Provider Support: Preferred Provider Organization Questions
We’re here to help!
WeShare® is a different kind of healthcare, called ‘health sharing’.
It differs to health insurance in that our caring community of members join to help with each other’s medical costs. We are a caring community dedicated to keeping our members healthy, happy, and in control of their wellbeing.
We are equally committed to our PHCS® PPO Network, and your overall satisfaction.
Our efficient, streamlined experience is designed to bring maximum convenience to our providers, every time. Our goal is to be the best healthcare sharing program in the United States, which extends to our network of providers just as much as it does for our members.
UHSM Doctors & Hospitals PHCS® PPO Network
PHCS is America’s No. 1 PPO provider and the largest in the nation. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother process and overall cost savings.
Obtain healthcare sharing preauthorization
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 preauthorization for all medical services, except wellness and preventative, immunizations, urgent care, emergencies, DocDay and CVS MinuteClinic services.
To request and obtain preauthorization, please follow the steps below:
Please note that UHSM has a standard turnaround time of five (5) business days on all prior authorization requests. If you require any help with the form, need status of your request, or are unable to determine if a procedure requires preauthorization please contact us at (757) 210-3435.
Prior Authorizations are for professional and institutional services only. All oral medication requests must go through members’ pharmacy benefits. By submitting this prior authorization, you are agreeing to work with UHSM on in-network pricing.
Preferred Providers FAQ
At UHSM we work hard to make sure our members and providers have simple and fast medical bill processing. Our members will have preset, per-visit consult fees that operate similar to your insurance patient’s co-pay. We promptly process your remaining network-contracted fees. Here are some frequently asked questions and answers regarding care within PHCS® PPO Network.
UHSM currently uses Claimsnet for the clearinghouse and is in the system as “UHSM WeShare” with NAIC# 07689, claim type HCFA. While all the trading partners have been notified, many won’t set up the payer ID until a provider requests it. To request UHSM setup, as the provider all you have to do is:
- Open a customer service ticket at your clearinghouse — Request the setup of payer ID 07689, with routing to SSI Claimsnet.
- Then send that service ticket number along with the clearinghouse name to Claimsnet helpdesk to complete the integration firstname.lastname@example.org.
You will need to be contracted with our preferred network PHCS PPO. Please click here to join PHCS. If you are contracted as a PHCS provider, you will be paid at the contracted rate. UHSM is committed to processing all medical bills promptly and efficiently, and to making your job as a provider as seamless as possible.
UHSM is committed to quickly processing all medical bills through the PHCS PPO Network. We work as fast as we can. It can take up to 60 days to process the medical bill according to PHCS PPO network policies.
Mail paper HCFAs or UBs to:
PO Box 247
Alpharetta, GA 30009
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 annual wellness 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. If you have additional questions please contact us.
For questions about the eligibility of medical services that may be recommended following an appointment, please submit a UHSM preauthorization form here or contact us at (757) 210-3435.
Preauths take 3 – 5 business days maximum.
Hear What Providers Have To Say About UHSM
Member-to-member Health Sharing
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