dean health plan request to add a practitioner

Dean Health Plan | Pay Your Bill Online | doxo.com Ask questions if you have doubts or concerns. LLC, Internet The following types of physicians can be a primary care physician for you: Family Practice doctors treat people of all ages. 0000006903 00000 n Dean Health Plan identifies quality of care issues through member complaints, inpatient - The National Patient Safety Foundation has information on how to ensure safer health care for you and your family. Provider Directory Go to Dean's Resources for State of Wisconsin members page to access a provider directory. Then click Edit. There may be an error. May involve Dean Health Plan, Inc. - PDF Free Download - DocPlayer Complex case management and care coordination Edit dean health plan practitioner. startxref services, For Small assunnahtrust. PDF Dean Health Plan Provider News Spring 2020 - deancare.com Practitioner Manual Dean Health Plan Practitioner Manual Table of Contents Health Plan Overview . Edit your dean health plan practitioner form online. Replace text, adding objects, rearranging pages, and more. com. working schedule and take back control over your free time. For a list of participating health care professionals, Even if your health benefits or insurance plan covers your first exam, you can get another one later at a discounted price from a provider participating in the discount program. You have been successfully registered in pdfFiller. Prepared Exclusively for The McClatchy Company. When a more immediate need arises, you do have other options. This amount is applied to the Dean Health Plan contracted fee or Maximum Allowable Fee. You may transmit a PDF by email, text message, fax, USPS mail, or online notarization directly from your account. Last First. Examples of Procedures/Services Requiring Prior Authorization All Non-Plan Provider services Radiology services (in-network and out-of-network) - CT scan - Nuclear exercise tolerance test (ETT) - MRI/MRA - PET scan Cardiac rehabilitation - Phase II greater than 18 visits Pulmonary rehabilitation greater than16 visits Non-emergent ambulance transport and elective air ambulance transport Home health care Durable medical equipment (DME) greater than $250 Therapies (physical therapy, occupational therapy, speech therapy) Potentially cosmetic procedures (e.g., varicose vein treatments, breast reduction/ augmentation, blepharoplasties) New technologies not commonly accepted as standard of care Hospice Transplants (except cornea) Elective inpatient surgical procedures All hospital admissions, includes observation and inpatient stays Select diagnostic testing (e.g. Online Only. For changes in benefits, see page 9. However, if you are in the hospital when your enrollment in our Plan begins, call our Customer Care Center immediately at If you are new to the FEHB Program, we will arrange for you to receive care and provide benefits for your covered services while you are in the hospital beginning on the effective date of your coverage. For example, if you go 19 months without Medicare Part D prescription drug coverage, your premium will always be at least 19 percent higher than what many other people pay. Virtual care is available to members through age 75. While death is the most tragic outcome, medical mistakes cause other problems such as permanent disabilities, extended hospital stays, longer recoveries, and even additional treatments. You do not have a right to benefits that were available before January 1, 2012, unless those benefits are also shown in this brochure. Make sure your medicine is what the doctor ordered. Aetna Choice POS II Health Fund Plan. Please check your spelling or try another term. You may check the status of your request atMyPrevea.com. The Medical Peer Review Committee will review the quality of care issues referred by the DHP Medical You must, Blue Care Network www.bcbsm.com Customer Service: 1-800-662-6667 2015 A Health Maintenance Organization () This plan s health coverage qualifies as minimum essential coverage and meets the minimum value, MVP Health Care www.mvphealthcare.com 2015 A Health Maintenance Organization This plan s health coverage qualifies as minimum essential coverage and meets the minimum value standard for the benefits it, The Federal Employees Health Benefits Program and Medicare This booklet answers questions about how the Federal Employees Health Benefits (FEHB) Program and Medicare work together to provide health benefits, Health Insurance Plan (HIP/HMO) http://www.emblemhealth.com Customer Service 1-800-HIP-TALK (1-800-447-8255) 2015 A Health Maintenance Organization () This plan's health coverage qualifies as minimum essential, Humana Benefit Plan of Illinois, Inc. http://feds.humana.com Customer service 1-800-4HUMANA 2014 A Health Maintenance Organization (High and Standard Option) This plan's health coverage qualifies as minimum, Kaiser Foundation Health Plan, Inc. http://kp.org/feds 1-800-464-4000 (TTY 1-800-777-1370) 2014 A Health Maintenance Organization (High, Standard and Basic Options) This plan s health coverage qualifies, Kaiser Foundation Health Plan of the http://kp.org/feds Member Services Department 1-877-KP4-FEDS (1-877-574-3337) (TTY: 301-879-6380) 2015 A Health Maintenance Organization (High and Standard Options), Humana Health Plan, Inc. http://feds.humana.com Customer Service 1-800-4HUMANA 2015 A Health Maintenance Organization (High and Standard Option) This plan's health coverage qualifies as minimum essential, Group Health Cooperative www.ghc.org/fehb Customer Service 1-888-901-4636 A Health Maintenance Organization (high and standard option) 2015 This plan's health coverage qualifies as minimum essential coverage, Aetna Whole HealthSM http://www.aetnafeds.com Customer service 1-888/238-6240 2014 An Accountable Care Collaboration This plan's health coverage qualifies as minimum essential coverage and meets the minimum, Aetna HealthFund HDHP and Aetna Direct Plan http://www.aetnafeds.com Customer service 1-888/238-6240 2015 An individual practice plan with a high deductible health plan option and an individual practice, KPS Health Plans www.kpsfederal.com Customer Service 1-800-552-7114 2015 A Prepaid Comprehensive Medical Plan (high and standard option) with a Point of Service product, and a high deductible health plan, Blue Cross and Blue Shield of Illinois www.bcbsil.com Customer Service: 1-855-676-4482 2015 A Health Maintenance Organization This plan's health coverage qualifies as minimum essential coverage and meets, Health Net of California www.healthnet.com/fehb Customer service 1-800-522-0088 2015 A Health Maintenance Organization (high and standard option) This plan s health coverage qualifies as minimum essential. We are not affiliated with any brand or entity on this form. Contactthe Customer Care Centerat1-877-230-7555, if possible, when you receive emergency, care. Durable Medical Equipment (DME) - The Plan will decrease the DME co-insurance from 25% to 20% co-insurance up to a $2,000 annual out-of-pocket maximum Dean Health Plan, Inc. 9 Section 2, 12 Section 3. Rates are shown at the end of this brochure. Level 4 Peer Review Review Required - Serious substandard care with permanent patient If your plan terminates participation in the FEHB Program in whole or in part, or if OPM orders an enrollment change, this continuation of coverage provision does not apply. 0000006117 00000 n We encourage you to learn more about what Dean Health Plan has to offer by visiting our website and reading about the following: National Committee for Quality Assurance (NCQA) Accreditation. You or your provider must send the information so that we receive it within 60 days of our request. Example: In this Plan, you pay 50% of actual charges for diagnosis and treatment of infertility services and 20% for durable medical equipment up to an annual out-of-pocket maximum of $2,000. Your primary care physician will provide most of your health care, or give you a referral to see a specialist. Facts about this HMO Plan This Plan is a health maintenance organization (HMO). We cannot guarantee that any one physician, hospital, or other provider will be available and/or remain under contract with us. A Health Maintenance Organization (High Option) www.mibcn.com. Prepared Exclusively for Vanderbilt University. Your primary care physician will create your treatment plan. Upload a file. Forms must be submitted prior to any services being rendered. PDF Dean Medical Center Dean Health Plan - Intermountain Healthcare 0000007328 00000 n Please note that if you are currently using Dean Clinic - Riverview or Dean Clinic - Northview in Janesville, your physician and care will move over to the new Dean Clinic - Janesville after it opens in January. /. Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective 7/1/2015, Independent Health s Medicare Passport Advantage (PPO), Compass Rose Health Plan: High Option Coverage Period: 01/01/2015 12/31/2015, January 1, 2015 December 31, 2015 Summary of Benefits. follow the process outlined in the policies listed below: CR 3016: Altering Participation Status, CR 3017: Practitioner Appeal Process for Decisions Resulting in Reduction, Suspension or -. Box Madison, WI This brochure is the official statement of benefits. Dean Health Plan - Prevea360 West and Mayo Clinic Health System It also includes important phone numbers, website URLs, and references to provider resources and how to access them. 0000009067 00000 n You ll have to pay this higher premium as long as you have Medicare prescription drug coverage. The purpose of the Medical Peer Review Committee is to function as an editingdocuments and forms in the cloud. Internal Medicine doctors treat adult men and women. In these cases, follow-up care requires written, approved Prior Authorization by Dean s Medical Affairs Division prior to services being rendered by a Non-Plan Provider, including a non-plan facility Dean Health Plan, Inc. 12 Section 3, 15 How to request precertification for an admission or get prior authorization for other services Non-urgent care claims First, your physician, your hospital, you, or your representative, must call us at before admission or services requiring prior authorization are rendered. Dental benefits52 Accidental injury benefit52 Section 5(h). If your dependents live out of the area (for example, if your child goes to college in another state), you should consider enrolling in a fee-for-service plan or an HMO that has agreements with affiliates in other areas. Dean Health Plan (DHP) was founded in 1983 as provider-sponsored plan . . Be sure you understand the instructions you get about follow-up care when you leave the hospital. Ask when and how you will get the results of tests or procedures. Name of Applicant Name OT Applicant. Other Federal Programs74 The Federal Flexible Spending Account Program FSAFEDS73 The Federal Employees Dental and Vision Insurance Programs FEDVIP74 The Federal Long Term Care Insurance Program FLTCIP74 Index80 Summary of benefits for the High Option Benefits of Dean Health Plan Rate Information for Dean Health Plan Dean Health Plan, Inc. 2 Table of Contents, 5 Introduction This brochure describes the benefits of Dean Health Plan, Inc. under our contract (CS 1966) with the United States Office of Personnel Management, as authorized by the Federal Employees Health Benefits law. You must show it whenever you receive services from a Plan provider, or fill a prescription at a Plan pharmacy. Kaiser Foundation Health Plan, Inc. http://kp.org/feds 2012 A Health Maintenance Organization (High and Standard Options) Serving: Northern California service area For changes in benefits, see page 10. To request a printed directory to mailed to you, call 877-230-7555. I get an error message. Your medical and claims records are confidential We will keep your medical and claims records confidential. 0000007480 00000 n Tribute Health Plan of Oklahoma HMO SNP, Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare, SUMMARY OF BENEFITS. Your member portal provides secure access to information about your health insurance benefits, access to make premium payments, view claims information and more. For more information about the study, go to deancare.com/about-dean/news. Quality Commitment. May 10, 2023 The May Insights highlights the 10 year anniversary of the NPDB-HIPDB merger. When you receive a referral from your primary care physician, you must return to the primary care physician after the consultation. 0000008396 00000 n Quality Improvement will determine if the individual(s) involved was a DHP member at the time of Then select the Documents tab to combine, divide, lock or unlock the file. 0000007930 00000 n Our customer care specialists are ready to answer your questions and address any concerns you may have about your plan benefits, such as: How to select a primary care practitioner (PCP) The details of your health care coverage Your financial responsibilities as a DHP member 2012 Dean Health Plan, Inc. 18 High Option, 21 High Option Prior authorizations and referrals Coordination of benefits Cost transparency Customer care specialists can be reached by calling between 7:30 a.m. and 5 p.m. Monday through Thursday or on Fridays between 8 a.m. and 4:30 p.m. You can also submit a question online at deancare.com/contact-us. Health Net of California www.healthnet.com/fehb 2012 A Health Maintenance Organization Serving: Northern and Southern California Service Areas Enrollment in this plan is limited. Request for Prior Authorization- J. Where you get covered care Plan providers You get care from Plan providers and Plan facilities. All benefits are subject to the definitions, limitations, and exclusions set forth in the FEHB, 2015 Summary of Benefits Value (HMO-POS) Essentials Rx (HMO-POS) (H4270) January 1, 2015 - December 31, 2015 Western Wisconsin (26 Counties) H4270_082914_1 CMS Accepted (09032014) SECTION I INTRODUCTION, January, 205 December 3, 205 Summary of Benefits H8649-003 80.06.36.-UTWY A Y0022_205_H8649_003_UT_WYa Accepted /204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of, To make this website work, we log user data and share it with processors. Physical, Occupational, Speech Therapy office visit - The Plan will eliminate member responsibility of a 20% coinsurance and add a $10 copay for each therapy visit. http://www.mvphealthcare.com, Blue Cross and Blue Shield Service Benefit Plan www.fepblue.org, SMALL GROUP PLAN DESIGN AND BENEFITS OPEN CHOICE OUT-OF-STATE PPO PLAN - $1,000, PLAN DESIGN AND BENEFITS POS Open Access Plan 1944, California Small Group MC Aetna Life Insurance Company, BENEFIT PLAN. Patient Safety. Also, read Section 9 about coordinating benefits with other coverage, including with Medicare. Provide recommendations to medical management, as needed, about individual practitioner The pdfFiller Gmail add-on lets you create, modify, fill out, and sign dean health plan practitioner and other documents directly in your email. Member Satisfaction Survey Results. Prior authorization is required for certain services, procedures and forout-of-networkproviders before you receive care. Thats why The Office of Personnel Management (OPM) has determined that Dean Health Plan's prescription drug coverage is, on average, expected to pay out as much as the standard Medicare prescription drug coverage will pay for all plan participants and is considered Creditable Coverage. This Dean Health Plan Provider Portal User Guide details how to use the self-service . Medical Peer Review Committee will determine the appropriate level of severity and disposition of the A copy of the request, including the determination, will be mailed to the member and the requesting practitioner. Dean Health Plan Prevea360 West and Mayo Clinic Health System, to access a provider directory. You can get care from the comfort of your own home. Get the free Dean Health Plan Practitioner Manual - pdfFiller a w www. peers and the QA and complaint processes of HMOs, hospitals, and other medical facilities. Customer Service 1-800-552-7114. Save the ready-produced papers to your gadget or print it like a hard copy. Annual Notice of Changes for 2015 You are currently enrolled as a member of Piedmont WellStar Medicare Choice HMO. For members with mental health and substance use disorders, Prevea360 Health Plan'sbehavioral health and substance use case management provides an individualized approach. Customer Service Focus In addition to our excellent telephonic Customer Care Center and comprehensive website, we now have an on-site Customer Care Specialist at two Dean Clinic sites in Madison (one at Dean Clinic - East and one at Dean Clinic - West) to answer questions about your health care benefits. Get access to thousands of forms. Member cost sharing for certain services, GHI Health Plan http://www.emblemhealth.com 2015 A Prepaid Comprehensive Medical Plan. trailer These Plan providers accept a negotiated payment from us, and you will only be responsible for your copayments or co-insurance. High Option Benefits Overview This Plan offers a High Option. Joining your new health plan doesn't have to be hard. Ask about any risks or side effects of the medication and what to avoid while taking it. 0000002106 00000 n Select "Online" or "Printable Provider Directory" under "Providers and Information." To request a printed directory be mailed to you, call 800-279-1301. 63 0 obj<>stream Level 5 Peer Review Review Required - Fatal substandard care with death directly related to To use this website, you must agree to our, Lovelace Health Plan Administered by Blue Cross and Blue Shield of New Mexico, Kaiser Foundation Health Plan, Inc. Northern California Region: Fresno, Kaiser Foundation Health Plan, Inc. Southern California Region, Kaiser Foundation Health Plan, Inc. Northern California Region, Capital Health Plan. Dean Health Plan offers a curent and complete listing of physicians, clinics, pharmacies and more at deancare.com. 0000001301 00000 n Begin by clicking Start Free Trial and create a profile if you are a new user. / - /. Dean Health Plan annually measures member satisfaction scores using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) study methodology. It depends on the type of care you need. Dealing with documents is always simple with pdfFiller. Tell them about any drug allergies you have. treatment or intervention. pdfFiller makes dealing with documents a breeze. Quality Improvement will document a summary of the investigation and a DHP Medical Director and/or You must live or work in our geographic service area to enroll. Members should contact the Customer Care Center at to verify whether a procedure/service requires a Prior Authorization. hospitalization or invasive corrective therapy. / - / /. This Plan does not have a deductible. Member Health Insurance Plan Study SM. How it works: You must submit the attached transition-of-care form no later than 14 days after your plan's effective date. DHP categorizes quality of care issues as follows: Select Add New on your Dashboard and upload a file from your device or import it from the cloud, online, or internal mail. involve loss of limb or permanently impaired bodily function. OPM s Office of the Inspector General investigates all allegations of fraud, waste and abuse in the FEHB Program regardless of the agency that employs you or from which you retired. its important to keep your paperwork organized while being aware of the tax rules and deadlines imposed by the IRS. It does not constitute a binding obligation of Dean Health Plan with respect to any matter herein. If he or she decides to refer you to a specialist, ask if you can see your current specialist. That s about 3,230 preventable deaths in the FEHB Program a year. Service, Contact Make sure that you review the benefits that are available. What Your Plan Covers and How Benefits are Paid. Form 225, Form 363, Form 510 (Form 224 unavailable in PDF) Check the Status of My Application. documents online faster. The High Option Section 5 is divided into subsections. 2. You pay only the copayments and co-insurance described in this brochure. 0000006751 00000 n billing address and practice location addresses), Practitioner information (e.g. A prior authorization is required for the following mental health and substance use services: For members with mental health and substance use disorders, Prevea360 Health Plan'sbehavioral health and substance use case management provides an individualized approach. Read the label and patient package insert when you get your medicine, including all warnings and instructions. Visit. - -. For non-urgent care claims, we will then tell the physician and/or hospital the number of approved inpatient days, or the care that we approve for other services that must have prior authorization. Guarantees that a business meets BBB accreditation standards and effective utilization of services. USLegal received the following as compared to 9 other form sites. in the US and Canada. Maternal/child health Subject to a request for additional information, we will notify you of our decision within 72 hours after receipt of your reconsideration request. Practitioner explanation was easy to understand. How to complete a dean health plan practitioner, Take a few steps to edit, fill out, sign, and share your dean health plan practitioner, Fill form Health Care Provider Resources - Dean Health Plan TTY users can call 1-877-486-2048. Dean Health Plan, Inc. has been is business since 1983 Dean Health Plan, Inc. is a for-profit HMO If you want more information about us, call , or write to Dean Health Plan, Attention Customer Care Center, P.O. Select the name of your file in the docs list and choose your preferred exporting method. If you or someone you know is struggling, you are not alone. A Customer Care Specialist is available at the clinics Monday through Thursday from 7:30 a.m. to 5 p.m. and Friday from 8 a.m. to 4:30 p.m. We are excited about the new in-clinic customer care sites and plan to expand into more clinics throughout And, as always, a Customer Care Specialist is available during the same hours by phone at (800) You can also send a secure message to the Customer Care Center any time of day via deancare.com/contact-us. / - / / / /. The Plan is solely responsible for the selection of these providers in your area. Please read the FEHB Plan RI 72-007 that contains the complete terms of this plan. Dean Health Plan identifies and investigates all instances of concern for the quality of care provided to Practitioner knew important issues in patient's medical history. Complex case management and care coordination, Medicare Advantage plans new member guide. standards. Home Employers Applications and forms Applications and forms All you need to apply for Prevea360 health insurance Small group options Employers with 2 to 50 employees Online quote Online quoting available exclusively for small businesses (2-50 employees). - / - /. Dean Health Plan - Products, Competitors, Financials, Employees Union Health Service www.unionhealth.org 2012 A Health Maintenance Organization Serving: Chicago Area Enrollment in this plan is limited: You must live or work in our Geographic service area to enroll. Find out more Forms You can find an in-network provider through theFind a Doctorpage. - "About how long will it take?" I also acknowledge that Dean . See back cover. Service area. What is the Dean Health Plan Formulary? Our benefit package is described in Section 5. Email, fax, or share your dean health plan practitioner form via URL. You have been successfully registered in pdfFiller, Complete the dean health plan practitioner for free, Fill out, edit & sign PDFs on your mobile, Restore Sign in the Assurance Agreement with ease, Restore Sign in the Bankruptcy Agreement with ease, Restore Sign in the Commercialization Agreement with ease. You will get a diagnosis, treatment plan and any needed prescriptions. Original Medicare, Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay.
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