Answer 1. Covered according to Massachusetts state mandate. Refuse treatment and to receive information regarding the consequences of such action. Letting us know if you have any questions, concerns, problems, or suggestions. It is important to sign this form and keep a copy at home. Your Explanation of Payment (EOP) will specify member responsibility. SeeGlossaryfor definitions of emergency and urgent care. Colorectal screening (age restrictions apply) 2. Your right to know your treatment options and participate in decisions about your health care For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). 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. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. allergenic extracts (or RAST allergen specific testing); 2.) If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. PPM/10.16 Overview of Plans Overview of products Coverage for medical emergencies without preauthorization. Please review the member's ID card to confirm the appropriate phone number. Bone mass measurement Answer 3. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. Physicians may make referrals to participating specialists without entering them into the telephonic referral system. PCPs:Advise your patients to contact ConnectiCare's Member Services at 800-224-2273 to designate a new PCP, even if your practice is being assumed by another physician. 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. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. Submit a Coverage Information Form. Providers | Gmr Our goal is to be the best healthcare sharing program on the planet and to provide. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. ConnectiCare involuntary disenrollment For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. Devices can include but not be limited to diskettes, CDs, tapes, mobile applications, portable drives, desktops, laptops, secure portals, and hardware. ConnectiCare offers both employer-sponsored plans and individual insurance plans. Members with End Stage Renal Disease (ESRD) will not qualify, except if they are currently covered by a ConnectiCare benefit plan through an employer or self pay (a commercial member). Glaucoma screening 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. Testing that exceeds this maximum is the members responsibility. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. 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. Some plans may have deductible requirements. Below are the additional benefits covered by ConnectiCare. 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. 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. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. Question 3. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. MRI/MRA (all examinations) (SeeOther Benefit Information). Examples of qualifying medical conditions can be found below. 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. Click on the link and you will then have immediate access to the Member portal. abnormal arthrogram. Examples of covered medical conditions can be found below. Question 2. 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. I really appreciate the service I received from UHSM. Providers are also required to contact ConnectiCares Notification Line at 888-261-2273 to advise ConnectiCare of the transport. Renal dialysis services for members temporarily outside the service area. info@healthdepotassociation.com, Copyright © 2023 Health Depot Association, All Rights Reserved, Supplemental Accident and/or Critical Illness, Follow the prompts to enter your search criteria. Use our online Provider Portal or call 1-800-950-7040. drug, biological or venom sensitivity.