Member Notice
Get a printable version of this Member Notice (PDF) to share or for reading on the go.
- We are here to help you!
- Member Services numbers for your county
- Self-management tools
- PerformCare non-incentive statement
- Quality improvement process
- Privacy rights statement
- Your rights
- Your choices
- Our uses and disclosures
- How we protect your information
- Out-of-network care
- If you need urgent or emergency services
- Out-of-town emergency care
- Member rights
- Self-referral for care management
- Provider information
- Complaints and grievances
- What is a complaint?
- What is a grievance?
PerformCare is available to answer questions you have about your behavioral health plan, your services, and your benefits. You can call any time! We have trained staff who can help you if you need behavioral health services or if you have any questions about your plan.
We can help you:
- Find services.
- Find out what is covered.
- Find information about providers.
- Get language assistance.
- Know what to do in case of an emergency.
- File a complaint or grievance.
These and other topics can be found in your Member Handbook (PDF). You can also call Member Services to ask for a copy.
Member Services numbers for your county
Capital Area
- Cumberland, Dauphin, Lancaster, Lebanon, and Perry counties: 1-888-722-8646 (TTY/TDD 1-800-654-5984) or PA Relay 711
NorthCentral Region
- Franklin and Fulton counties: 1-866-773-7917 (TTY/TDD 1-800-654-5984) or PA Relay 711
PerformCare cares about our members’ health and wellness. Our website has information about tools that can help you manage your own physical and behavioral health issues. Taking an active part in managing your own health problems is important to recovery. PerformCare has provided some information and tools to help you screen for problems, reduce your risk, manage your symptoms, and improve your health.
PerformCare also offers links to other helpful websites. The self-management tools are based on the latest research and are updated regularly. PerformCare also asks for member input and listens to what members have to say. We offer information on topics such as recovery, stress, depression, smoking cessation, domestic violence, and childhood obesity. Our materials are also available in paper form and can be requested by calling Member Services.
PerformCare non-incentive statement
PerformCare and the people who work for PerformCare will not say “no” or reduce the number, amount of time, or type of a service a member needs because of any promised gift or money. In utilization management (UM), we use a set of guidelines to help us decide if a requested service is necessary. This is done to make sure PerformCare members get the right services and supports at the right time, in the right amount, and for as long as they need them. This is the sole reason for our decisions.
We do not give money or gifts to the people who work for PerformCare and handle the UM decisions, including saying “no,” and limiting or stopping services:
- People who work for PerformCare make UM decisions by looking at whether the service and care are right for the member and whether the member joined HealthChoices.
- PerformCare does not give gifts to doctors or other people for saying “no” to a member’s coverage or service.
For members and families who want more information about what PerformCare does to improve both service and care, please check out the Quality Improvement (QI) program. You can learn more about the program in several ways.
You can:
- Call PerformCare and speak to someone in the QI department. A QI staff person can be reached by using the toll-free number assigned to your county. If you are deaf or hard of hearing, call TTY/TDD 1-800-654-5984 or PA Relay 711.
- Visit the QI section of our website.
- Request a paper copy of the QI Executive Summary, which explains goals, projects, and outcomes, by contacting a Member Services specialist at the number for your county. If you are deaf or hard of hearing, call TTY/TDD 1-800-654-5984 or PA Relay 711.
PerformCare’s Notice of Privacy Practices (PDF) describes how medical information about you may be used and disclosed and how you can access this information. Information about the notice is in the back of your Member Handbook (PDF). Call PerformCare at the number for your county if you have any questions about the notice or how to obtain a copy.
You have the right to:
- Get a copy of your health and claims records.
- Correct your health and claims records.
- Request confidential communication.
- Ask us to limit the information we share.
- Get a list of those with whom we’ve shared your information.
- Get a copy of this privacy notice.
- Choose someone to act for you.
- File a complaint if you believe your privacy rights have been violated.
You have some choices in the way we use and share information as we:
- Answer coverage questions from your family and friends.
- Provide disaster relief.
- Communicate through mobile and digital technologies.
- Market our services and sell your information.
We may use and share your information as we:
- Help manage the health care treatment you receive.
- Run our organization.
- Pay for your health services.
- Administer your health plan.
- Coordinate your care among various health care providers.
- Help with public health and safety issues.
- Do research.
- Comply with the law.
- Respond to organ and tissue donation requests and work with a medical examiner or funeral director.
- Address workers’ compensation, law enforcement, and other government requests.
- Respond to lawsuits and legal actions.
How we protect your information
We are dedicated to safeguarding your protected health information (PHI). We set up policies and procedures to make sure your PHI is secure. We keep your oral, written, and electronic PHI safe using physical, electronic, and procedural means. These safeguards follow federal and state laws.
Some of the ways we keep your PHI safe include offices that are kept secure, computers that need passwords, and locked storage areas and filing cabinets. We have written policies and procedures requiring our employees to protect PHI. The policies limit access to PHI to only those employees who need the data to do their jobs.
Employees are also required to wear ID badges to keep unauthorized people out of areas where sensitive data such as PHI is kept. Also, where required by law, our affiliates and non-affiliates must protect the privacy of data we share in the normal course of business. They are not allowed to give PHI to others without your written OK, except as allowed by law.
If you are already getting behavioral health treatment and are already enrolled in HealthChoices, you will probably not need to go to a different provider. Ask your provider if they are part of PerformCare’s network. If your provider is in the network, you do not need to do anything else. If they are not in the network, call PerformCare and tell us. You can also find the PerformCare number for your county in the Important Phone Numbers section in the back of your Member Handbook (PDF).
Remember: PerformCare will make every effort to ensure our provider network can provide all covered services for all members, including special-needs populations. PerformCare will use out-of-network providers if the available network cannot provide covered services under any of the following conditions:
- The member has special needs that cannot be accommodated by the network.
- Network services are not accessible within time or geographic standards, but are available through a qualified non-network provider.
- The member has experienced a behavioral health emergency while outside of PerformCare’s service area.
PerformCare will contract on a case-by-case basis with non-participating providers, using established rates for the provision of services.
If you are unsure if your provider is in the PerformCare network, call us and we can tell you. Our goal is to not interrupt your treatment.
If you are being treated by a provider and become enrolled with HealthChoices while you are getting treatment, PerformCare may be able to pay the provider for the service for an amount of time known as a “transition period.” This allows for transition time before asking you to change to another provider who is in the PerformCare network. Transition payments can only be paid to Pennsylvania Medicaid-enrolled providers.
If you need urgent or emergency services
An urgent situation means you or another responsible person thinks you need care before the situation turns into an emergency.
You can get urgent care within 24 hours. Here is what to do:
- Call PerformCare at the number listed for your county.
- Contact any PerformCare provider.
- Call the County Crisis Intervention Line. To find the crisis numbers for your county, go to the Important Phone Numbers section in the back of your Member Handbook (PDF).
If the provider cannot see you within 24 hours, they will contact PerformCare. We will help you get the care you need.
If you have a life-threatening situation you must act quickly. Call 911. You may also go to an emergency room at a hospital. You do not need to call us first.
If you are away from home and have a behavioral health emergency or a life-threatening situation, go to a hospital emergency room. We will pay for the service if you have to go into the hospital. Please let the hospital know you are a member of PerformCare and which county you live in. Ask the hospital to call PerformCare as soon as possible to let us know about the emergency. You should not get a bill. Please call us right away if you do get a bill.
As a member of PerformCare, you have rights and responsibilities, listed below. We invite you to call us using the toll-free number for your county if you need help understanding your rights and responsibilities. Your rights and responsibilities are also in your Member Handbook (PDF).
You have the right to:
- Receive information. Each member has the right to receive information about PerformCare, our policies and procedures, our services, our practitioners and providers, and your rights and responsibilities.
- Dignity and privacy. Each member is guaranteed the right to be treated with respect and with due consideration for their dignity, right to privacy, and right to confidentiality.
- Receive information on available treatment options. Each member is guaranteed the right to receive information on medically necessary available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand, regardless of the cost or benefit coverage.
- Participate in decisions. Each member is guaranteed the right to participate in decisions regarding their behavioral health care, including the right to refuse treatment. You can be a part of your treatment team by asking questions and getting answers before and during your treatment, and by involving family members and other important people in your treatment.
- Refuse treatment. Each member (as part of making decisions regarding their care) can refuse treatment. You have the right, under these circumstances, to get an explanation of what may happen if you don’t get treatment.
- Ask for a therapist who understands your language and culture.
- Receive needed services at convenient times and places.
- Receive emergency care within one hour.
- Receive urgent care within 24 hours.
- Receive care within seven days of your request for routine care requests.
PerformCare providers must provide services within seven days for routine (non-emergency) needs, within 24 hours for urgent situations, and within one hour for an emergency situation.
Self-referral for care management
PerformCare’s Care Managers help us provide the best care for our members. Care Managers work with adults and children. They also work with therapists, doctors, social workers, and others involved in a member’s care. Care Managers aren’t just in charge of managing care for members. They make sure that members are getting the services that fit their needs. They also make sure that members are getting the right kind and amount of care. At times, they may call the member to talk about how things are going.
If you feel you would benefit from care management, please enter a request using the Secure Contact Form.
This form is secure and will only be seen by PerformCare staff. This email box is not monitored 24 hours per day. If you or your family member is in an emergency situation, particularly situations involving risk of harm to self or others, please call 911 or go directly to an emergency room for assistance.
If you are deaf or hard of hearing, please note this in the comment section of the form so the Care Manager can use the PA Relay when they call you. If you or your family member needs an interpreter, please note this and the language the member speaks in the comment box also.
If you do not have access to a computer, you can call the Member Services number in your area and request to be referred to Care Management.
As a member of PerformCare, you have the right to obtain care from behavioral health providers. You can access providers by using our online provider directory or by calling the Member Services number for your area. You can ask for information about the provider, including:
- Name, address, and phone number.
- Professional qualifications.
- Specialty.
- Board certification status.
If you have special needs, such as a language request, or are hard of hearing, PerformCare can help you find the right provider. PerformCare will help you find the closest provider to your home.
We pay the bills for services we have approved. You are not supposed to pay for any behavioral health services that we approve. If you ever get a bill from our providers, please call and tell us. You can also send the bill to:
PerformCare
8040 Carlson Road
Harrisburg, PA 17112
If you are unhappy with PerformCare or your provider or you do not agree with a decision PerformCare made about the delivery of your care, you can do something about it by filing a complaint or grievance.
A complaint is when you tell us you are unhappy with PerformCare or your provider, or you do not agree with a decision made by PerformCare. Here are some examples of a complaint:
- You are unhappy with the care you are getting.
- You are unhappy that you cannot get the service you want because it is not a covered service.
- You are unhappy that you have not received services you have been approved to get.
A grievance is what you file when you do not agree with PerformCare’s decision that a service that you or your provider asked for is not medically necessary or appropriate. You can file a grievance if PerformCare does any of these things:
- Denies a service you have requested fully or denies part(s) of a service you requested.
- Denies, suspends, or terminates a service you have been receiving.
- Approves less than what was asked for.
- Approves a different service from the one that was asked for.
PerformCare’s providers must provide services within one hour for emergencies, within 24 hours for urgent situations, and within seven days for routine appointments and specialty referrals. If a treatment plan is approved, services must be provided according to the prescribed treatment plan.
You can call or write PerformCare to find out what you can do if you are unhappy with PerformCare, or if your provider or you do not agree with a decision made by PerformCare.
Staff is available to tell you what your rights are and what actions you can take if you are unhappy with your care or your provider, or if you are dissatisfied with a decision PerformCare made.
If you would like to know more details or have questions about complaints, grievances, and fair hearings, call PerformCare Member Services for your area or refer to your Member Handbook (PDF).
Capital Area
Cumberland, Dauphin, Lancaster, Lebanon, and Perry counties
Member Services
1-888-722-8646 (TTY/TDD 1-800-654-5984) or PA Relay 711
NorthCentral Region
Franklin and Fulton counties
Member Services
1-866-773-7917 (TTY/TDD 1-800-654-5984) or PA Relay 711
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