Provider Support
Help for questions from preferred providers
Health Sharing with UHSM: A Different Approach to Healthcare
UHSM is one of the fastest-growing health sharing organizations in the country, bringing together individuals and families who are committed to their health and to one another. As a UHSM partner, your practice accesses an engaged, value-driven patient community focused on preventive care. UHSM facilitates payments for eligible services provided to participating members.
Optum ConnectCenter
We partner with Optum to offer real-time eligibility verification through ConnectCenter (our provider portal) or via your native eligibility verification system.
- For providers who prefer to use Optum’s ConnectCenter, visit ConnectCenter Client Setup to register (there’s no cost). The needed UHSM Vendor Code 396668 will automatically populate on the registration form to get you started. ConnectCenter registered providers can access ConnectCenter
- Providers who prefer to use their own software vendor or another clearinghouse to review UHSM Member information will need to consult their vendor or clearinghouse to request Claims and Real Time Eligibility for payer ID WESHR and UHSM1 to be setup. If needed, the vendor/clearinghouse can contact the Optum sales team by clicking the “Contact Sales” button at the top of the Business Customer Support |
Optum Business webpage.
Contact Us
Phone
Fax
Main Office
Dominion Tower
999 Waterside, Suite 2600
Norfolk, VA 23510
Hours of Operation
Monday – Friday:
10:00am – 8:30pm ET
PHCS PPO Network & Billing
UHSM members carry an ID card that references the PHCS PPO Network, the largest provider network in the United States with 1M+ doctors, specialists and ancillary providers. If your practice participates in PHCS, UHSM members are easily integrated into your practice—no new contract, new credentialing, or changes to your existing workflow. Here’s how their seamless claims process works:
- Simply use the EDI system to submit bills with no changes to your billing workflow.
- After submission, bills are routed through the PHCS network to UHSM for processing.
- Providers receiving payment by paper check will find the EOS attached to their check. Providers enrolled in ePayment will receive the EOS by mail following payment.
If you need to refer a member to a specialist, they receive discounted, contracted rates and broader sharing support when accessing a PHCS provider.
How to Obtain Healthcare Sharing Pre-Certification
We strive to help our members understand their program benefits and make educated decisions avoiding surprise bills after care is obtained. To achieve this goal, we require pre-certification for MedWatch’s standard pre-certification list.
Pre-certification is required for:
- Inpatient hospitalizations (including maternity and long-term acute care), 23-hr observations, skilled nursing facilities
- Surgeries not performed in the doctor’s office
- Certain surgeries, regardless of the place of service: biopsies (when checking for or to rule out cancer), arthroscopy or joint surgery, bladder repair, cardiac cath/angioplasty, deviated septum/nasal surgery, laminectomy/spinal surgery, implants, transplants (except corneal), mammoplasty, blepharoplasty, varicose veins stripping, and ligation
- Diagnostic endoscopic, laparoscopic, and colonoscopy procedures
- Imaging such as EBCT (Electron Beam Tomography), CT scan, MRI, and PET scans
- Chemotherapy and radiation
- Trigger point or pain management injections, infusion therapy, biologic drugs, ablations, stimulators, blocks, and any drugs >$1,500 a dose
- Physical, Occupational, and Speech Therapy
- Durable Medical Equipment >$2,500
- Home healthcare
- Dialysis
- Behavioral health (intensive outpatient program, residential treatment centers, partial hospitalization program)
- Hospice
- Tobacco related illnesses
Not all of the above services are eligible under each UHSM program. Please contact UHSM to understand the Member’s program benefits.
To request and obtain pre-certification, please click here to complete the digital form. Please include all requested documentation.
Please note that UHSM has a standard turnaround time of seven (7) business days on all pre-certification requests. If you require any help with the form, need status of your request, or are unable to determine if a procedure requires pre-certification please contact us at (800) 900-8476
Pre-certifications are for professional and institutional services only. All oral medication requests must go through members’ pharmacy benefits. By submitting this pre-certification, you are agreeing to work with UHSM on in-network pricing.
UHSM Preferred Providers FAQS
At UHSM, we aim to make medical billing simple and efficient for all UHSM providers. Once submitted, we promptly process your bills according to the Member’s program benefits, leveraging your PHCS network rates. Here are some frequently asked questions and answers regarding care within PHCS® PPO Network.
You will need to be contracted with our preferred network PHCS PPO. Please click here to join PHCS. UHSM ensures that UHSM providers have a seamless billing experience and prompt payment processing, making your job easier. Members may have limited access to utilize an out-of-network provider. Such situations need to be approved by Member Services. In the event an out-of-network provider is approved, the out-of-network provider can also submit bills electronically or via paper.
Electronic Submission:
PAYER EDI#: WESHR
Mail paper HCFAs or UBs to:
UHSM WeShare
P.O. Box 99
Orange, CA 92856
Just like any other payer within the PHCS PPO Network, your medical service fees will be paid according to your contracted rate.
All UHSM programs include benefits in which members pay you (the provider) a consult fee per office visit, unless the appointment is a routine annual physical or preventive care, in which case the per visit fee to members is $0.
If you are wondering how much to charge a UHSM member for a particular visit please reference the front of the PHCS UHSM member ID card or the specific Program Details. The per visit consult fee each UHSM member pays varies per program, but operates similarly to co-pay by aligning with the type of medical consult: primary doctor, specialist, urgent care and emergency room visits. For other services where a consultation fee does not apply, an Annual Member Care Share amount applies, which works similarly to a deductible. If you have additional questions please contact us.
For any questions about the eligibility of medical services, please submit a preauthorization form here or contact us at
(800) 900-8476.
Pre-certifications take up to 7 business days maximum.