To “Verify” if you are a provider in the Network:
- By dialing 800.645.1006 you can enter your Enter your Tax ID to verify network participation. The system has an automated response letting you know if you’re in the network. Please have your practice tax ID handy.
- You can verify network participation here. Please have your tax ID handy.
We’re a new, national PPO network in partnership with other networks to bring physicians low cost employee benefits.
We’re accepting new providers. There is no cost or risk to join. It is a great patient referral source and affords many benefits to the practice. It’s also an open panel PPO. If you’d like to join, please click here. After submitting your information, we’ll send you a network fulfillment packet, where you’ll have the ability to review your contract. If you change your mind for any reason, just sign the form and send it back.
Nominating a provider or a colleague is easy. Click here to access our “Nominate a Provider” form. After submitting, you will receive an e-mail confirmation notifying that we have received your request to “Nominate a Provider”. We will then contact the provider and recruit them to the network.
Please contact us to verify or change your member information.
You can submit the claim via paper form to the address on your ID card. Or you can send it electronically through any major clearing house.
Please contact the insurance company listed on the back of the card for your claims status.
You can mail the claim to the address found on your ID card.
To address this, please contact the actual insurance company or claims payor. The phone number should be located on the ID Card. If you cannot find it, alternatively, you can contact the HR department or representative of the insured.
Yes. Please contact us and we can mail you a copy.
Please contact us to speak with a provider relations representative.
We are only the network and do not handle claims. The insurance company on the back of your ID card can help you with your question.
HIPAA mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. The Secretary adopted the NPI. The NPI is a numeric 10-digit identifier, consisting of 9 numbers plus a check-digit in the 10th position. It is accommodated in all standard transactions, and contains no embedded information about the health care provider that it identifies. Effective May 23, 2007, the NPI will be the only healthcare provider identifier that will be accepted/used for identification purposes for standard transactions by covered entities.
All health care providers that meet the definition of a covered entity (healthcare providers that conduct certain transactions in electronic form, health plans, or healthcare clearinghouses), as defined in 45 CFR 160.103, are eligible for NPIs. Health care providers who transmit any health information in electronic form in connection with a transaction are required to obtain and use NPIs. Health care providers who are not considered covered entities may also apply and be assigned an NPI. However, entities that do not provide health care (e.g., transportation services) are not eligible to be assigned NPIs because they do not meet the definition of “health care provider” and are not subject to HIPAA regulations.
The National Plan and Provider Enumeration System (NPPES) is the contractor hired by CMS to assign and process the NPIs, to ensure the uniqueness of the health care provider, and generate the NPIs. The NPPES will be able to produce reports and information based on requests from the health care industry and others. To learn more about the NPI and how to apply for an NPI, visit http://www.cms.hhs.gov/NationalProvidentStand/ on the CMS web site.
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We are only the network. Please check the back of your card for contact information for your claims administrator or insurance company, and they will update your information for you.
Use our Provider Look-up tool to find a provider in your area.
For patient benefit information, please contact your insurance company, HR representative or plan administrator. That telephone number can usually be found on the back of your ID card.
To check the status of your claim, please contact the insurance company on the back of your ID card.
One of the features of our program is that it’s an “any doctor” plan. You have the freedom to see any doctor you choose, as long as you nominate or refer your doctor prior to your date of service. This is referred as our nomination program. If you’d like to nominate or refer your provider, please click here.
Yes, it’s a good idea to keep your card on you. It tells your doctor how to verify information and submit a claim. The PHN logo must be presented at the time you receive services if you want to receive the best possible discounts and rates. If you do not present your card, you will be risking the chance that a provider will not honor the discount if it is not provided up front.
Under a PPO, you can see any physician you’d like, but you best discount or benefit is when you visit an “in-network” physician.
Usually it is not necessary when you have a PPO plan. But this is something that you will need to confirm with your insurance company or discuss with HR.
This is an insurance related question. Physicians Health Network is not an insurance company. We work with your employer by offering a provider network. If you are insured through PHA Group Benefit Trust, please contact us and we can direct you to a benefits representative.
Payors are individuals or groups that assume the risk of paying for medical treatments. Payors can be Insurance Carriers, Self-Funded/Self-Administered Employer Groups, and Third Party Administrators.
For payment questions - including those about co-payments - deductible and premiums - you will need to contact your human resources representative, health plan administrator or your benefits company directly. Contact information for your benefits company is usually listed on the back of your ID card.
For benefit and eligibility questions, you will need to contact your human resources representative, health plan administrator or your benefits company directly. Contact information for your benefits company is usually listed on the back of your ID card.
For claims questions, you will need to contact your human resources representative, health plan administrator or your benefits company directly. Contact information for your benefits company is usually listed on the back of your ID card.
For questions regarding Cobra coverage, you will need to contact your human resources representative, health plan administrator or your benefits company directly. Contact information for your benefits company is usually listed on the back of your ID card.
For questions regarding enrollment, you will need to contact your human resources representative, health plan administrator or your benefits company directly. Contact information for your benefits company is usually listed on the back of your ID card.
To obtain a HIPAA Certification (verification of insurance coverage) you will need to contact your previous insurance company, human resources representative or benefits administrator directly.
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Physicians Health Network has negotiated deep discounts for services provided by physicians and hospitals, which also saves employees and employers money.
Yes. They just need to inform us who their providers are. We provide an on-line tool that you can send them tool called “Nominate a Provider”. All they need to do is fill out the fields to let us know what providers they’d like to continue seeing and we’ll contract them for you.
Yes, network changes are usually done along with other changes to insurance coverage.
No, you can change at any time.
As a member of PHN you will have access to a network of quality physicians, access to the latest trends in healthcare, participate in physician forums, streamlined office claims administration, attend educational events and presentations and have the ability to promote your practice.
We provide you a comprehensive disruption report to demonstrate provider representation. If you do not have a provider on network that you would like in our network, you can nominate them on-line or using the paper process, in which we will contract them to the network.
Yes, we can work with your broker and TPA
Claims are administered by Medical Benefits Admimistrator of MD, a leader in benefit administration to business association in compliance with state and federal regulators. MBA utilizes experienced staff and the smartest technology in automated claims processing to meet and exceed rigorous accuracy and turnaround standards.
We have an online provider look-up in which employees can access the list of physicians on the network.
On the network website employees can enter a physician/hospital and PHN will contact the provider to request their participation in the network.
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