||If you are looking to submit an
application to participate within the ConnectiCare network of participating
health care providers.
If you are an Individual Outpatient Rehabilitation Provider, please use the Credentialing Data Form for Outpatient Rehabilitation Providers.
- Print the form.
- Fill in the appropriate information.
- Fax the completed form, along with a W-9 form, to Network Operations at
(860) 674-2849 or mail to ConnectiCare, Attn: Network Operations, 175 Scott
Swamp Road, Farmington, CT 06032-3124.
- If you have any questions, call ConnectiCare’s Provider Services Dept. at
1-800-828-3407, 8:30 a.m. to 5:00 p.m. Monday through Thursday, and 9:00 a.m. to
5:00 p.m. on Fridays, Eastern Time.