The Certificate of Coverage outlines a member’s rights and responsibilities as a member of PHP, and details the coverage and benefits that are purchased by an employer. The Certificate of Coverage provides full explanations and details for a plan, how to use services, eligibility conditions, and other services related to using a health plan with PHP. PHP members and employers may access their Certificate of Coverage and other contract materials online, in the Benefits and Contracts section of the Member and Employer portals.
Whoops! Looks like we got off-course somehow.
Below are the results of our most recent Member Surveys which are compared to over 200 other commercial health plans across the United States.
Note: Percentages reflect members responding 8, 9, or 10 (on a scale of 0-10, where zero is the worst and 10 the best); or “Usually” or “Always” depending on question format.
PHP is proud to be URAC accredited.
What is URAC Accreditation?
Accreditation is an evaluative, rigorous, transparent, and comprehensive process in which a health care organization undergoes an examination of its systems, processes, and performance by an impartial external organization (accrediting body) to ensure that it is conducting business in a manner that meets predetermined criteria and is consistent with national standards.
By joining the Board of Directors with Physicians Health Plan, board members have input in comparing fees paid by competitors, medicare fees, and additional input based on our geographic area. Meet our dedicated board members pictured below and consider joining the PHP Board of Directors.
At PHP, we care about your good health. That is why we provide you with healthcare coverage that emphasizes preventive care.
PHP can team with you to help promote employee health. Finding potential health problems before they require costly treatment and offering a variety of opportunities to help your employees adopt a healthier lifestyle are just a few of the ways we help to decrease healthcare costs.
Please be sure to verify with PHP Customer Service that these programs are included in your benefit plan before receiving services, as there are some restrictions.
We offer the following resources as part of our Get PHP Fit! program:
At PHP, we work together as a team to help make your health insurance purchasing and use as painless as possible.
Our friendly staff is here to serve you. If you have a question regarding plans, claims, payment, becoming a broker, credentialing or anything else, feel free to contact us. We would be happy to help!
Not sure who to talk to? Simply fill out our contact form, and we will get back to you as soon as possible.
Indiana Grown, Growing Indiana
Did you know PHP is the only not-for-profit health insurance company in Indiana? With this, comes a true commitment to improving the quality of life in the communities we serve. A core value at PHP is community. And we put our money where our mouth is. In 2016 alone, PHP gave more than $650,000 across 120 different charitable organizations. Add in paid staff volunteer time and in-kind donations, and the impact to our community grows to nearly $700,000!
Our staff also contributes by giving of their time and talent. Through board and committee service, volunteer hours, and supply and collection drives, PHP employees are impacting our community for the better.
Positioned in Indiana, PHP has a unique view of health and wellness, as well as the opportunity to engage members and families through our insurance products. Living and working in the same region as our members allows us to connect on a personal level, making sure health care decisions positively impact the communities we serve in. More so than ever, we are uniquely qualified and prepared to advance the health and well-being of Indiana as a trusted, local resource.
PHP offers a one-of-a-kind working experience that continuously challenges all who are a part of it. We are a unique blend of top-notch professionals within a family environment with the talent to compete in the ever-changing health insurance industry and the passion to provide the highest level of customer service.
These service values extend into the community that we serve. Employees have the opportunity to volunteer and actively support a variety of organizations through company-sponsored participation in events as part of PHP's goal to be a leading corporate and philanthropic partner in the communities we serve.
Here to serve you.
We know health insurance can be complicated. If you have questions, let the insurance experts at PHP break it down for you in easy-to-understand terms. When you call PHP, you'll speak with a live, local person whose goal is to exceed your service expectations.
PHP is a local, community-based leader in providing cost-efficient and innovative healthcare solutions. Our vision and values are carried out by providing you exceptional customer service, wellness initiatives, and reliable resources.
The videos below will help you get acquainted with commonly used health insurance terms. Our fun little family is scattered throughout the site to bring you helpful information and insurance basics. Enjoy!
It can be a hassle to find all the information needed for a seamless healthcare visit. Access commonly used forms, downloads, and links to help make your healthcare experience more enjoyable and efficient.
You have questions . . . we have answers. Browse through some of our most commonly asked questions or contact us for additional information.
When it comes to health insurance, all of the terms are clear, simple, and easy-to-understand...right? Wrong! We know health insurance can be tricky but this glossary can help.
PHP offers a wide variety of products - perfect for any business.
To find out what product might be the best fit for your company, visit our Plan Finder tool.
We value our partnership with local healthcare providers and facilities, and we strive to be a valuable resource for them in all aspects. Whether it's providing outstanding service, giving quick access to the forms and tools they need, or presenting them with the latest in industry news, we are here to serve.
The healthcare industry is in the midst of a shift to value-based reimbursement, which is a dramatic change from the old model of "fee-for-service." As you make progress toward creating positive quality and cost results to ensure the best possible outcomes in your plan, keep these steps in mind:
By joining the Board of Directors with Physicians Health Plan, board members have input in comparing fees paid by competitors, medicare fees, and additional input based on our geographic area.
We value our partnership with our local brokers, and we strive to be a valuable resource for them in all aspects. Whether it's providing outstanding service, giving quick access to the forms and tools they need, or presenting them with the latest in industry news, we are here to serve.
Service complaints from your clients are a thing of the past with PHP. Our member satisfaction numbers are proof that PHP takes service to another level. When your groups are with PHP, you have more time for your own business, not chasing down complaints and resolving clients issues. You can have confidence that PHP is focused on bringing you the tools and resources you need to serve your clients in the most efficient way possible.
PHP offers a variety of health insurance products for groups. Any health and life licensed agent in the State of Indiana can quote and sell PHP products.
Contact one of the friendly PHP Sales Representatives listed below for more information about PHP products and services, or to receive website login information to gain access to tools and resources to help you sell.
As your Third Party Administrator (TPA), we can offer you self-funding options that allow you to use your health benefit plan dollars the way they were intended—to attract and retain the finest employees in the industry. Benefits can be customized to meet your employees’ needs while still satisfying company objectives. PHP Management Systems, Inc. will help you design your self-funded plan and handle the day-to-day plan administration that comes with it.
Groups have a few options when considering a self-funded product for their health plan. A self-funded healthcare plan is one in which the employer is financially responsible for part or all of the healthcare expenses of its employees. This means that the employer pays directly for any claims submitted by the people on their plan instead of paying a fixed premium to an insurance carrier.
We care about our members. That's why we try to make it as easy as possible for you to access the forms and downloads that you need.
When you take responsibility for your health by exercising regularly, eating right, managing stress, and knowing as much as you can about general health and wellness, you can increase your lifespan and improve your quality of life overall. Our member discounts make this even easier! Simply show your PHP ID card at one or more of the following organizations and receive a variety of special discounts just for being a PHP member!
Improving your quality of life is something we take very seriously. In fact, strengthening the health and wellness of our communities is one of PHP's primary objectives. We know that productivity in the workforce is directly impacted by the health and wellness of its people. Good health is critical to good business, and good health insurance is critical to good health.
Being a local, trusted resource, PHP has respect for, and is involved in, the long-term growth and success of Indiana. By cultivating specific data, we can tailor healthcare services to particular populations and foster initiatives focusing on improving wellness right here in Indiana.
For general questions, please complete the contact form and we will be in touch as soon as possible.
Looking to contact a specific department, inquire about translation services, or file a grievance? Browse our list of helpful information below the contact form.
Thank you for your interest in PHP! We hope you'll use this page as a trusted resource for wellness tips, healthcare information, and industry news.
We publish a quarterly newsletter with health, wellness, and PHP information for our members. To view a PDF version of our most recent newsletter, click here.
If you are a media contact and need additional information, please contact:
First step accomplished—you’ve reached your dashboard! Below you’ll find all your new employee training materials and a special welcome message from our CEO. Welcome to the team!
We can't seem to find your Plan Finder results at the moment, but we're doing everything we can to track them down. In the meantime, feel free to contact a PHP customer support representative to move forward with your health insurance search.
Point of Service Plans
High Deductible Plans
Small Group Sample 2018 HDHP HMO Plans - Prime Network
Sample 2018 HDHP HMO Plans - Options Network
Sample 2018 HDHP HMO Plans - Classic Network
Sample 2018 HDHP POS Plans - Prime Network
Sample 2018 HDHP POS Plans - Classic Network
Sample 2018 HDHP HMO Certificate of Coverage
Sample 2018 HDHP POS Certificate of Coverage
Small Group Sample 2017 HDHP HMO Plans - Prime Network
Sample 2017 HDHP HMO Plans - Options Network
Sample 2017 HDHP POS Plans - Prime Network only
Sample 2017 HDHP HMO Certificate of Coverage
Sample 2017 HDHP POS Certificate of Coverage
Large Group Sample 2017 HDHP HMO Plans - Prime Network
Sample 2017 HDHP HMO Plans - Options Network
Sample 2017 HDHP POS Plans - Prime Network only
Sample 2017 HDHP HMO Certificate of Coverage
Sample 2017 HDHP POS Certificate of Coverage
2018 Survey Results
|PHP Results||Other Health Plans' Results|
Ease of getting care needed
Ability to get care quickly
How well do your doctors communicate with you
Customer service experience
|Claims handled quickly and accurately||89%||89%|
|Rating of healthcare||74%||79%|
|Rating of your personal doctor||86%||84%|
2017 Survey Results
|Key Questions||PHP Results||Other Health Plans' Results|
|Ease of getting care needed||89%||86%|
|Ability to get care quickly||85%||85%|
|How well do your doctors communicate with you||95%||95%|
|Customer service experience||90%||88%|
|Claims handled quickly and accurately||94%||86%|
|Rating of healthcare||75%||78%|
|Rating of your personal doctor||84%||85%|
2016 Survey Results
|Key Questions||PHP Results||Other Health Plans' Results|
|Ease of getting care needed||87%||88%|
|Ability to get care quickly||83%||86%|
|How well do your doctors communicate with you||97%||95%|
|Customer service experience||88%||88%|
|Claims handled quickly and accurately||94%||89%|
|Rating of your healthcare||78%||78%|
|Rating of your personal doctor||88%||85%|
Accreditation Status: Full Accreditation
Accredited Since: 2013
Expiration Date: 5/1/2019
We can help!
In conjunction with any well care benefits an employer may select, PHP sends out various educational and informational pieces and also works with employers who wish to institute employee health education programs and various wellness initiatives. These efforts include:
Physicians Health Plan (PHP) is committed to the prevention of healthcare fraud. Fraud or abuse of healthcare benefit payment results in higher healthcare costs and higher insurance premiums for everyone. Healthcare fraud is a crime. It is the policy of PHP to monitor for evidence of fraud and to investigate allegations of fraud or abuse of healthcare benefit coverage.
Examples of Healthcare Fraud
Healthcare fraud is committed when someone intentionally submits false or misleading information to obtain payment for healthcare services. Examples include:
- A healthcare provider or member submitting a claim for an item or service more expensive then the item or service provided.
- A healthcare provider or member submitting a claim for services not rendered, or not necessary, or provided to a person other than the covered member.
- One individual using another individual's insurance coverage information to receive services. (One person posing as another person.)
- A health plan member enrolling an individual who is ineligible for coverage under the plan.
Preventing Healthcare Fraud
How You Can Avoid, Identify, and Prevent Healthcare Fraud
- Ask questions about the services you receive.
- Fill out, sign, and date one claim form at a time; never sign a blank form.
- Question advertisements or promotions by providers that offer free tests, treatment or services, especially if you are required to provide insurance information.
- In general, be careful about disclosing your insurance information. Protect your identification card. It represents your benefits.
- Examine your medical bills and compare your bills to your records and your PHP Explanation of Benefits (EOB).
- Report suspected fraud to a PHP representative.
Reporting Possible Healthcare Fraud
Each of us can help control healthcare costs by being alert for signs of possible fraud. Please notify PHP if you suspect that your information has been utilized in an attempt to fraudulently obtain payment or services.
The HIPAA portability provision, as the name implies, is designed to improve the portability of health coverage for people who are changing jobs and to make it easier to add family members to an employees’ coverage. HIPAA portability applies to group health plans and issuers of group health plans. So both the employer and the insurer are obligated to comply.
Certificate of Creditable Coverage
Part of the HIPAA portability provision is issuing a Certificate of Creditable Coverage (COCC). The COCC must indicate the date that any waiting period began and the dates that coverage under the plan began and ended. On the back of the COCC is educational information explaining HIPAA rights. PHP issues a COCC:
- when regular coverage is lost;
- when COBRA coverage is lost;
- when a COCC is requested by a member while still active; and
- within two years after losing coverage.
After termination of coverage, if a member is moving to another health plan that has a pre-existing condition exclusion (PCE), the timeframe reflected on the COCC can be used to reduce the PCE period by one day for every day of creditable coverage listed on the COCC.
HIPAA requires a group health plan to provide a special enrollment opportunity to employees and their dependents under certain circumstances. A few examples of these circumstances are listed below.
If the employee and or dependent did not enroll in the plan because they had other coverage and requested special enrollment within 30 days, they would be eligible for special enrollment when:
- they lost coverage because they lost eligibility;
- the employer contributions for the coverage ceased;
- the COBRA period of 18, 29, or 36 months was exhausted; or
- an employee acquires a new spouse or dependent by marriage, adoption, placement for adoption or birth. The special enrollment right applies to the employee, the employee’s spouse and the newly acquired dependent.
If coverage is gained or lost under a Medicaid or CHIP Program, the special enrollment period is 60 days.
Department of Labor resources for more HIPAA Portability information:
What is HIPAA?
PHP has always recognized the importance of privacy and security of member health information.
In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). This Act established a number of significant regulatory requirements for health plans. Title II of HIPAA deals with, among other issues, the creation of standards for the collection, use, disclosure, and electronic transmission of healthcare information by healthcare providers, health plans, and healthcare clearing houses ("covered entities"). Those provisions are referred to as the "administrative simplification" requirements of HIPAA.
Administrative Simplification Requirements of HIPAA
The major requirements of administrative simplification are:
PRIVACY OF HEALTH INFORMATION
The standards of health information privacy govern the use and disclosure of individually identifiable health information by health plans, healthcare providers, and healthcare clearinghouses and their business associates.
SECURITY OF HEALTH INFORMATION
The security rule provides safeguards for data storage, protection of information transmission systems, and the establishment of chain-of-trust agreements between covered entireties and their business partners.
ELECTRONIC TRANSACTIONS STANDARDS & IDENTIFIERS
This rule establishes standards for eight healthcare transactions (healthcare claims or equivalent encounter information; eligibility for health plan; referral certification and authorization; healthcare claims status; enrollment and disenrollment in a health plan; healthcare payment and remittance advice; health plan premium payments; and coordination of benefits) and designates the code sets used for those transactions.
The identifier rules are intended to establish unique identifiers for employers and providers that will be used in electronic healthcare transactions.
DISCLAIMER: The subject matter covered has been provided with the understanding that PHP is not engaged in rendering legal or other professional services. If legal advice or other expert assistance regarding compliance with HIPAA laws and regulations is required, the service of a competent professional person should be sought. The user of this HIPAA information shall assume total responsibility and risk of its use. In no event shall PHP be liable for any damages whatsoever, including but not limited to special, direct, indirect, consequential, or incidental damages, or damages for lost profits, loss of revenue, or loss of use, arising out of or related to the information provided.
June 8, 2016
PHP is committed to accessibility, diversity and inclusion. We believe all of our members and visitors should be able to easily access and use our web site portals and digital offerings.
If you're using assistive technologies to access our site, our mission is to deliver the experience you expect. We want PHP to be your preferred health insurance provider in all channels by fulfilling our brand promise of "PHP Easy."
How we are accomplishing these goals:
We've set high standards for our web accessibility and are planning a complete web redesign by the close of 2016. PHP is committed to ensuring that its website is accessible to people with disabilities. All the pages on our website will meet W3C WAI's Web Content Accessibility Guidelines 2.0 conformance when our new site is launched.
Questions about our position and/or policy should be directed toward: email@example.com
The PHP Foundation
The PHP Foundation is dedicated to building healthier communities by addressing the health and wellness needs of low-income, high risk individuals in the neighborhoods we serve.
Through the PHP Foundation, we offer grants to tax-exempt, private agencies and/or public charities in 40 northern Indiana counties. These grants, totaling more than $10 million in the past 15 years, have helped fill voids in community needs.
PHP charitable contributions have offered broad social benefits to organizations including Matthew 25, Neighborhood Health Clinics, Super Shot, Inc., Francine's Friends, and others. In addition, more than a million lives have been improved through improved access to medical and dental education, treatment, medications, and more; most often reaching low income, disadvantaged, medically and emotionally challenged individuals.
For almost 30 years, PHP has awarded academic scholarships to high school seniors in our service area pursuing careers in health-related fields. Nearly 100 students have received a total of more than $150,000 for educational expenses at a college, university, or technical school.
Applications are posted on our website in October each year, with this year's application deadline being February 23, 2018. Eligibility requirements and a downloadable application can be accessed here.
At PHP, we believe in celebrating individual and team achievements such as Years of Service anniversaries and team project successes. The diverse experiences and expertise of each PHP team member is an advantage over our competition and gives us reason to celebrate.
Ready to join the PHP team?
Check out these current opportunities:
Want to receive alerts when new openings are posted? Set up an account with just a few pieces of information.
Get in touch with us using one of the options below and let PHP start serving you today.
- Voice: 260-432-6690, ext. 11
- Toll Free: 1-800-982-6257, ext. 11
- Hearing Impaired: 260-459-2600
- Fax: 260-432-0493
- Email: firstname.lastname@example.org
- Address: 8101 W Jefferson Blvd, Fort Wayne, IN 46804
We answer phones on weekdays from 8:00 AM - 5:00 PM. If you leave a voice message, we will return your call within 24 hours.
If possible, please leave the following information when leaving a voicemail:
- PHP ID number (if you are a member)
- Contact information (phone or email)
PHP is licensed to sell products and services in 40 Northern Indiana counties (statewide for TPA services). Additionally, PHP's Provider Network extends beyond this service area to provide comprehensive choice in doctors, hospitals, facilities, and pharmacy access for our members.
To see if PHP is available where you are, view our coverage map. If you're an employer and you'd like to get PHP insurance coverage for your employees, click here to get started.
Our Values: What is Important to Us
- Innovation – We embrace an environment that encourages free thinking, new ideas, and a nimble response
- Collaboration – We are an agile team that identifies and implements strategic solutions
- Integrity – We act and speak honestly and ethically
- Development – We provide opportunity for employee growth, both personally and professionally
- Social Purpose – We are committed to philanthropy, actively involved and supportive of the communities we serve
Our Vision: Why We Exist
PHP and Pro-Claim deliver innovative strategies and services for the health of our communities by:
- Personally engaging to provide service excellence for those who put their trust in us
- Embracing our responsibility to improve economic growth and help employers sustain a healthy, efficient workforce
- Sharing information to create both well-informed consumers and providers to foster effective decision making
These commonly used terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. Some of these terms might not use the exact same definition in your policy or plan. Be sure to review your Summary of Benefits and Coverage for information on your specific plan or policy.
If you're looking for a new doctor, or just want to verify that the doctor you see is in PHP's provider network, use this online directory to help your search.Find a Healthcare Facility
Choosing a hospital or healthcare facility can be difficult when there are so many selections near you. Use this tool to narrow down in-network facilities.Find a Pharmacy
Looking for a pharmacy near you? Be sure to find a pharmacy that operates within PHP's network. This online directory can help you!
The ever-changing world of health insurance can be complicated – we know that! We're here to make it easy on you with a list of commonly used terms you'll want to remember.Frequently Asked Questions
If a question or concern is eating away at you, chances are, others have felt the same way. Here's a list of frequently asked questions to get to the bottom of things.Forms, Downloads & Links
Searching for the right forms can be tedious and time consuming. We've made this part PHP Easy so you can find the forms you need all in one spot.
As a local, not-for-profit health service, we frequently interact with the communities in Northern Indiana. Check out a few of our service projects and learn how we're bringing health to Hoosiers.Industry News
Stay up-to-date with news and popular topics in the healthcare industry. We'll also share about our community service initiatives and provide updates from the PHP Foundation.Press Kit
If you are a media outlet looking for information or someone to speak with, find your answers, branding materials, and potential contacts here.
1) Provide increased access to data
Health industry data can't (and shouldn't) be locked and guarded in the silos it's been isolated in up until now. Data must be available to the ones who can use it to improve healthcare quality while lowering costs by tracking performance and measuring action plans and their outcomes.
2) Share knowledge and learn from others
With a unified goal in mind, sharing knowledge outside of organizational walls will reduce financial waste, improve workflow, and provide evidence-based content to enable a faster, easier learning curve.
3) Develop strategies through assessment
First, determine your current status, strengths, and weaknesses. Look at your plan for the next several years and determine where you can best implement your strategies for value-based reimbursement.
The physician membership of PHP elects 10 of the 15 Board of Director positions; the remaining five are appointed consumer directors.
The Board of Directors has input on the following:
- Comparing fees paid by competitors
- Medicare fees and payment methodology
- Usual and customary fees for our geographic area
If you are interested in joining the PHP Board of Directors, contact:
Become a Participating Provider
Participating providers are able to provide services to our members as part of our plan networks. If you would like to become a part of our network, you will need to complete the credentialing process. Get started by downloading one of our credentialing forms or by filling out the online form below.
Become a Member Physician
Member Physicians not only provide services to our members, but also participate in the governance of our plan. As a member physician, you would have a say in developing and maintaining a local, not-for-profit health plan that is an alternative to the big insurance plans out there today.
If you have any further questions, please contact our Provider Relations team by completing the form below.
Download our Credentialing Criteria brochure.
Thank you for your interest in becoming a provider with Physicians Health Plan of Northern Indiana (PHP). Providers who would like to apply to be a participating provider must first complete and return the following to our Credentialing Coordinator:
- Participation Application Request Form
- A copy of their professional liability insurance cover sheet or declaration sheet
- Unrestricted state license or certification
The completed documents may be sent to our Credentialing Coordinator at email@example.com or via fax at 260‐436‐4809. For questions about initial credentialing, re-credentialing requests, and related information, contact:
Provider Relations Staff
Send your Participation Application Request Form, a copy of your professional liability insurance cover sheet or declaration sheet, and your unrestricted state license or certification to our Credentialing Coordinator at firstname.lastname@example.org or via fax at 260‐436‐4809.
We will review your documents and you will be sent directions for completion of the Council for Affordable Quality Healthcare (CAQH) application for practitioners. This process includes primary source verification of key elements of your application.
Once the verification process is completed, you will be notified within 10 business days of the recommendation of the Credentials Committee, and if eligible you will be contacted by the Provider Services Department to initiate contracting with PHP.
The following provider types are required to successfully complete the credentialing process:
- Doctors of Medicine
- Doctors of Podiatry
- Doctors of Osteopathic Medicine
- Doctors of Dentistry (including oral maxillofacial surgeons)
- Nurse Midwives
- Nurse Practitioners in Independent Practice
- Clinical Nurse Specialists
- Doctorial & Clinical Psychologists
- Master’s Level Clinical Social Workers
- Addiction Counselors
- Licensed Mental Health Counselors
- Long & Short Term Acute Care Hospitals
- Home Health Agencies
- In‐patient Rehabilitation Hospitals
- Specialty Facilities such as Cancer Hospitals and Birthing Centers
- Ambulatory Surgical Centers
- Behavioral Health Hospitals
- Skilled Nursing Facilities
Upon receipt of the completed Participation Application Request Form and attached documents, your request will be reviewed and if you meet the requirements, you will be sent directions for completion of the formal application. As required by the State of Indiana for Health Plans, PHP utilizes the Council for Affordable Quality Healthcare (CAQH) application for practitioners. If you are not already a registered user, you will be sent directions on how to access the application. Facility providers will be sent directions for a separate application.
Once the application has been completed, attestations signed, and our Credentialing Department notified, the formal credentialing process begins. This process includes primary source verification of key elements of your application. Should incomplete, inaccurate or conflicting information be identified, the applicant will be contacted and given an opportunity to correct the information and resubmit it to the Credentialing Department. It is the applicant’s responsibility to work with the organization that reported the inaccurate, conflicting or incomplete information to get it corrected. The applicant, at any time during the credentialing process, may also contact the Credentialing Department to check the status of their application. Once the verification process is completed, the applicant will be notified within 10 business days of the recommendation of the Credentials Committee.
Once the credentialing process is complete, you will be contacted by the Provider Services Department to initiate contracting with PHP.
At least every three years from the date of the initial appointment, providers will be recredentialed and evaluated for continued participation in the PHP Network. The CAQH application is again used, and the provider should keep this application form up‐to‐date. An updated signed attestation form will also be required. Information that may have changed since your initial application will be verified with the primary source. If inaccurate, conflicting or incomplete information is identified, the provider will again be contacted and given an opportunity to correct the information and resubmit it to the Credentialing Department. It is the applicant’s responsibility to work with the organization that reported the inaccurate, conflicting or incomplete information to get it corrected. At any time during the recredentialing process, the provider may contact the Credentialing Department to check the status of their recredentialing.
At the conclusion of the recredentialing process and recommendation of the Credentials Committee, the provider is considered to be recredentialed unless otherwise notified. Providers will be notified by letter when the recommendation of the Credentials Committee is other than full reappointment. This letter is sent within 10 business days of the recommendation of the Credentials Committee.
Hospital Based Providers
Providers who are strictly hospital based, such as Emergency Department Physicians, Hospitalists, Radiologists, Pathologists, hospital‐based Nurse Practitioners or Clinical Nurse Specialists, and any other providers who only see patients as a result of them being admitted or directed to a specific hospital are not listed in our Provider Directory, and are therefore not required to be credentialed in order to participate in the PHP Network.
However, if the provider is listed in our Provider Directory, or has a private practice outside the hospital, they must go through the formal credentialing process.
Other Health Service Individuals or Organizations
PHP contracts for many types of health services provided by individuals or organizations that are not required to be credentialed as described in our Credentials Plan or summarized above. These individuals and organizations must still meet certain standards of participation, which will be verified. Clinical individuals and organizations are required to provide proof of professional medical liability insurance at a level not less than $250,000 per occurrence/$750,000 in the aggregate. There are specific standards to each service type that must be met and PHP will verify these before the contracting process can be initiated.
Please contact the Provider Services Department at 800‐982‐6257, for a list of individuals or organizations that fit in this category and their specific requirements.
Group Sales Staff
Together, we can create a platform for your benefits portfolio that encourages taking cost-effective measures and coupling them with your personalized strategic planning. Our programs include:
- Utilization Review / Case Management
- Pharmacy Benefit Manager Relationships
- Claims Administration
- Cost Savings and Containment Systems
- Compliance and HIPAA
- Fraud Prevention
- Information Systems, Web Access, and Reporting
- Plan Administrator Website
- Wellness Programs
- Preventive Services Initiatives
- Benefit Design / Summary Plan Description Development
- Standard or Custom Administrative Packages
For More Information
Contact Ava Lillmars, Manager of TPA Services, at 1-800-982-6257, ext. 306 or email@example.com for more information or to receive a customized quote today.
PHP Management Systems, Inc.
PHP Management Systems, Inc., a fully-owned subsidiary of Physicians Health Plan, is locally sponsored and governed by area physicians dedicated to providing quality, affordable healthcare in our community. With exceptional customer service and satisfaction, industry expertise, strength, and stability, our team will partner with you to focus on cost savings objectives while helping you achieve your health benefit goals.
Administration Services Staff
Why consider self-funding?
In short, you have more control, lower taxes, improved cash flow, less regulations, and plan flexibility with a self-funded plan.
Increased Financial Control
With self-funded plans, employers have the advantage of using their money for funding claims only when they are due rather than continually funding an insurance company through premium payments. This allows the employer to have greater control over funds that would otherwise be held by their insurance carrier in various reserves, such as unreported claims and pending claims.
By funding claims directly, an employer avoids the insurers’ costs of claim reserves, administrative costs, profit margin, risk charges, premium taxes, and contingency margins—basically, you're cutting out the middleman and likely saving money because of it.
Self-funded plans allow employers ultimate flexibility in designing their own health benefit plan. Because self-funded plans are exempt from state insurance laws, employers have more control over where their claim dollars are being spent as opposed to insurance carriers who are tied to a variety of laws and restrictions. This allows employers to pick and choose plan options based upon their values, budget, and strategic planning objectives.
Utilization and Plan Management
The design flexibility and ongoing expense analysis of self-funded plans allows employers to continuously make the plan design changes that they need in order to manage their costs effectively. Self-funded plan designs can even include strategies to monitor use and assure appropriateness of care for inpatient and outpatient services, all while maintaining the benefit of discounts from a variety of network partners.
In a self-funded plan, employers have secured access to all of the information needed to manage their plan effectively. Authorized individuals will have access to confidential monthly reports and benefit-related information and insured clients will have access to their eligibility, claims, and reporting system through our encrypted website. This allows employers to have greater time control and use of their plan's data.
I'm convinced. Now what?
If you're interested in a self-funded plan and ready to take the next step, we encourage you to contact Pro-Claim Plus, PHP's TPA subsidiary, to get started on creating a customized health plan just for you. Why Pro-Claim Plus you ask? Here are just a few reasons:
- We're an experienced third party administrator with local market knowledge.
- We represent three primary roles: design, communication, and service.
- You'll have access to a dedicated account manager.
- We offer convenient walk-in customer service.
- Top-notch claims administration is included.
- We offer a contracted utilization review and medical management cost savings programs.
- We are technology, HIPAA, and compliance-driven.
- We are a value-added service.
- Our clients have access to experienced sales management and service-oriented, exceptional claim payment operations through our TPA services.
- All of our clients receive guidance on their compliance demands regarding their personal health plan activity. Also, actuarial resources are available to provide specific guidance on statistical data.
Administration Services Staff
Typically clinics can be found inside of stores or pharmacies, like the Minute Clinic at CVS. Clinics are great for simple health issues such as earaches, colds, coughs, strep throat, flu shots, etc. They are usually staffed by Nurse Practitioners or Physician Assistants making them an economical option for your more routine health care needs.
These clinics are generally required to have a doctor on-site. This allows them to treat a wider variety of injuries and illnesses such as upper respiratory infections, minor burns, sprains, cuts, and rashes. Simple lab tests and x-rays can often be done, but urgent care clinics should not be used for chronic conditions or emergency situations.
An emergency room should be used for life-threatening or serious situations that may require a specialist or advanced testing. These situations may include heart attacks, strokes, serious injuries, extensive burns, or loss of consciousness. ER visits are generally the most expensive option, so it is best to save for extreme circumstances only.
Talk to a Nurse, 24 hours a day.
Questions about a medicine that you are taking or symptoms you might be experiencing can come up at all hours of the day and night. It is nice to have a quick response to your healthcare questions. That's why we offer MyNurse 24/7, a toll-free nurse help line for non-emergency situations. This free benefit allows members to speak with experienced, knowledgeable nurses about specific health concerns. Nurses will answer your questions with sound, clinically based information. Since they are available 24 hours a day, 7 days a week, and 365 days a year, you can have peace of mind when it comes to getting the answers you need. Call anytime at 1-800-931-4714.
What should I do in case of an emergency while outside of my service area?
If you are traveling and an emergency occurs, contact the nearest emergency service. It is a good idea to discuss with your doctor what to do in the event of an urgent medical situation before it happens. Being prepared and having information about existing healthcare conditions and any medications currently being taken is important. This information will assist the emergency healthcare providers in their choice of treatment options and can improve your likelihood for a healthy outcome.
Founded in 1983, Physicians Health Plan of Northern Indiana, Inc., is a physician-sponsored not-for-profit health insurance company whose focus has always been on providing our customers with quality, affordable health care customized to meet the specific needs of Indiana residents. More than 30 years later, PHP remains locally sponsored and governed by area doctors and business representatives who are committed to supporting patient/physician relationships and healthcare options for better health outcomes and healthier communities.
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