Q & AWho do I contact if I have billing questions?Please call the local PHPSM Sales Department for all billing questions at 517-782-7154. Where do groups mail the monthly premiums?The PHP remit address for group premiums is:
PHPSM Please remind groups to include the payment coupon to assure that the payment is credited to the correct account. Why are the benefit numbers on a group's renewal paperwork different than they were last year?As of 1/1/07, PHPSM started using different characters to represent our medical and prescription drug products. The benefits behind the numbers, however, did not change. Please visit PHPCares.com to view and print the new benefit summaries. Who do I contact for enrollment related issues?Please call our local PHPSM Customer Service Department at 517-787-6865 for all enrollment related issues. What is the new enrollment/change process?To submit a new enrollment or a change to PHPSM, fill out the new Enrollment/Change Application. This form can be found in the Employer page of PHPCares.com. Please make sure that the application is complete, including section H (For Employer Use Only). If you know your group's 4-digit class code, you may mail your form to:
PHPSM If a group has multiple plans, and does not know the class code for each plan, please fax the Enrollment/Change Application to 517-782-4512. Enrollments/changes will be processed within 3-5 business days. When do members receive new ID cards?ID cards are automatically generated in the following situations:
If a member receives a new ID card and has not had one of the above changes, please contact the PHPSM Customer Service Department at 517-787-6865. Who do I call if I have questions about prescription drug coverage?Please contact our PHPSM Customer Service Department for questions or problems with prescription drug coverage at 517-787-6865. If a member receives an EOB (Explanation of Benefits) and it states that coverage was denied by PHPSM, what should I do?Please contact the Customer Service Department immediately for verification of member eligibility. Sales Department Contact Information
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Pardon our Dust!
During 2006, Physicians Health Plan of South Michigan worked with our sister health plan Physicians Health Plan of Mid-Michigan to upgrade and expand our computer systems to provide new and better services to our clients and members. On January 1, 2007, we transferred our business to a new system.
As we moved administrative functions from one large, complicated computer system to a new one, we experienced problems with data transfer, information placement and unintended outputs. These problems resulted in some members having problems using their PHPSM cards and some employers receiving confusing invoices. Often these problems were indicators of problems in several areas of the system and required complicated repairs. In general, we are finding that the problems are more challenging than expected and are taking longer than expected to fix.
Currently, a team of experienced health plan Customer Service Representatives is working every day to audit processes and claims payments on the new computer system to make sure that things are running right. We anticipate that this effort and the "construction dust" will continue for another month or so.
In the meantime, PHPSM appreciates your patience and partnership as we work to clean things up and ultimately bring you new and better options built on a tradition of excellent, personal service. If you experience problems with ID cards, invoices, commissions, or claims payment, please contact us so that we can resolve the issue. Your feedback and inquiries help us to locate and resolve problems quicker.
Thanks for your patience and understanding as we upgrade and build a better health plan in Jackson.
Cheryl Stacey
Director of Sales
PHPSM
HealthWeb®
Again PHPSM ranks 39 out of the top 246 Commercial Health Plans.
America's Best Health Plans ranks health plans in every state in the nation based upon clinical performance, patient experience and satisfaction, as well as National Committee for Quality Assurance (NCQA) status. PHPSM's ranking as one of the nation's leading commercial managed care plans is based on our commitment to improving the health status of our members. We provide programs with proven success, and the products and services are customized to the health needs of our community. That's why we are among the best in the nation.
Global Care Replaces Options PPO
In the event a member is traveling outside his or her designated network service area, GlobalCare provides:
- Telephonic access to Registered Nurses
- Clinical assessments, if appropriate
- Referrals to a contracted "in-a-network" provider that participates with any one of GlobalCare's 118 local, regional and national PPO network partners
- Services priced at a network discounted rate.
Global Care is also assisting PHPSM in expanding our primary network offered to PHPSM members who reside outside our traditional service area. If a member lives out of the PHPSM service area and is in an Out-of-Area class:
- The member will be assigned a "primary network" where their HMO benefits will be applicable. The primary network is printed on the front of their ID card.
- The logos on the back of the card represent their "travel networks," which are just a few of the networks where members can obtain discounts on quality healthcare through a worldwide coordinated network of providers and facilities.
- If a member sees a provider within the networks on their Out-of-Area ID card, the service will be charged at the network discount rate.
- The PHPSM Plus product is required for coverage of out-of-area services for those members who reside outside the PHPSM service area.
- Emergency and Urgent services are covered out-of-area for all PHPSM members.
- PHPSM Plus members should check to see if their provider is part of the Global Care network they are assigned.
Policy Enforcement - Group Terminations
The PHPSM group contract states that a group can terminate their health plan policy with a 30-day prior written notice. It is important that clients notify the plan in a timely manner because we cannot guarantee a retro termination prior to the date of the termination notice and the employer group may be responsible for any applicable balance. If you have any questions about our Group Termination Policy, please contact your Account Service Representative at 517-782-7154.