Partners with BECOME AN ACCEPTING PROVIDER! It’s BETTER for You, It’s BETTER for Your Patients, It’s BETTER for the Country BECOME AN ACCEPTING PROVIDER! When you combine an experienced and efficient non-profit health cost sharing organization with an expert wellness education and management platform, you get the most comprehensive health sharing program available today – Health Excellence Select! The Health Excellence Select health sharing program featuring Liberty HealthShare Allows patients to take back control of their health care costs through health sharing Allows physicians to take back control of their patients’ health with no bureaucratic intervention. Offers its Members (your Patients) six affiliate services to assist them in becoming an MPowered Self-Pay Patient. What is Health Cost Sharing? It’s a program managed by a Non-Profit Organization that helps like-minded, health-focused members share their medical expenses. It allows access to ANY Accepting Provider Physician or Hospital nationwide. It costs up to 50% less monthly than traditional health insurance. It’s RECOGNIZED BY & EXEMPT FROM the tax penalties imposed by the Affordable Care Act, but is NOT insurance. It has a 30 year track record of medical cost sharing success. What is an Accepting Provider? It’s a Physician, Health Care Professional, Hospital or Medical Facility who agrees to accept the higher and quicker reimbursements of Health Excellence Select’s cost sharing component, Liberty HealthShare. Benefits to Accepting Providers. Increased revenue based on reimbursement rates of Medicare PLUS 50% - 70%. Rapid payment for services rendered. New Patient referrals. Assistance to grow your practice! (See details on page 9) In the pages that follow, you’ll learn more about how Liberty HealthShare and Health Excellence Select have partnered to offer you an inspiring and exceptionally effective solution to benefit you, your patients and your practice! Find out more – www.MyLibertyHealthShare.com Become a Provider - www.AcceptingProvider.com It’s BETTER for You, It’s BETTER for Your Patients, It’s BETTER for the Country Find out more – www.MyLibertyHealthShare.com Become a Provider - www.AcceptingProvider.com Submit Clean Medical Bills To Global Care For Pricing In 3 - 7 business days, bills are forwarded to Liberty HealthShare for Processing Receive Payment within 30 Days Explanation of Annual Unshared Amount (Members Responsibility) within 30 days Annual Unshared Amount (AUA) is the amount of eligible need that does not qualify for Sharing. This amount is paid directly by the Patient to the billing Physician or Provider Find out more – www.MyLibertyHealthShare.com Become a Provider - www.AcceptingProvider.com Health Care BY Americans, FOR Americans Dear Physicians and other Healthcare Providers, As you are aware, medical offices must contend with many different types of health plans in terms of referrals, authorizations and uncertain reimbursements. Each patient potentially represents a different set of requirements. When a Liberty HealthShare member becomes your patient there are no referrals needed and very limited notifications, freeing the healthcare provider and staff of the cumbersome daily tasks which many offices experience when dealing with the rules of insurance companies. Liberty HealthShare is a health cost sharing program that provides our members with an affordable healthcare option without utilizing a network and with the flexibility to see the provider of their choice. Healthcare sharing is an acceptable choice in the Affordable Care Act, and fulfills the individual mandate. All medical bills are re-priced by Global Care Inc. within 3 – 7 business days, giving us the ability for payment to be made within 30 days. Members are responsible for their Annual Unshared Amount of $500 for a single membership, $1000 for a couple, and $1500 for a family. All medical providers are reimbursed per the terms of the health share guidelines up to the maximum payable amount. Reimbursement is based on the following: • For all Physician-related office visits, payment shall be reimbursed at Medicare rate +50% for prevailing area where service is rendered. Claims must be submitted to Global Care, Inc., on a HCFA 1500 form, or electronically, inclusive of the rendering address with street, city, state and zip code only, no P.O. boxes. • For all Inpatient-related services, payment shall be reimbursed at Medicare rate +60% for prevailing areas where service is rendered. Claims must be submitted to Global Care, Inc., on HCFA 1500 or UB04 form, or electronically, inclusive of the rendering address with street, city, state and zip code only, no P.O. boxes. • For all Outpatient- related services, payment shall be reimbursed at Medicare rate +70% for prevailing areas where service is rendered. Claims must be submitted to Global Care, Inc., on a HCFA 1500 or UB04 form, or electronically, inclusive of the rendering address with street, city, state and zip code only, no P.O. boxes. Bills must be sent directly to the address shown on the member’s identification card. This program provides you, the provider of medical services, with timely, accurate and reasonable reimbursement for services rendered within your service area. The Medical Cost Sharing Summary has been attached for your review. Please feel free to contact me with any questions or concerns you have. I will be happy to discuss this with you, at your convenience. Thank you, Liberty HealthShare Kimberly Pantoya Provider liaison Phone: 855–585–4237 EXT. 1170 Email: [email protected] 4845 Fulton Dr. NW. Canton, OH 44718 Find out more – www.MyLibertyHealthShare.com Become a Provider - www.AcceptingProvider.com MEDICAL COST SHARING SUMMARY Expenses Eligible For Sharing Health after Excellence Health Excellence Select 100% up to $1 million AUA Select Annual Unshared Amount (AUA) – first dollar amount of annual medical costs not eligible for sharing)* Annual Unshared Amount (AUA)* Single Couple Family $500 $1,000 $1,500 *Note: the annual unshared amount (AUA) is the amount of an eligible expense that does not qualify for sharing, and is calculated upon each members enrollment date until their next annual enrollment date. Note: A medical expense incident is the charge (s) incurred for eligible medical treatment arising from any illness or accident of a sharing member, and any fees incurred by Liberty HealthShare to reduce such charges. All providers treating the same illness (diagnosis) are combined in the same incident. Maximum Eligible Sharing Limit Per Incident Single Couple Family 100% up to $1,000,000** **Guardians Group is for catastrophic expense needs up to $1 million is included with Health Excellence Select. Note: The following expenses will not apply towards the maximum expense limit: (1) Reduced share amount for failure to follow healthcare management procedures. (2) Any charge excluded in the sharing guidelines. (3) Any other charges that exceed maximum limits. Pre-Notification Step One: The Pre-Notification staff must be notified of the following services before occurrence: • Inpatient confinements (including hospital, skilled nursing, inpatient rehabilitation facility & hospice care) • Emergency admission (within 48 hours) • Pregnancy/Maternity STEP ONE: • Organ/tissue transplants services Call Pre-Notification at 877-202-6379 • Home healthcare services • Outpatient surgery Step Two: Contact customer service@ 855–585–4237 to verify eligibility of charges. Charges will be ineligible for sharing if timely notification is not received for all charges for rendered services listed above. Pre-notification (step one above) does not guarantee that your expenses will be shared. Please contact customer service to verify eligibility for sharing. Health Excellence Select 100% up to $1 million after AUA Accidents Chiropractic Services (accidents are investigated for other party liability) Limit 12 visits per Calendar Year Accidents Involving Recreational Vehicles Ambulance Services brought to you by Find out more – www.MyLibertyHealthShare.com Become a Provider - www.AcceptingProvider.com MEDICAL COST SHARING SUMMARY- Continued… Diagnostic X-ray and Laboratory Services Emergency Room Hospital And Physician Services Inpatient/Outpatient/Independent lab (outside lab) (Routine treatment excluded) Home Health Care Hospital Services Limit 30 days per Incident Inpatient: Daily Room and Board limited to the average semi-private room rate. Maternity Care Physician Office Services Normal delivery (including physician charges, office visits, hospital charges and birthing centers) cesarean section and/or complications treated as new incident with new per incident limits Per incident visit. All other physician office services included per incident. (Charges billed by a physician if performed in the physician’s office: injection, surgery, lab, x-ray, special diagnostic interpretation.) Prescription Drugs Surgery Per incident (charges must occur within 45 the days before or after any related medical incident) Surgeon, Assistant Surgeon and Anesthesiologist Services. Inpatient/Outpatient services. Outpatient surgery facility Therapy Limit 20 visits per Calendar Year (Combined with Speech, Respiratory, Physical, Occupational Therapy) All Other Eligible Expenses (Unless limited by the guidelines) Naturopathic and/or Alternative Treatments Treatment provided by a Naturopath or other practitioner of alternative treatments is eligible for sharing if such treatment meets the following criteria: A- It treats a medically diagnosed condition. B- It is less invasive than conventional medical treatment for the diagnosed condition. C- It is less costly than conventional medical treatment and is expected to prevent more costly future conventional treatment. D- It is presented for prior approval to Liberty HealthShare™ and the member agrees to any alteration of the treatment plan made by Liberty HealthShare™. Health Excellence Select 100% up to $1 million NO AUA Preventative Screening Mammograms, Pap smears, PSA tests, Screening Colonoscopies Limit: 1 every 2 years; 1 per year over 50 Wellness Babies 0-1 one year – well baby checkups including vaccinations. Adults 1 year and older includes labs, x-rays (one per membership year) Find out more – www.MyLibertyHealthShare.com Become a Provider - www.AcceptingProvider.com brought to you by Dear Doctor and Other Healthcare Providers: Thank you for your decision to accept Liberty HealthShare members into your service and billing system based on the following reimbursement rates as shown on this signature form. Upon your signature and submission, Liberty HealthShare Inc will expedite reimbursement(s) to the Provider within the agreed upon payment time period. For questions, please contact Kimberly Pantoya, Provider Liaison, at 855-585-4237 ext. 1170. Authorized Signature Office Name: Provider Tax ID: Mailing Address: Street: City: Phone: Fax: State: Contact Persons Name: Physician-Related Office Visits: Inpatient-Related Services: OutpatientRelated Services: Zip: Position: Payment shall be reimbursed at Medicare rate plus 50% for prevailing area where service is rendered within 30 days of billing receipt. Payment shall be reimbursed at Medicare rate plus 60% for prevailing area where service is rendered within 30 days of billing receipt. Payment shall be reimbursed at Medicare rate plus 70% for prevailing area where service is rendered within 30 days of billing receipt. Authorized Signature Date Print Name Title By signature above, I approve the reimbursement schedule for all Liberty HealthShare, Inc. members as billed by my office according to the following terms: 1. Provider agrees to accept the adjusted price for the services rendered, and to not bill the patient or other responsible party for the discounted amount, if any. 2. Provider may bill the patient or other responsible party for any “Ineligible for Sharing” (denied) amounts related to the services rendered. 3. All reimbursements are per the terms and conditions of the patient’s healthshare program guidelines. After signing this form, please FAX to: Kimberly Pantoya at 216-456-8115, OR scan and attach to an email and send to [email protected] It’s BETTER for You, It’s BETTER for Your Patients, It’s BETTER for Your Practice and It’s BETTER for the Country As An Accepting Provider… You may participate in the Health Excellence Select comprehensive health sharing program in 1 of 2 ways: 1. Accepting Provider – you agree to accept the Liberty HealthShare reimbursement schedule from participating Health Excellence Select members. 2. Provider Affiliate – you want to capitalize on Health Excellence Select’s comprehensive Health Sharing program in your practice to increase your patient base and improve your bottom line. The Provider Affiliate platform is a NO Cost “Health Sharing Patient Awareness Program” that assists in communicating the benefits of Health Excellence Select and Liberty HealthShare to your Patients. As a Health Excellence Select Provider Affiliate, you will be equipped with a unique “Health Sharing Patient Awareness Program” Blueprint created by the Health Excellence Select team, tailored to meet the needs of your practice. Your “Patient Awareness Program” may include: Join Us Today (855) 816-4650x404 Find out more – www.AcceptingProvider.com For More Information Call – (855) 816-4650x404 or email [email protected]
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