Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. The plan cannot and will not disenroll a member because of the amount or cost of services used. We also work with our clients to develop direct contracting, specialty networks, and cost plus models. This includes the right to stop taking your medication. Please note: This network is available only outside of Oklahoma. Pay applicable copayments, deductibles or coinsurance. Electronic submission through provider portal: rightcare. If you need help with communication, such as help from a language interpreter, please call Medicare Member Services. Your right to get information in other formats Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. 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. To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. Portal Training for Provider Groups 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. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. 860-509-8000, (TTY) 860-509-7191. 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. ConnectiCare takes all complaints from members seriously. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. To find a participating provider, Click Here to return to the CommunityCare Life & Health PPO page and select the appropriate provider directory network. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Note: The list of covered DME and disposable supplies is reviewed periodically and subject to change at the sole discretion of ConnectiCare. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. As always, confirm benefits by contacting Provider Services at 877-224-8230. Outside of our normal office hours, there is always a live person available to handle emergencies. You can sometimes get advance directive forms from organizations that give people information about Medicare. The plan contract is terminated. Any personal information that you give us when you enroll in this plan is protected. We also cover additional benefits beyond Original Medicare alone. A 3-day covered hospital stay is not required prior to being admitted. Acting in a way that supports the care given to other patients and helps the smooth running of your doctors office, hospitals, and other offices. PET scans A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Box 21155 Eagan, MN 55121. Browse the list to see where your plan is accepted. Your right to get information about your prescription drugs, Part C medical care or services, and costs 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. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Letting us know if you have any questions, concerns, problems, or suggestions. You may want to give copies to close friends or family members as well. 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. You have the right to an explanation from us about any bills you may get for services not covered by our plan. If you need more information, please call our Member Services. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. Please check the privacy statement of the website where this link takes you. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. Documents called "living will" and "power of attorney for health care" are examples of advance directives. ConnectiCare will communicate to your patients how they may select a new PCP. 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. For all of your RN, LPN, CNA, or CBRF staffing needs 414-541-5500. (800) 557-5471. Call our Provider Unit today at 877-625-0205. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. Actual copayment information and other benefit information will vary. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. You also have the right to ask us to make additions or corrections to your medical records (if you ask us to do this, we will review your request and figure out whether the changes are appropriate). Upon registration you will receive separate e-mails containing your user id password. View Benefit Information PROTECT YOUR SOCIAL SECURITY NUMBER: Beginning on July 1, contract rate and provider information will be posted publicly in machine-readable files. AvMed recommends that you confirm provider participation directly with the provider's office before obtaining care. You can also get free help and information from CHOICES - your SHIP. You have the right to timely access to your prescriptions at any network pharmacy. 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. membership eligibility is updated to reflect all members assigned to the practice. Medical Providers Nova Healthcare Administrators. If you have any concerns about your health, please contact your health care provider's office. Please contact PHCS at our Milwaukee office. Providers are also required to contact ConnectiCares Notification Line at 888-261-2273 to advise ConnectiCare of the transport. Note: These procedures are covered procedures, but do not require preauthorization in network. 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. 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. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. SeeAutomated and Online Featuresfor additional information. To inquire about an existing authorization - (phone) 800-562-6833 Subscriber SSN or Card ID*. No referrals needed for network specialists. Select Doctor or Facility search, then click continue. Glaucoma screening View Eligibility. CommunityCare is here for you. Letting us know if you have additional health insurance coverage. 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. For benefit-related questions, call Provider Services at 877-224-8230. 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. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. High Deductible Health Plan (Health Savings Account [HSA] Compatible). Members receive out-of-network level of benefits when they see non-participating providers. Services or supplies that are new or recently emerged uses of existing services and supplies, are not covered benefits, unless and until we determine to cover them. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. If you are unable to find what you're looking for, please call Client Services and we will be happy to get you the information you need. We must tell you in writing why we will not pay for or approve a prescription drug or Part C medical care or service, and how you can file an appeal to ask us to change this decision. Isolating due to Coronavirus? part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. You also have the right to get information from us about our plan. We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. 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. Regardless of where you get this form, keep in mind that it is a legal document. Please note: The benefit information provided is not a comprehensive list and is subject to change. All Practitioners:Please notify ConnectiCare in advance prior to taking any action to remove a specific member from your practice for any reason. Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. Refractions are not covered by ConnectiCare Medicare Advantage plans. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. A voluntary termination initiated by a practitioner should be communicated to ConnectiCare verbally or in writing, in accordance with the terms set forth in the contract, but no less than sixty (60) days before the effective date. 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). 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. ConnectiCare takes all complaints from members seriously. You have the right to make a complaint if you have concerns or problems related to your coverage or care. phcs provider phone number for eligibility. ConnectiCare offers both employer-sponsored plans and individual insurance plans. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; You may also call the Office for Civil Rights at 800-368-1019 or TTY:800-537-7697, or your local Office for Civil Rights. 1.888.847.7902 ; Medicare, 1.877. network hospital, the hospital will submit the claim form directly to PHCS . A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. 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. Medicare Advantage or Medicaid call 1-866-971-7427. This includes information about our financial condition, about our plan health care providers and their qualifications, about information on our network pharmacies, and how our plan compares to other health plans. Members must reside in the service area. After the deductible is met, benefits will be covered according to the Plan. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. 2. We must investigate and try to resolve all complaints. Customer . ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Your right to use advance directives (such as a living will or a power of attorney) Contact PHCS - Professional Health Care Services, Inc. Health Details: Looking for Health Care Staffing Nationally or in Metro Milwaukee?Contact PHCS 414.541.5500, 800.236.6623, [email protected] phcs for providers eligibility Verified 9 days ago Url: phcsonline.com Go Now Get more: Phcs for providers eligibility Show List Health Nuclear cardiology Members pay a copayment as cost-share for most covered health services at the time services are rendered. 866-323-2985. Reminding the patient to notify ConnectiCare; and Simply call 800-455-9528 or 740-522-1593 and provide:. ConnectiCare cannot reverse CMS' determination. ConnectiCare eligible members shall not be discriminated against with respect to the availability or provision of health services based on an enrollee's race, sex, age, religion, place of residence, HIV status, source of payment, ConnectiCare membership, color, sexual orientation, marital status, or any factor related to an enrollee's health status. 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