Department/Vendor

Services

Contact Information

Behavioral Health Program

Optum coordinates and manages behavioral health and substance abuse services for members of most plans.

Claims address:

Optum Behavioral Health
P.O. Box 30757
Salt Lake City, UT  84130-0757

888-946-4658

Coordination of Benefits

Determines order of payment responsibility when a member is covered by more than one health plan or insurer.

860-674-5850
or 800-828-3407

Credentialing

Reviews and assesses the qualifications of practitioners/providers applying for participation in our network, and periodically thereafter. Certain changes in a practitioner’s status may require review by the Credentialing Department, such as completely moving into a new service area or a specialty change. Inquiries about the status of an application should be directed to this unit.

CCI-Credentialing@MolinaHealthcare.com

Electronic Claims Submissions, Remittances and EDI Requests

For claim status inquiries, please sign in to our secure portal.

For questions, please reach out to the clearing house to whom you submitted your claims. 

Eligibility Line

Provides touch-tone phone access to verify member benefits and eligibility.

800-562-6834

855-999-2329

855-973-2803

IPA/PHO

The medical directors of participating IPAs and PHOs may consult with practitioners for the first line of appeal for any clinical decisions. Please consult your IPA or PHO.

Free multi-language interpreter service is available to assist providers and their patients. Services are available in over 200 languages, including English, Spanish, Chinese Mandarin, Chinese Cantonese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portuguese, French Creole, Polish, Hindi, and Japanese. Available Monday through Friday from 9 a.m. to 6 p.m.

Administers authorization of the following medical and surgical services for our members so they receive clinically appropriate care:

• Lumbar, cervical, and thoracic spine surgery (open, closed, or minimally invasive)
• Adult deformity surgery
• Implantable infusion pump insertion

Member and Provider Services

Responds to your telephone, mail, or facsimile inquiries regarding claim submissions, status of checks, benefits, eligibility, and policies. When you are not certain where to direct your call, start here. Also responds to inquiries from members who require more information.

Providers:
860-674-5850 or
800-828-3407

CT & MA Members:
860-674-5757
or 800-251-7722

Notification Line

Provides a voice message system for physicians and other providers who need to notify us of a hospital admission or skilled nursing facility (SNF) admission that occurred on a weekend or holiday. SNF admissions on weekends or holidays will be automatically approved through the next business day following the admission. However, admission to a SNF for rehabilitation, in the absence of a hospitalization or acute episode of illness requires preauthorization and is subject to medical necessity review.

Pharmacy Services

Manages ConnectiCare’s pharmacy benefit, preauthorization program, and drug list. Available 8:30 a.m. to 5 p.m., Monday – Thursday, 9 a.m. through 5 p.m. on Friday.

800-828-3407;

Fax: 860-674-2851
or 800-249-1367

Email: pharmacy@connecticare.com

Preauthorization Program

Coordinates preauthorization of those services and procedures that require prior review by ConnectiCare. Use to initiate an authorization or pre-certification for a member.

800-562-6833

Provider File

Maintains provider records in ConnectiCare’s automated claims payment system and makes necessary changes to provider information, such as address, tax ID number, etc. We require that you submit your changes in writing attention to Network Operations, 175 Scott Swamp Road, Farmington, CT 06032-3124. Please include the effective date of the change and contact Provider Services to notify them of the change.

860-674-5850 or
800-828-3407

Radiology Preauthorization Program

Administers preauthorization of imaging and radiation oncology services, as appropriate, for all product lines. Go to radmd.com to view clinical guidelines, begin the authorization process, track pended preauthorization requests, or verify authorizations.

877-607-2363

Providers:
860-674-5850 or
800-828-3407

Members:
860-674-5757 or 
800-251-7722
(TTY: 711)

Special Investigative Unit

A confidential and anonymous hotline for reporting suspected fraudulent or abusive billing activities. The line is available 24 hours a day to members, providers, employees, and government officials.

888-4KO-FRAUD
(888-456-3728)

Switchboard

Assists you in reaching a department or specific employee within ConnectiCare.

860-674-5700

Utilization Management

Nurse case managers, in consultation with medical directors, work with doctors and members to get information needed to help make benefit determinations about the appropriateness and medical necessity of certain health care procedures and services. Case managers are available for other management questions, 9 a.m. to 5 p.m., Monday through Friday. Please leave a voicemail message after hours.

Enter a preauthorization request on our provider portal along with supporting medical documentation.

800-562-6833

Website

Provides useful information on topics such as community wellness programs, products, health management programs and more.
Gives you access to the provider manual, our online Provider Directory, downloadable forms, Pharmacy Central, and more.

800-828-3407