Answers to some FAQs about Encore

Here’s the what, the who, the how and the why regarding some of our most frequently asked questions.


Q. What is Encore Health Network?
A. Encore Health Network helps hold down the cost of your medical plan by contracting with physicians and hospitals and other providers for a discount on the services they render. Encore provides access to more than 31,000 physicians and 170 hospitals and ancillary medical facilities to our members through self-insured companies, health and welfare trusts, and third-party administrators. Encore is not an insurance company. Encore does not pay any medical claims or bills.

Q. Who do I call for eligibility, benefits, ID cards, referrals, and pre-certifications?
A. Because we are not an insurance company, Encore cannot provide any of this information. Your health plan administrator or your payor (health insurance company) can assist you with this information request and answer any related questions. Please note that your human resources department can provide you payor contact information; or consult the payor number listed on your Encore Health Network member ID card or health plan booklet.

Q. How do I know where to send claims/bills if the correct address is not on the ID card?
A. Contact your health insurance company, health plan administrator, or your human resources department for assistance.

Q. Why do claims sometimes need to be sent to Encore before going directly to my health insurance company?
A. If indicated on your Encore membership card, claims sometimes need to be sent to Encore to be repriced because the network provider that was used has a contract or fees were negotiated based upon provisions of the plan.

Q. How do I know which hospitals or physicians are in the Encore network?
A. Your plan administrator or human resources department can provide a printed Encore Health Network Provider Directory for your assistance. In some cases (per your request), Encore can mail you a complete Provider Directly free of charge. Or you may conveniently access Encore’s online Provider Directory at encoreconnect.com.

Q. Can I use only the physicians and hospitals that participate in the Encore Health Network?
A. No. However, please keep in mind that you receive better coverage if you use an Encore provider. If the physician or hospital is not in the Encore network, your benefits will be lower, meaning you will have to pay a larger portion of the cost of the medical services you receive. Your health plan or insurance company can assist you with this process and should be consulted for benefits and eligibility information regarding the use of non-participating providers.

Q. What is the difference between out-of-network and in-network deductibles?

A. Out-of-network providers do not participate in the Encore Health Network. Therefore, they have not agreed to keep their charges within your healthcare plan’s allowable amount. Out-of-network providers may charge any amount for services provided. Of course, you have the option of visiting an out-of-network provider at any time. However, you should know that you are responsible for paying any amount above that of your health insurance plan’s out-of-network allowable amount for services or supplies you receive. Out-of-network expenses may not count toward your deductible or maximum out-of-pocket expense. You are also responsible for the copay required at the time of service.

Q. How can I check to see if my medical claim has been re-priced?

A. Just call Encore Customer Service toll free at (888) 574-8180. In Indianapolis, dial (317) 621-4250.

Q. I know Encore is my healthcare network. But who is my health insurance company?

A. Your health insurance company should be identified on your Encore member ID card. Please feel free to call us at the Encore phone numbers listed above for any clarification you might need.

Q. How can I find out what laboratory services are in the Encore network?

A. Simple. Just check out Encore’s . If you have any questions, please contact Encore Customer Service toll free at (888) 574-8180. In Indianapolis, dial (317) 621-4250.

Q. I’m going on vacation out of state. If I need to see a physician or go to a hospital, does Encore provide out-of-state coverage?

A. It depends on what states you are traveling through and your vacation destination. Encore has a small number of in-network providers in Kentucky, Ohio, and Illinois. We advise you to contact your health insurance company directly to see how out-of-state coverage is handled according to your plan.

Q. I have some questions about the Explanation of Benefits (EOB) and medical bills I recently received. Can Encore answer my questions, or should I get in touch with my health insurance carrier directly for assistance?

A. Please contact your health insurance carrier. Your payor will be able to help you with any questions about your EOBs and billing.

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If you have any questions, please contact webmaster@encoreconnect.com
Special Authorization is required to access the Payor Updates.
Please contact one of the following Account Executives for access:
· Holly Joyce at (317) 621-4263 or hjoyce@encoreppo.com, or
· Kevin McShay at (317) 621-4264 or kmcshay@encoreppo.com

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Notice

Encore has entered into a new arrangement for chiropractic services with HSM, Inc. HSM, Inc., a Minnesota-based specialty network services organization, will administer the chiropractic network for our Encore and Encircle service areas.

HSM will directly hold contracts with all participating chiropractors; therefore, there are some changes of which you should be aware. Regarding billing, chiropractors will now send their claims directly to HSM. HSM will collect the data in their system, including treatment plans for case management, and forward claims to the appropriate Encore payor. The payor will send all payment directly to HSM, who will in turn reimburse the chiropractor according to the negotiated rates.

If you are interested in becoming a participating chiropractor in the Encore Health Network, please contact HSM at 800-432-3640 or visit their web-site at www.hsminc.com.

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Current Worker's Comp Payors

Arete USA D/B/A The Covenant Companies
HealthSmart
HFN, Inc
Indiana University
InterPlan Health Group
IU Health Plan
MCMC LLC
ASU Group
Major Hospital
ACS CompIQ Corporation, A Xerox Company

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Payor and Provider Resources

Payors please contact Account Executive Kevin McShay at (317)621-4264 or kmcshay@encoreppo.com for access.

For any provider issue, please contact Provider Contracting Coordinator, Tina Bilodeau at (317)621-4269 or tbilodeau@encoreppo.com.