For Providers
Verify eligibility.
To verify eligibility, exclusions, and covered services, please call our Member Services team.
Monday - Friday 7am-5pm MT
Timely filing deadline = 90 days
Prior authorization.
We do not currently require prior authorization. However, we encourage you to contact us for detailed information about what services are covered under your patient's plan.
Network
No network restrictions
Most health plans are open network. For a very few plans, we may use the MultiPlan/PHCS Specific Services network. Please call
888-920-7526 to verify.
Care Coordination
We will work with any provider. Please call our Care Coordination team at 435-275-4492.
Claims
Electronic
Payer ID: 65241
First Class Mail
Planstin (SDS)
PO Box 21747
Eagan, MN 55121
MEC plan information for providers.
Minimum Essential Coverage (MEC) plans cover preventive care and basic services. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member's plan documents at the time of service. Listed below is an example of covered benefits for some of the plans we manage to give you an idea of how a claim from your office might be paid.
This information is for example purposes and does not guarantee eligibility or payment.
Appeals
Documentation
A provider, member, or their authorized representative has 180 days following receipt of an Adverse Benefit Determination within which to request a Standard Internal Appeal. You may request an appeal by sending a written request.
All Comments, documents, records, and other information submitted and relating to the claim will be reviewed without regard to whether such information was submitted or considered in the initial Adverse Benefit Determination. The appeal will be conducted by an appropriately named fiduciary of the plan who is neither the individual who made the Adverse Benefit Determination that is the subject of the appeal, nor the subordinate of such individual. The named fiduciary will conduct a completely new review, not considering the initial determination.
Written Request Address
Planstin Administration
ATTN: Claims/Appeals
1506 S. Silicon Way, Suite 2B
St. George, UT 84770
Required Information
Please include the following information in your written request:
- Member Name & Date of Birth
- Member ID & Group Number
- Claim Number
- Date of Service
- Name of Provider
- Reason for appeal
Expedited Appeals
Expedited AppealsIf your patient's situation meets the definition of "urgent" under the law, you may ask for and Expedited Appeal. If you, as their healthcare provider, believe that the patient's condition could seriously jeopardize their life, health, or ability to regain maximum function or would subject them to severe pain that cannot be adequately managed without care of treatment by waiting up to 30 calendar days for a decision, you may ask for an Expedited Appeal.
Expedited Appeals may be requested in writing or by calling our Member Services team at 888-920-7526. If you make a request in writing, see the mailing address and information requirements above.
We will respond to requests for an Expedited Appeal within 72 hours from the date we receive the request.
Independent External Review
If you still disagree with our decision and all the plan's internal appeal processes have been exhausted as outlined in the member's plan documents, you are entitled to request an Independent External Review of our decision.
You or your authorized representative must file the request within
4 months after the date of receipt of a notice of an Adverse Benefit Determination or Final Internal Adverse Benefit Determination.
Verify Eligibility
To verify eligibility, exclusions, and covered services, please call our Member Services team.
Monday - Friday 7am-5pm MT
Benefits that actually benefit people.
Employee benefits for all.