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INDIVIDUAL MARKETPLACE Network Provider Directory · PDF file Network Provider Directory INDIVIDUAL MARKETPLACE ... programs established by Titles XVIII and XIX of the Social Security

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  • Network Provider Directory INDIVIDUAL MARKETPLACE

    This directory of network health care providers is

    subject to change as new providers are added or

    discontinued. You may also check our website at

    www.pchp.net or call Piedmont customer service at

    434-947-4463 / 800-400-PCHP.

    — www.pchp.netCommunity Partners For Quality Healthcare

  • This Directory identifies physicians, hospitals and ancillary service providers participating in the provider network at the time it is printed. This Directory is subject to change as cur- rent network participants change their participation status, move or retire. You should always ask the doctor, hospital or other health care provider each time you request health services if they participate with the Piedmont Community Health Plan network.

    For participant status updates, please check our website at www.pchp.net or call Piedmont Community Health Plan at: 1-434-947-4463 or 1-800-400-7247.

    OUR COVERAGE AREA

    Piedmont does not use quality measures, member experience measures or cost-related measures to select practitioners.

    Piedmont does not use use quality measures, member experience measures, patient safety measures or cost-related measures to select

    hospitals.

    Piedmont Community HealthCare does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity,

    sexual orientation or health status in the administration of the plan, including enrollment and benefit determinations.

  • Introduction and Welcome

    As Central Virginia's very own managed healthcare organization, Piedmont Community HealthCare, Inc. (Piedmont) is dedicated to providing its members with access to medical care that represents the highest standards for quality and efficiency. We operate on the principle that your personal physician should manage your healthcare and that there should be close cooperation between healthcare providers, patients and the health plan.

    This Directory identifies physicians, hospitals and ancillary service providers participating in the provider network at the time it is printed or posted to the Piedmont website; however, it does not guarantee that the provider is still in the network or accepting new patients at the time of your visit. It is the member’s responsibility to know which providers are participating providers in Piedmont’s network. You should always ask the doctor, hospital or other health care provider each time you request health services if they participate with the Piedmont Community HealthCare, Inc. network.

    For the latest participant status updates, please check our website at www.pchp.net or call Piedmont at 434-947-4463 or 800-400-7247.

    As a Piedmont member, you will receive the highest level of benefits at the lowest out- of-pocket expense to you when you use a participating provider of the Piedmont Provider Network. If you choose to receive care from a provider who does not participate in Piedmont’s network, you will be subject to a reduced level of benefits called out-of-network benefits, you may be subject to balance-billing by that provider, and you will be responsible for filing their claims. You should refer to your Plan documents for detailed information concerning your benefits.

    Providers

    This Piedmont provider network contains primary care, specialist, and mental/behavioral health providers. In this Directory, Physician means a person who is certified or licensed under the laws of the state to provide medical services within the scope of such certification or licensure, such as a Doctor of Medicine or a Doctor of Osteopathy. Any other health care provider or allied practitioner who is mandated by state law and who acts within the scope of their license will be considered on the same basis as a Physician. Physician includes Primary Care Physician (PCP), Specialist Physician, nurse practitioner, physician assistant, and any other qualified licensed clinician.

    Piedmont has created this network to ensure that our members have a sufficient number and type of providers to assure that all services will be accessible without unreasonable delay and within reasonable distance and time parameters.

  • A Credentialing Program has been created to ensure that licensed health care providers meet the minimum credentials and performance standards for participation in Piedmont’s network. The credentialing and re-credentialing processes encompass a thorough review and validation of a practitioner or provider’s credentials and qualifications, including, but not limited to, malpractice history, licensure status, and quality of care issues. In conjunction with established credentialing policies and procedures, Piedmont utilizes the most up-to-date NCQA and CMS standards. These standards are intended to comply with Commonwealth of Virginia law.

    Piedmont’s Medical Affairs Committee is responsible for examining the qualifications and practice patterns of individual applicants and re-applicants. The Medical Affairs Committee makes the final determination regarding provider membership in the Piedmont network.

    Piedmont does not use quality measures, member experience measures or cost- related measures to select practitioners.

    Hospitals/Facilities

    Hospital shall mean a skilled medical facility or hospital licensed under the appropriate state law as a general acute care facility and eligible for participation under the programs established by Titles XVIII and XIX of the Social Security Act.

    Piedmont has created this network to ensure that our members have sufficient access to quality hospitals and acute care facilities without unreasonable delay and within reasonable distance and time parameters.

    Before Piedmont contracts with an organizational provider such as a hospital, Piedmont will assess that the organizational provider is in good standing with state and federal regulatory bodies and confirms accreditation by an appropriate accrediting body. Acceptable regulatory and accrediting bodies for hospitals and acute care facilities are The Joint Commission (TJC), Healthcare Facilities Accreditation Program (HFAP), Center for Improvement in Healthcare Quality (CIHQ), and National Integrated Accreditation for Healthcare Organizations (NIAHO).

    Piedmont does not use quality measures, member experience measures, patient safety measures or cost-related measures to select hospitals.

  • H1659_Nondiscrim2017_NM PCHP.NDN (Iss.2016.12.13)

    Nondiscrimination Notice

    Piedmont Community Health Plan, on behalf of itself and its affiliates (hereafter “Piedmont”) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Piedmont does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

    Piedmont:

    Provides free aids and services to people with disabilities to communicate effectively with us, such as:

    o Qualified sign language interpreters

    o Written information in other formats (large print, audio, accessible electronic formats, other formats)

    Provides free language services to people whose primary language is not English, such as:

    o Qualified interpreters

    o Information written in other languages

    If you need these services, contact Customer Service at 1-800-400-7247 (TTY: 711)

    If you believe that Piedmont has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Compliance Officer by mail or phone:

    Compliance Officer Piedmont Community Health Plan 2316 Atherholt Road Lynchburg, VA 24501 434-947-4463 (TTY: 711)

    You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

    U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, DC 20201 1-800-368-1019, 800-537-7697 (TDD).

    Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

  • H1659_Nondiscrim2017_NM PCHP.NDN (Iss.2016.12.13)

    PIEDMONT COMMUNITY HEALTH PLAN English ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-400-7247 (TTY: 711). Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-400-7247 (TTY: 711). 한국어 (Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-

    800-400-7247 (TTY: 711) 번으로 전화해 주십시오. Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-400-7247 (TTY: 711).

    繁體中文 (Chinese) 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-800-400-7247 (TTY:711)

    1-800-400-7247ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم (Arabic)العربية (.711)رقم هاتف الصم والبكم: