Commercial - Automated and Online Features
ConnectiCare encourages providers to take advantage of many online and
automated tools that can expedite and simplify transactions. We believe you
will find electronic information exchange to be a fast, convenient, and
cost-effective way to do business with us.
Listed below are some of the capabilities available to you. For additional
information about any of the features described in this section, please contact
your Provider Education & Service Representative or Provider Services at
1-800-828-3407, unless otherwise noted.
Online and automated tools allow you to:
Obtain information using Internet technology.
Provider Connections is our online self-service tool, which allows you
24/7 access to eligibility and benefits, claim status, referral entry and status, plus a whole lot more. It
offers providers the flexibility of having direct access to the information they need from ConnectiCare.
In addition, providers may also use Capario for online services. To find our more, contact Capario directly
Submit claims electronically. This is the most efficient, cost-effective means of
claim submission. We have contracted with vendors who review the data for errors
or omissions and forward it to us once it is error-free. You may receive an
acceptance or rejection report, highlighting any problems encountered. To sign
up for electronic claims submission, contact one of the following clearinghouses
Note: From time to time ConnectiCare will
coordinate with other vendors. Please contact your Provider Education &
Service Representative to find out more.
through direct deposit. On the same day we issue reimbursement
checks, we can instead make an electronic funds transfer to your bank account.
When you choose EFT, you accelerate the cash collection process for your office,
because the funds go directly into your account, not in the mail. (See EFT Form, for applicable registration form.)
Automate your patient account
reconciliation process. The electronic remittance advice (ERA) is
sent out within one day of claims reimbursement. Similar to electronic claims
submission, ConnectiCare works with WebMd to provide you with the necessary
resources you'll need to accept remittance advice electronically. While the
paper statement generally follows 3-5 days following remittance of your check,
you'll receive your electronic statement within a day of claims reimbursement.
To sign up for ERA, contact WebMD at 1-800-366-5716.
Verify authorizations for radiology
services. From the provider page on our website, access our radiology
program at www.RadMD.com to
view clinical guidelines, begin the authorization process, track pended
pre-authorization requests, or verify authorizations.
Enter referrals and verify eligibility
status via an automated phone line. You can verify member
eligibility, enter referrals, receive copayment information, and edit or inquire
about existing referrals—all with the simple touch of a button. Referrals are
automatically loaded into our claims processing system and matched up with the
corresponding claims when we receive them.
The automated eligibility and referral line is conveniently available Monday
through Friday, 7 a.m. to 6 p.m. and 7:30 p.m. to 9:30 p.m., as well as
Saturdays from 7 a.m. to 2 p.m. A flowchart of how the process works is detailed
on the following page.
Click here for a printer
friendly version of the Automated Eligibility & Referral Line flowchart.