Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. Your right to the privacy of your medical records and personal health information. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . 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. ConnectiCare reserves the right to terminate coverage for members who repeatedly fail to make the required copayments, coinsurance or deductibles, subject to the terms outlined in the applicableMember Agreement, Evidence of Coverage, or other governing contract. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. Requests may be made by either the physician or the member. Your rights include knowing about all of the treatment options that are recommended for your condition, no matter what they cost or whether they are covered by our plan. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. After the deductible has been met, coinsurance will apply to the covered benefits. If you do not inform ConnectiCare according to these guidelines, the SNF may not receive payment for any additional days of the member's stay. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. Regardless of where you get this form, keep in mind that it is a legal document. Choose "Click here if you do not have an account" for self-registration options. We believe there is no such thing as a standard cost management approach. There are different types of advance directives and different names for them. ConnectiCare will communicate to your patients how they may select a new PCP. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. PET scans 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. You have the right to refuse treatment. Examples of qualifying medical conditions can be found below. UHSM Health Share and WeShare All rights reserved. You can reference your plan document for the complete list. Provider Portal Eligibility inquiry Claims inquiry. In addition, information is protected by information systems security, and authentication and authorization procedures, such as but not limited to: password-protected files; storage, data disposal, and reuse of media and devices; and transmission and physical security requirements using company-protected equipment including access to devices and media that contain individual-level data. We must tell you in writing why we will not pay for or approve a service, and how you can file an appeal to ask us to change this decision. You may want to give copies to close friends or family members as well. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. ConnectiCare takes all complaints from members seriously. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. Optional Life Insurance *. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Portal Training for Provider Groups (More information appears later in this section.). 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. Visit our other websites for Medicaid and Medicare Advantage. It includes services and supplies furnished to a member who has a medical condition that is chronic or non-acute and which, at our discretion, either: Are furnished primarily to assist the patient in maintaining activities of daily living, whether or not the member is disabled, including, but not limited to, bathing, dressing, walking, eating, toileting and maintaining personal hygiene or. 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. Provider. Your right to know your treatment options and participate in decisions about your health care Nutritionist and social worker visit (SeeOther Benefit Information). MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. Reminding the patient to notify ConnectiCare; and From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. 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. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Keep scheduled appointments or give sufficient advance notice of cancellation. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). Your benefits, claims and/or eligibility are available 24/7 via our member portal. faq. (214) 436 8882 There are different types of advance directives and different names for them. UHSM is NOT an insurance company nor is the membership offered through an insurance company. abnormal MRI; and 2.) Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. Access to any Medicare-approved doctor or hospital in the United States. The following are samples of each type of ID card that ConnectiCare issues to members. ConnectiCare enrolls individual members into the ConnectiCare plan. Bone Mineral Density exams ordered more frequently than every twenty-three (23) months This line is available twenty-four (24) hours a day, seven days a week. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. 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. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. To pre-notify or to check member or service eligibility, use our provider portal. ConnectiCare will also notify members of the change thirty (30) days prior to the effective date of the change, or as soon as possible after we become aware of the change. Welcome to the MultiPlan Provider PortalThe portal lets you view and update your network-related information, manage tasks such as credentialing and track your customer service case history. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. Information is protected as outlined in ConnectiCare's policies. Note: Some plans may vary. 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. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! Popular Questions. Notifying providers when seeking care (unless it is an emergency) that you are enrolled in our plan and you must present your plan enrollment card to the provider. It is generally available between 7 a.m. and 9:30 p.m., Monday through Friday, and from 7 a.m. to 2 p.m. on Saturday. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. (800) 557-5471. I'm a Broker. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. ConnectiCare cannot reverse CMS' determination. You will now leave the AvMed web site once you click the "I agree" button. To get any of this information, call Member Services. The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. 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. Documents called "living will" and "power of attorney for health care" are examples of advance directives. You and your administrative staff can quickly and easily access member eligibility and claims status information anytime, on demand. Influenza and pneumococcal vaccinations We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. Initial chiropractic assessment Covered according to Massachusetts state mandate. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. 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. Additional term life coverage can be elected in increments of $10,000 to a maximum of $500,000 or 5 times your salary, whichever is less; paid for through payroll deductions. SeeAutomated and Online Featuresfor additional information. Answer 1. Referrals must be signed in ConnectiCares referral system viaProvider Connection. Members are required to see participating providers, except in emergencies. That goes for you, our providers, as much as it does for our members. Read the Membership Agreement, Evidence of Coverage, or other Plan document that describes the Plans benefits and rules. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. If you have any concerns about your health, please contact your health care provider's office. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. PPM/10.16 Overview of Plans Overview of products Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button Once your account has been created you will only need your login and password. We must investigate and try to resolve all complaints. You have the right to get information from us about our plan. Best of all, it's free- no downloads required or software to install. We also cover additional benefits beyond Original Medicare alone. If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement As always, confirm benefits by contacting Provider Services at 877-224-8230. The temporary card is a valid form of ConnectiCare member identification. Regardless of where you get this form, keep in mind that it is a legal document. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. 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. Our plan must have individuals and translation services available to answer questions from non-English speaking beneficiaries, and must provide information about our benefits that is accessible and appropriate for persons eligible for Medicare because of disability. You have the right to be treated with dignity, respect, and fairness at all times. Bone mass measurement See the preauthorization section for a listing of DME that requires preauthorization. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. Visit www.uhsm.com/preauth Download and print the PDF form Fax the preauth form to (888) 317-9602 GET PREAUTH FORM member-to-member health sharing How Healthshare Works with UHSM, it's Awesome! The sample ID cards are for demonstration only. allergenic extracts (or RAST allergen specific testing); 2.) 100 Garden City Plaza, Suite 110 Garden City, NY 11530. sales@ibatpa.com. 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. Voice complaints or appeals/grievances about us or the care you are provided. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. I really appreciate the service I received from UHSM. 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. You should consider having a lawyer help you prepare it. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. That goes for you, our providers, as much as it does for our members. The Evidence of Coverage (EOC) will instruct them to call their PCP. Visit Performance Health HealthworksWellness Portal. Christian Health Sharing State Specific Notices. With the PHCS Network in your cost management strategy, you give your health plan participants the choice of over 4,100 hospitals, 70,000 ancillary care facilities and 630,000 healthcare professionals nationwide, whether they seek care in their home town or across the country. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Your right to make complaints If you dont know the member's ID number, contact Provider Services during regular business hours to verify eligibility and benefits. Describe the range or medical conditions or procedures affected by the conscience objection; 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 sometimes get advance directive forms from organizations that give people information about Medicare. (SeeOther Benefit Information). You can sometimes get advance directive forms from organizations that give people information about Medicare. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. All routine laboratory services must be obtained from participating laboratories. Members receive out-of-network level of benefits when they see non-participating providers. plan. Click on the link and you will then have immediate access to the Member portal. A new web site will open up in a new window. Provide, to the extent possible, information providers need to render care. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. Members pay a copayment as cost-share for most covered health services at the time services are rendered. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. Glaucoma screening Although not a provider of health insurance, PHCS is a provider of PPO (Preferred Provider Organization) networks.
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