Resources & Tools
Frequently Asked Questions
The following responses are "general" in nature. For complete benefit
information refer to your Physician Manual. If you have additional questions,
please e-mail our Claims & Customer Service Center at info@connecticare.com
or call at 1-800-828-3407.
Registration
Who can enroll in ConnectiCare's secure provider online self-services (Provider Connections)?
My tax ID number is not being recognized, but I do participate with ConnectiCare. What should I do?
Is there a cost associated with this service?
What is the role of the Account Administrator?
How do I register?
Do I need to register separately and set up a separate account for each provider I work for?
Our office is currently using similar services offered through Medavant. Do we need to continue to use Medavant if we register with Provider Connections?
I'm the administrator for my office, but would like to have a back up for when I am not in the office. Can I appoint additional people in my office as an administrator?
What's Available?
Can I obtain eligibility, benefits, and claim status information for all my patients who are ConnectiCare members, including members of your Medicare Plans?
How often is the data updated on this site?
Can I view my fee schedule online?
If I don't have a member's ID number can I still access eligibility?
Security
How often do I need to change my password?
How secure is the site?
What computer system requirements do I need to access the secure website?
Technical Support
Who can I contact for technical questions, such as resetting my password or website issues?
What if I forgot my hint questions?
Administration
How do I update our online account if the Account Administrator has left our office?
National Provider Identifier (NPI)
What is the NPI?
I need to submit a new NPI to ConnectiCare. How do I do this?
Authorizations/Referrals
What is a
referral?
What services require a
referral?
What is pre-authorization or
pre-authorized?
What is
pre-certification or pre-certified?
Billing and Payment
Can I file my
claims electronically?
What is the
filing limit for in-plan claims?
What do
I need to do to change my payment and/or office address with
ConnectiCare?
How can I assure that my
payment will go to the appropriate office?
When can I request an adjustment to a claim?
Under what circumstances do I need to resubmit a
claim?
How do I request an appeal on a
claim that was denied?
When does
ConnectiCare pay it's Providers?
Materials
How can I get a printed version of the Physician & Provider Manual?
How can I order
additional forms, stickers, and/or labels?
Miscellaneous Benefits
How is
genetic testing and/or genetic counseling covered?
What is a referral?
An approval by the member's PCP (or the covering physician designated by the
member's PCP), an OB/GYN that is a participating physician, or for mental health
and alcohol and substance abuse care, our Behavioral Health Program, that is
provided prior to the member's receipt of health care services from
participating specialist physicians and other participating providers.
What services require a referral?
The following services require a referral for Personal Care Plan members
(REFERRAL REQUIRED on the ID card): Medical and surgical specialty visits;
podiatric services. chiropractic services; non-routine vision services.
What is pre-authorization or pre-authorized?
The authorization, based on medical necessity, is needed in advance of the
member’s receipt of certain specified health services that are obtained from us,
or in the case of mental health and alcohol and substance abuse services, from
our Behavioral Health Program. Pre-authorization also includes the written
authorization, from us, or in the case of mental health and alcohol and
substance abuse services, from our Behavioral Health Program, needed in advance
of the member’s receipt of Health Services from a non-participating provider.
What is pre-certification or pre-certified?
The registration and approval process, based on medical necessity, needed in
advance of the member’s partial hospitalization or inpatient admission to a
hospital, hospice, residential treatment facility, rehabilitation facility or
skilled nursing facility (with the exception of emergency services) that is
obtained from us, or in the case of mental health and alcohol and substance
abuse services, from our Behavioral Health Program.
Can I file my claims electronically?
All members of the health care community - health care providers, patients
and insurance carriers - realize numerous benefits with electronic claims
filing. Not only is electronic data transmitted faster and more accurately,
saving processing and response time, but per transaction costs are ultimately
reduced. Click here to receive more information regarding Electronic Data
Interchange (EDI).
What is the filing limit for in-plan claims?
The filing limit for in-plan claims is 180 days.
What do I need to do to change my payment and/or office address with
ConnectiCare?
Payment and office addresses must be communicated to ConnectiCare in writing.
Please submit a letter requesting the change on your new letterhead to
ConnectiCare via fax or mail. Always include your tax ID number and ConnectiCare
provider ID number.
How can I assure that my payment will go to the appropriate office?
Our general policy is to maintain one payment address for each provider. If a
physician participates under multiple tax ID numbers, he or she should submit
claims with the appropriate 6-digit provider ID number and 4-digit site
number.
When can I request an adjustment to a claim?
An adjustment should be requested if all the data elements on the originally
submitted claim are correct, but the claim has not been paid for all
reimbursable services or has been denied inappropriately. For additional
details, visit our Physician & Provider Manual
online.
Under what circumstances do I need to resubmit a claim?
A claim should only be resubmitted if the claim data on the originally
submitted claim was incorrect or missing information. For additional details,
refer to the Physician
& Provider Manual online.
How do I request an appeal on a claim that was denied?
Requests for appeal may be made in writing to ConnectiCare. For additional
details, refer to the Physician & Provider Manual
online.
When does ConnectiCare pay it's Providers?
See our check run
calendar. Calendar is subject to change. Please allow 5-10 business days for
mail time.
How can I get a printed version of the Physician & Provider Manual?
The Physician & Provider Manual exists on this website in its entirety. To obtain a printed
copy, go to the Physician & Provider Manual online and select
Download Manual in PDF Format.
How can I order additional forms, stickers, and/or labels?
You may request these provider supplies by visiting our Online Forms resource
and choosing Reorder Form for providers. This form must be printed out,
completed and mailed to ConnectiCare.
How is genetic testing and/or genetic counseling covered?
Genetic analysis and testing are excluded as follows:
• Genetic analysis of the products of conception;
• Genetic analysis of a stillbirth other than chromosome analysis;
• Deoxyribonucleic acid (DNA) banking;
• Paternity testing;
• Genetic testing for the following carrier status: carrier screening for
breast cancer, ovarian cancer, colon cancer, Factor V (Leiden) deficiency, and
cystic fibrosis; or
• Y-chromosome DNA assay for microdeletions.
What is the NPI?
The National Provider Identifier (NPI) is a unique 10 digit identification
number assigned to health care providers for use in transmitting standard health
care transactions electronically (e.g., electronic claims and eligibility
verification) through the National Provider System (NPS).
This identifier, which fulfills a requirement of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), was required by health plans
and health care clearinghouses in HIPAA standard electronic transactions as of May
23, 2008.
NPIs replace other provider identifiers previously used by health
care providers (and assigned by payers).
NPIs did not replace tax identification number (TINs) used for tax
reporting on HIPAA electronic transactions.
I need to submit a new NPI to ConnectiCare. How do I do this?
Call Provider Services at 1-800-828-3407.
Who can enroll in ConnectiCare's secure provider online self-services (Provider Connections)?
All participating providers are eligible to register with ConnectiCare's provider online self-services.
If you have difficulty registering, please contact Provider Services at 1-800-828-3407 so that they may assist you.
My tax ID number is not being recognized, but I do participate with ConnectiCare. What should I do?
If your tax ID number is not recognized, please contact Provider Services at 1-800-828-3407 so that they may assist you.
Is there a cost associated with this service?
There is no cost associated with Provider Connections.
What is the role of the Account Administrator?
The Account Administrator is responsible for adding new users or removing existing users from your online account and protecting the confidentiality of patient information. Please note that the first person to register under your applicable tax identification number should be your office Account Administrator.
How do I register?
Simply select "Register Now" and complete each section of the screen. Once complete, ConnectiCare will follow-up with a confirmation letter that will provide you with your pass code so that you may activate your account. Please note that the first person to register under your applicable tax identification number should be your office Account Administrator.
Do I need to register separately and set up a separate account for each provider I work for?
Registration on Provider Connections is based on each provider's tax ID number. If each provider in your office bills under the same tax ID number, then you need only to register once under that tax ID number. When adding users to the online account the Account Administrator determines which providers' patient information each user will have access to.
Our office is currently using similar services offered through Medavant. Do we need to continue to use Medavant if we register with Provider Connections?
No, the two services are independent of one another, though Provider Connections does provide you some additional features. Whether or not you continue to use Medavant in addition to Provider Connections is your decision. If you have direct electronic eligibility checks that go through Medavant, you may want to continue to utilize Medavant for those services as ConnectiCare is not currently set up for this.
I'm the administrator for my office, but would like to have a back up for when I am not in the office. Can I appoint additional people in my office as an administrator?
Only one administrator may be appointed for each provider tax identification number. When a new administrator is selected, the prior administrator will become a user and will no longer have administrator privileges. For purposes of coverage while out of the office, you (the administrator) may wish to temporarily select a new administrator and switch back upon your return. Keep in mind that you will need to change your password in order to be selected as the administrator again.
When an admin is logged on allow him/her to select another user as the admin and forfeit the admin status. The access level for the old admin goes to 2 and the new admin gets 3 and also gets all providers assigned to him/her. The old admin is auto signed out an forced to sign back in. The new admin must have signed in at least once to have a strong password and hint questions selected.
Can I obtain eligibility, benefits, and claim status information for all my patients who are ConnectiCare members, including members of your Medicare Plans?
- Eligibility & benefits - this information is available for members covered under all commercial plan types. Benefit information is not currently available for members in our ConnectiCare VIP Medicare Plans; however, you can determine whether or not a member is enrolled in one of these plans.
- Claim inquiry - you can search on the status of both paid claims and claims in process for members in our commercial plans only. Claim inquiry is not currently available for members in our ConnectiCare VIP Medicare Plans.
- Referral - allows you to access information on active referrals and make new referrals for members covered under a plan that has referral requirements.
- View EOPs - provides access to view and print statements for claims that have been processed by ConnectiCare for commercial and self-funded check runs only.
How often is the data updated on this site?
The data which feeds our secure site is refreshed nightly for claims information; however, referral information is updated hourly.
Can I view my fee schedule online?
At this time fee schedules are not available on the website. If you are contracted through an IPA or PHO, please contact them directly to obtain your applicable fee schedule. If you are directly contracted with ConnectiCare, please contact your Provider Education and Service Representative.
If I don't have a member's ID number can I still access eligibility?
Yes, you can also search based on a member name and date of birth.
How often do I need to change my password?
In order to maintain a high level of security, ConnectiCare will require that you change your password every 90 days. However, you may choose to change your password more frequently if you would like. Simply go to the Manage Your Account page and select "Change Password."
How secure is the site?
One of the main factors in determining our standard is the ability of the browser to maintain a high level of security. This is primarily reflected in the encryption code. To ensure the security of valuable and personal information, users may only access our private site using a browser equipped with 128-bit encryption or higher.
What computer system requirements do I need to access the secure website?
ConnectiCare.com is dedicated to supporting the latest technologies, as well as to provide service to our customers with the most recent, top-level software. In order to best experience ConnectiCare's web site, we recommend one of the following browsers:
Internet Explorer - 5.5 and higher
Firefox - 2.x and higher
For additional information go to: http://connecticare/GlobalFiles/SiteRequirements.asp.
Who can I contact for technical questions, such as resetting my password or website issues?
Using the answers you previously provided to some hint questions, you can reset your own password. If you have additional questions, please contact Provider Services at 1-800-828-3407.
What if I forgot my hint questions?
If you forgot your hint questions, contact Provider Services at 1-800-828-3407 so they may assist you.
How do I update our online account if the Account Administrator has left our office?
If the Account Administrator should no longer have access to your office's online account with Provider Connections, please contact Provider Services at 1-800-828-3407 so they may assist you.
