PHP accepts electronic claims from all clearinghouses, as well as HIPAA-compliant files from providers. Our payer ID number is 12399.*
If you have any questions or issues regarding electronic claim submission, please contact PHP Customer Service at (260) 432-6690, ext. 11; toll-free at 1-800-982-6257, ext. 11; or custsvc@phpni.com.
* Our payer ID number is also 12399 for electronic remittance advice (835).
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We would like to take this opportunity to welcome you and your staff to our participating provider network. PHP offers many online tools to assist you, find out more!
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The healthcare industry is in the midst of a shift to value-based reimbursement, which provides increased access to data, strategy development through assessments, and knowledge sharing.
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At PHP, we want to provide you with the highest quality of healthcare coverage. If you have concerns about your coverage, or questions regarding a claim payment, a grievance procedure has been established that allows you to request a reconsideration of any decision that you disagree with. To begin the process, please complete and return the Appeal Filing Form (included with every Explanation of Benefits) or call the Grievance and Appeal coordinator stating your question or concern. We will assist you in any way we can.
Grievance Appeal Coordinator
1-800-982-6257, ext. 361
custsvc@phpni.com
For questions about your rights or for assistance if your coverage is a group health plan through your employer, you can also contact:
Employee Benefits Security Administration
1-866-444-EBSA (3272)
Indiana's Department of Insurance
www.in.gov/idoi
Ohio's Department of Insurance
www.insurance.ohio.gov
Additionally, a consumer assistance program can help you file your appeal. Click here for a list of all state's agencies.
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A tiered copayment benefit means there are several possible copayment levels. A member’s copayment is based on the prescription drug being purchased. For example, the first tier represents a preferred generic drug that has the lowest copayment.
Traditional Drugs
- Tier 1 Preferred Generic: Covered drugs that are no longer protected by a drug company patent allowing other drug companies to manufacture equivlant versions of the same drug at a reduced cost.
- TIER 2 Non-Preferred Generic: Similar to Tier 1 covered drugs, but available with a higher copayment.
- TIER 3 Brand Formulary: A list of brand-name drugs that PHP participating network doctors are encouraged to prescribe, when appropriate, for treatment of a medical condition.
- TIER 4 Brand Non-Formulary: Covered drugs that are not included in the formulary listing. You may obtain non- formulary brand-name drugs with a higher pharmacy copayment.
- TIER 5 Specialty Drugs: Specialty drugs are generally injectable, high-cost medications, which you may obtain through our specialty pharmacy, unless administered by a PHP network provider.
If you or your doctor want a brand name drug when there is a generic drug available, you will have to pay more than the formulary or non-formulary brand copayment.
Speciality Drugs
- Tier 1 Preferred Speciality Drugs*: These medications can be injectables or orals that are extremely expensive, must be fulled at a specialty pharmacy, and may need special instructions and handling.
- TIER 2 Specialty Drugs: These medications can be injectables or orals that are extremely expensive, must be fulled at a specialty pharmacy, and may need special instructions and handling.
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