Contact & Member Resources
Everything you need to understand your PHS coverage — including who to call, how to read your ID card, and how to submit claims.
Everything you need to understand your PHS coverage — including who to call, how to read your ID card, and how to submit claims.
Deductibles: $2,000 / $4,000
OOP Max: $3,000 / $10,000
Deductibles: $4,000 / $8,000
OOP Max: $6,000 / $20,000
Primary Care: 0% / 10% / 40%
Specialist: 0% / 10% / 40%
15% / 30% / 50% / 30%
Three tiers reflect the PHS network structure. 0% = PHS Community Partner (preferred). 10% = standard in-network provider. 40% = out-of-network.
Providers flagged as PHS Community Partners are Medicare Plus contract providers. Choosing them first means no cost share for Primary Care and Specialist visits.
Present your BIN 610852, GRP CAPLRX1, and PCN CHM at any participating pharmacy. For help, call Capital Rx at (844) 622-7798.
Failure to present your ID card at the time of service may result in providers not applying contractual discounts. Keep it accessible at every visit.
Providers submitting electronic claims use Payer ID 04320. Paper claims go to: PO Box 845, Arnold, MD 21012.
Prior authorization is required before certain services. Failing to obtain pre-certification may result in a reduction of benefits. When in doubt, call before the service.
Required for any planned hospital admission. Call at least 7–10 days in advance, or within 48 hours of an emergency admission.
Any surgical procedure performed outside a physician's office requires pre-certification prior to the procedure date.
Your physician must call for pre-treatment authorization for advanced imaging and high-cost radiology services.
Any drug or infusion above $500 per dose, and all cancer treatment, requires physician-initiated pre-authorization.
Providers and members can submit claims electronically or by mail. Use the information below to ensure claims are routed correctly.
04320
PO Box 845
Arnold, MD 21012