Important Tips and Reminders

Covering Physicians:
Please remember that as a US Family Health Plan provider you have agreed to provide continuous 24-hour, 7 day a week access to care for US Family Health Plan Members.  If you are a PCP, you are responsible for arranging for a covering PCP when you will not be available, and for assuring that the covering physician will abide by plan policies and procedures.  During a period of unavailability or absence from the practice, please be sure to notify the Network Representative for your network 5 to 7 days before your leave with the name of your covering physician and contact information. 

TIN (Tax Identification Number) Changes:
We always ask that you please contact the Plan if you make any changes to your service addresses, phone numbers, billing address, etc.; however, it is also extremely important to remember to contact the Plan when there is a change in the Tax Identification Number (TIN) you use for submitting claims.  The TIN you use directly affects your payment from the Plan. If the TIN you use changes and the Plan is not notified, you will most likely experience disruption in the processing of your claims, which as you know, ultimately affects your reimbursement.  For this reason, we strongly urge you to notify the Plan as soon as you know your TIN will be changing, and in advance of claims submissions with the new TIN, so that our system and records can be updated accordingly.  (Depending on your TIN change, you may also be asked to sign a new agreement with the Plan to reflect the new business entity’s name and information.) 

When you change your TIN, you can:

  1. Notifying the Network Representative for your network of the change by sending a letter that indicates the new TIN and the effective date of the change and attaching a copy of your new W-9 form or a copy the IRS 187C letter.  This information can be faxed directly to 281-936-7915 or mailed to following address:

    US Family Health Plan
    2707 North Loop West
    Houston, Texas 77008
    Attn: Provider Relations Department
  2. Or, you can complete the “Change of Information Request Form” located under the Provider Roster section of our website, include a copy of your new W-9 form or the IRS 187C Letter and fax both items to 281-936-7915 to the attention of the Provider Relations Department. 

Please remember to send your information prior to the changing of your TIN and include the effective date of the change and a copy of your new W-9 or your IRS 187C Letter.  We will not be able to make the change in our system without this information.

If you have questions regarding a change in your TIN, please be sure to contact the Network Representative for your network. 

Changes in Provider Information

Please remember to notify the Plan when the following occurs:

  • There is a change in your physical address/service address(es),
  • Addition of a new service address/location,
  • There is a change in your billing address,
  • There is change in your phone or fax number,
  • There is a change in your TIN (Tax Identification Number),
  • A new physician is added to your practice,
  • You leave or change practices,
  • You will be leaving the area or closing your practice (Note:  a 90-day prior written notification is required when leaving the Plan.),

Oftentimes, the Plan is notified after a change has occurred which, depending on the change, can cause such challenges as disruptions in payment to the provider or incorrect information being disseminated to providers and/or members. Correct information regarding your practice or facility is extremely important, so we ask that you please notify us as soon as you know that these changes will be occurring so that we can reflect those changes in our systems and records. 

To assist you in your notification process, we have created a “Change of Information Request Form.”  The form is located on our website under the “Provider Directory” section.  The form can be used for changes related to your physical or service addresses, your phone numbers, your billing address or your TIN.  You can always submit the information on your letterhead as well to the following address or fax number:

US Family Health Plan
2707 North Loop West
Houston, Texas 77008
Attn: Provider Relations Department

When adding a physician to your practice or leaving a practice, please contact the Network Representative for your network.  Your representative will assist you with these changes.  

If you are leaving the area, closing your practice, or wish to terminate with the Plan, per your agreement, you will need to provide written notification 90 days prior to leaving the Plan.  You can submit your notification to the address listed above or you can fax your notification to 281-936-7915 to the attention of the Provider Relations Department.  

If you have questions regarding any of the above, please be sure to contact the Network Representative for your network or you can e-mail your questions to  HYPERLINK "mailto:ProviderRelations@usfhpchristus.org" ProviderRelations@usfhpchristus.org.

Billing Medicare

A provider may not bill Medicare for US Family Health Plan covered benefits provided to a US Family Health Plan member.  Should a provider bill Medicare for US Family Health Plan covered services, the US Family Health Plan is required to investigate and if appropriate disenroll the member from the Plan.
        
Should a member possessing Medicare benefits disenroll from the plan, their Medicare benefits are automatically reinstated.  (Please note:  if a member is age 64 and younger, care reverts to Tricare Standard.)

End Stage Renal Disease- Kidney Failure:

  • Special rules apply for the coverage and payment for maintenance kidney dialysis.  Members, regardless of age, diagnosed with End Stage Renal Disease (ESRD) become eligible and must apply for Medicare coverage.  US Family Health Plan will provide full coverage for ESRD patients for up to the first 90 days depending on the method of dialysis.  After the 90th day of maintenance dialysis, Medicare replaces US Family Health Plan as the primary insurance for ESRD related care.  US Family Health Plan becomes secondary to Medicare thereafter, and covers coinsurance charges for which patients would otherwise be responsible.
  • Part A Medicare insurance is the basic coverage provided under Medicare and Part A insures inpatient dialysis related services.  Part B Medicare insurance covers doctor’s services, outpatient hospital services, and many other health services and supplies.  Most of the services and supplies needed by people with permanent kidney failure are covered by Part B.  Part B has monthly premiums that must be paid by the member.  Although Part B is optional, for ESRD patients it is imperative.  Enrollment fee is waived for members with Medicare Part B.  ESRD patients who do not obtain Part B insurance, will lose their US Family Health Plan benefit, and will be responsible for all charges related to ESRD.
  • Members who have had Medicare before developing permanent kidney failure and have not signed up for Part B, can apply for this protection.  Those who already have Part B but are paying a premium penalty for late enrollment can have their premium amount reduced to the current basic rate.  Members can obtain more information by contacting the Social Security Administration. 

Mental Health Services

Mental health services are available for US Family Health Plan members through APS (American Psychiatric Systems).  Members can self-refer to an in-network mental health provider up to 8 times by calling (800) 406-0022.  For a list of covered services, please see Chapter 6 of your Provider Manual.

Family Planning

Family planning services are covered as a part of the US Family Health Plan package of benefits, however, since this benefit conflicts with Catholic Directives and cannot be provided by CHRISTUS Health facilities, Adaptis Health Inc., administers the family planning benefit for US Family Health Plan members.
    
Adaptis Health, Inc. contracts directly with physicians to provide family planning services and services are paid directly through Adaptis Health, Inc. If you have questions regarding Adaptis Health, Inc., you can contact them directly at (732) 562-2822 or you can contact the US Family Health Plan Network Representative for your network.
 
For family planning services, members should be directed to contact the Adaptis Health Inc., Member Services Department at 1-800-254-0130. 

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