Member Information

• There is important information available in our Member Guide that may be valuable to you. The Member Guide includes information on:
  
  • Language/interpreter services
  
  • New technology assessment/evaluation
  
  • Pharmacy program
  
  • Obtaining a Primary Care Physician (PCP), specialist, behavioral healthcare services and hospital services
  
  • Obtaining emergency/urgent care services whether in or out of the network and during or after normal business hours, including an inpatient admittance
  
  • How and when to submit an appeal or complaint, including the independent appeals process
  
  • How to submit a claim for covered services
  
  • Benefit restrictions outside of the network
  
  • Services included and excluded from your coverage, including co-payments and other charges for which members are responsible
  
  • Enrollee Rights and responsibilities
  
  Click here to view the Member Guide
  
  

As a valuable AultCare member, you have access to information regarding your health plan. This information is available on our website.


Our searchable provider directories include information about our network of healthcare professionals. You can search by network, specialty, name, hospital affiliation, languages are spoken, gender, zip code, county, and whether or not they are accepting new patients. Click here to visit our provider directory.

Access to eligibility, benefit, and claims payment information can be found by logging into your online account. Click here to log into your account or sign up for an account.

Notice of Privacy Practices

Pre-certification/Utilization Review Policy

AultCare communicates your appeal rights in many ways to ensure each member understands their rights. Your plan documents, your Explanation of Benefits, and a benefit denial letter describe your appeal rights as an AultCare member. Every member is granted the same first level of appeal rights or internal review. If you initiate a first-level appeal and we uphold our original decision, your resolution letter will outline your additional appeal rights, which may include external review rights. Your rights vary depending on state and federal laws.

For more information on your appeal rights, you can review your plan document, Explanation of Benefits, benefit denial letter, appeal resolution letter or contact AultCare customer service for a copy of your appeal procedure at 330-363-6360 or toll-free 1-800-344-8858.

AultCare offers Population Health Management and Care Coordination programs to its members at no cost. To learn of the programs and services we offer, you can visit our webpage dedicated to this information here.

If you would like more information regarding these programs, please contact customer service at 330-363-6360 or 1-800-344-8858.

Within our member guide, you can learn more of your rights and responsibilities as a member. Quality healthcare benefits are responsibilities shared with your doctors and your plan. We want you to know your rights and responsibilities. Please read your plan documents for a full description. If you have a question, concern,  or a recommendation for how AultCare could improve its policies for promoting enrollee responsibilities and rights, contact us through our website at www.aultcare.com or call customer service at 330-363-6360 or toll-free at 1-800-344-8858.

Click here to view your Enrollee Rights and Responsibilities within our member guide.

You also have access to the pharmacy directory, formularies, recall information, and prior authorization/step therapy/quantity limit information. All of this important pharmacy information can be found here.

‍As an AultCare member, you have the ability to get answers to your questions regarding the Utilization Management decision-making process. You also have the right to learn the status of a request.

• You can speak with a Utilization Management staff member Monday through Friday from 8:00 am to 4:30 pm.
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• Utilization Management staff members are able to receive inbound communication after normal business hours via voicemail or fax.

• Staff members typically send outbound communication regarding Utilization Management inquiries and requests during normal business hours.

• Utilization Management staff members will identify themselves by name, title, and organization when initiating or returning phone calls.

• TTY/Hearing impaired and language assistance is available for members and providers. See below for contact information.

Utilization Management decisions are based on the appropriateness of care and services as well as eligibility and coverage of requested services. AultCare does not reward practitioners or other individuals for issuing denials of coverage or service of care and there are no financial incentives for Utilization Management decision makers that result in underutilization. The specific criteria used in decisions are available to you at no cost by contacting the Utilization Management department at the phone number listed below and a physician, nurse, or pharmacist reviewer is available to discuss Utilization Management denial decisions.

Help us stop Fraud, Waste, and Abuse. Report instances such as:


• Services are rendered at an unlikely location
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• Provider’s care plans reflect the same treatment
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• Provider’s office visits are billed at the same level
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• Provider bills for services that were never provided
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• Provider’s notes do not support the treatment that was rendered
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• Member reports frequently lost prescriptions or DME items
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• Member has identical prescriptions from multiple providers