment accuracy services as building blocks for medical payors to customize the healthcare cost management programs that work best for them. All oral medication requests must go through members' pharmacy benefits. 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. Some plans may have deductible and coinsurance requirements. 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. PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. Documents called "living will" and "power of attorney for health care" are examples of advance directives. When performed out-of-network, these procedures do require preauthorization. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. Once you have completed the Registration form you will be emailed a link to confirm your Registration. 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. drug, biological or venom sensitivity. For emergency care received outside the U.S. there is a $100,000 limit. 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. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. What does Transition of Care and Continuity of Care mean? If you admit a member to a SNF on a weekend or holiday, ConnectiCare will automatically authorize payment for SNF services from the day of admission through the next business day. The admitting physician is responsible for pre-authorizing elective admissions five (5) working days in advance. 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. Covered at participating urgent care providers. View sample member ID cards forcopayandhigh-deductibleplans for details. The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. The sample ID cards are for demonstration only. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time TTY users should call 877-486-2048. We conduct routine, focused surveys to monitor satisfaction using the Consumer Assessment of Health Plan Satisfaction (CAHPS) survey and implement quality improvement activities when opportunities are identified. You have chosen PHCS (Private Healthcare Systems, Inc.). First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). Information is protected as outlined in ConnectiCare's policies. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. MultiPlan can help you find the provider of your choice. Question 4. You can sometimes get advance directive forms from organizations that give people information about Medicare. 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. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. SeeMedical Management. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. After the Plan deductible is met, benefits will be covered according to the Plan. Your right to get information about our network pharmacies and/or providers Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. Your right to get information about your prescription drugs, Part C medical care or services, and costs Members have an in-network deductible for some covered services before coverage for the benefits will apply. Your providers must explain things in a way that you can understand. 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. What services are available to me that could save me money? Some plans cover preventive dental services: Receive information about us, our services, our participating providers, and "Members Rights and Responsibilities.". part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. Remember, it is your choice whether you want to fill out an advance directive (including whether you want to sign one if you are in the hospital). Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). If you want a paper copy of this information, you may contact Provider Services at 860-674-5850 or 800-828-3407. 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. Requests may be made by either the physician or the member. Christian Health Sharing State Specific Notices. If you have questions or concerns about your rights and protections, please call Member Services. Timely access means that you can get appointments and services within a reasonable amount of time. The provider must agree to accept network rates for the defined period of time. You must apply for Continuity of Care within 30 days of your health care providers termination date (this is the date your provider is leaving the network) using the request form below. Question 1. All routine laboratory services must be obtained from participating laboratories. 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. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. No referrals needed for network specialists. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). Female members may directly access a women's health care specialist within the network for the following routine and preventive health care services provided as basic benefits: Annual mammography screening (age restrictions apply) No out-of-network coverage unless preauthorized in writing by ConnectiCare. Your Explanation of Payment (EOP) will specify member responsibility. This system requires that you have a touch-tone phone and know your ConnectiCare provider ID number, as well as the member's identification number, to verify eligibility. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. ConnectiCare will communicate to your patients how they may select a new PCP. Follow the plans and instructions for care that they have agreed on with practitioners. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive, take a copy with you to the hospital. Your right to use advance directives (such as a living will or a power of attorney) 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. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. There are federal and state laws that protect the privacy of your medical records and personal health information. These services are covered under the Option Plan nationwide. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. We request your cooperation in investigating and resolving these complaints. 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. We will make sure that unauthorized people dont see or change your records. Prior Authorizations are for professional and institutional services only. We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. 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. 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. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Premier Health Solutions, LLC operates as a Third-Party Administrator in the state of California under the name PHSI Administrators, LLC and does business under the name PremierHS, LLC in Kentucky, Ohio, Pennsylvania, South Carolina and Utah. Once your account has been created you will only need your login and password. 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. 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. Describe the range or medical conditions or procedures affected by the conscience objection; SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. 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. Life Insurance *. The provider must agree to accept network rates for the defined period of time. 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) You are now leavinga ConnectiCare website. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . P.O. ConnectiCare will disclose to the Centers of Medicare & Medicaid Services (CMS) all information that is necessary to evaluate and administer our Medicare Advantage plans, and to establish and facilitate a process for current and prospective members to exercise choice in obtaining Medicare services. However, the majority of PHCS plans offer members . 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. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. MedAvant Once submitted, ConnectiCare will verify the eligibility of the member with the Centers for Medicare & Medicaid Services (CMS) as they are the sole arbiter of eligibility for Medicare. Choose "Click here if you do not have an account" for self-registration options. 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 Your right to use advance directives (such as a living will or a power of attorney) ConnectiCare takes all complaints from members seriously. Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. Members receive in-network level of benefits when they see participating providers. Portal Training for Provider Groups ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. Network providers and practitioners are also contractually obligated to protect the confidentiality of members information. Refractions are not covered by ConnectiCare Medicare Advantage plans. You should consider having a lawyer help you prepare it. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. TTY users should call 877-486-2048. Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. Some preventive services are covered at 100% and are exempt from the deductible requirement. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. Colorectal screening (age restrictions apply) Prior Authorizations are for professional and institutional services only. 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. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. What can you doif you think you have been treated unfairly or your rights arent being respected? For more information regarding complaint resolution, contact Provider Services at 877-224-8230. If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. 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 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. Since you have Medicare, you have certain rights to help protect you. PHCS is the leading PPO provider network and the largest in the nation. The following are samples of each type of ID card that ConnectiCare issues to members. Members are encouraged to actively participate in decision-making with regard to managing their health care. Pharmacy cost-share, if applicable. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. 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.
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