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To begin the precertification process, your provider(s) should contact Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. Coverage for skilled nursing facility (SNF) admissions with preauthorization. UHSM Health Share and WeShare All rights reserved. PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO Its affordable, alternative health care. Eligibility Claims Eligibility Fields marked with * are required. 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. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. How do I know if I qualify for PHCS insurance? These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. UHSM is not insurance. Examples of covered medical conditions can be found below. Visit Performance Health HealthworksWellness Portal. PHCS Health Insurance - Health Insurance Providers 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. Answer 5. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. Provider Portal Info > MultiPlan Your right to use advance directives (such as a living will or a power of attorney) In these cases, you must request an initial decision called an organization determination or a coverage determination. Your providers must explain things in a way that you can understand. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. 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. Although not a provider of health insurance, PHCS is a provider of PPO (Preferred Provider Organization) networks. You have the right to be treated with dignity, respect, and fairness at all times. Pelvic exam Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. Pay applicable copayments, deductibles or coinsurance. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. 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. For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. To get any of this information, call Member Services. Supporting evidence, which may be required includes: 1.) All oral medication requests must go through members' pharmacy benefits. 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. 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. Admission to a SNF for rehabilitation, in the absence of a hospitalization or acute episode of illness, requires preauthorization and is subject to medical necessity review. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. All genetic testing requires preauthorization, with the exception of the following: Routine chromosomal analysis (e.g., peripheral blood, tissue culture, chorionic villous sampling, amniocentesis) - CPT 83890 - 83914, billed withModifier 8A or ICD-9 diagnosis codes V77.6 or V83.81, DNA testing for cystic fibrosis - CPT 88271 - 88275; 88291, billed withModifier 2A - 2Z or ICD-9 codes V10.6x or V10.7x, FISH (fluorescent in situ hybridization) for the diagnosis of lymphoma or leukemia - CPT 88230 - 88269; 88280 - 88289; 88291; 88299. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. Accessing PHCS Savility PHCS Savility is available to insurers and benefit plan administrators meeting certain benefit design