| Provider Support and Information | ||
|---|---|---|
Department/Vendor |
Services |
Contact Information |
| ConnectiCare Secure Website | Online access to benefits, eligibility and claims information for ConnectiCare members, as well as referrals for Passage plans. | 800-828-3407 |
Behavioral Health Program |
Coordinates and manages behavioral health and substance abuse services for members of most plans. |
|
Coordination of Benefits |
Determines order of payment responsibility when a member is covered by more than one health plan or insurer. |
|
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. |
Credentialing: Recredentialing: |
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. |
|
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. |
|
| Manage Spine Surgery and Interventional Pain Management Program | Administers authorization of the following medical and surgical services for our members so they receive clinically appropriate care:
|
radmd.com or 877-607-2363 |
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: CT & MA Members: |
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. |
Fax: 860-674-2851 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. |
|
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. |
|
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. |
|
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 |
Switchboard |
Assists you in reaching a department or specific employee within ConnectiCare. |
|
| Total Population Health | Offers innovative programs to support members with specific conditions, including members with asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart failure, coronary artery disease (CAD), and other complex conditions. | 800-390-3522 |
Utilization Management |
Nurse case managers, in consultation with medical directors, work with physicians 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, 8 a.m. – 5 p.m., Monday through Friday (Please leave a voicemail message ater hours). |
Fax: |
Website |
Provides useful information on topics such as community wellness programs, products, health management programs and more. |
|
PPM/04.21
