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Help and support

Provider support and information

Department/Vendor

Services

Telephone

Behavioral health program

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

1-800-349-5365

Coordination of benefits

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

1-860-674-5850
or 1-800-828-3407

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, for example, 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:
1-866-610-8514

Recredentialing:
1-866-610-8515

Electronic online office support

Provides a standardized approach to receive member eligibility verification, claim submission, claim status, and referrals using Internet technology via the PNT Data.

PNT Data
1-860-257-2030
support@pntdata.com

Eligibility line

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

1-800-562-6834

Total Population Health

Offers innovative programs to support members with specific conditions, including members with asthma, chronic obstructive pulmonary disease, diabetes, heart failure, coronary artery disease and other complex conditions.

1-800-390-3522

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.

 

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:
1-860-674-5850 or
1-800-828-3407

CT & MA Members:
1-860-674-5757
or 1-800-251-7722

Notification Line

Provides a voice message system for physicians and other providers who need to notify us of a hospital admission, skilled nursing facility admission, or 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 pre-authorization and is subject to medical necessity review.

1-888-261-2273

Pharmacy Services

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

1-800-828-3407;

Fax: 1-860-674-2851
or 1-800-249-1367

E-mail: pharmacy@connecticare.com

Pre-authorization Program

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

1-860-674-5860
or 1-800-562-6833

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 to attention Network Operations, 175 Scott Swamp Road, Farmington, CT 06032-3124. Please include the effective date of the change. Please contact provider services.

1-860-674-5850 or
1-800-828-3407

Radiology Preauthorization Program

Administers pre-authorization of imaging services and radiation oncology services, as appropriate, for all for all product lines. Go online to view clinical guidelines, begin the authorization process, track pended pre-authorization requests, or verify authorizations at http://www.radmd.com/.

1-877-607-2363

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:

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

 

http://www.radmd.com/
or
1-877-607-2363

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.

1-888-4KO-FRAUD
(1-888-456-3728)

Switchboard

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

1-860-674-5700

Utilization management

Nurse case managers, in consultation with medical directors, work with physicians and members to obtain information necessary 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 – Friday (after hours, please leave a voicemail message).

1-800-562-6833

Fax:
1-800-923-2882

Website

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

1-800-562-6833

Fax:
1-800-923-2882

 

 

PPM/10.16

Automated and online features

AUTOMATED CAPABILITIES

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 Network Account Manager or Provider Services at 1-800-828-3407, unless otherwise noted.

Online and automated tools allow you to:

  1. 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, 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 PNT Data for online services (realtime claim and eligibility transactions). To find out more, contact PNT Data directly at 1-860-257-2030.

  2. 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 listed below:

    3. PNT Data (formerly Post-n-Track)
    www.PNTData.com
    1-860-257-2030

    Change Healthcare (formerly Emdeon)
    www.Changehealthcare.com
    1-877-363-3666

    		  

    Note: From time to time ConnectiCare will coordinate with other vendors. Please contact your Network Account Manager to find out more.

  3. Receive reimbursement 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 Forms for applicable registration form.)

  4. Automate your patient account reconciliation process. The electronic remittance advice (ERA) is sent out to our clearinghouses within one day of claims reimbursement. Similar to electronic claims submission, ConnectiCare works with our clearinghouses 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 remittance advice (ERA) within a day or two of claims reimbursement. To sign up for ERA, contact PNT Data (formerly Post-n-Track) at 1-860-257-2030 or www.PNTData.com or Change Healthcare (formerly Emdeon) at 1-877-363-3666 or www.Changehealthcare.com.

  5. 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.

    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.

 

PPM/10.16

Medicare provider support and information

Department/Vendor

Services

Contact information

Behavioral Health Program

Coordinates and manages mental health and substance abuse services for members of most plans. (Does not apply to the Private Fee-for-Service Plans.)

Claims: 1-866-214-6827
Intake: 1-800-349-5365

Coordination of benefits

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

1-877-224-8230

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; for example, 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:
1-866-610-8514

Recredentialing:
1-866-610-8515

Health Management Programs

Offers innovative programs to support members with specific conditions, including members with asthma, chronic obstructive pulmonary disease, diabetes, heart failure, coronary artery disease, and high-risk pregnancy.

1-800-390-3522

Medicare Case Management Program

Identifies members with special needs who would most benefit from direct intervention in their case, before their health condition or living situation deteriorates. The primary focus is on assessment, triage, and follow up. This is accomplished through comprehensive telephonic assessment of the member's medical and functional status and development of a plan of care to include health coaching and care coordination.

1-800-509-3181
Network Account Manager Conducts new office orientations, educational and problem-solving visits, and general and specialty workshops for participating providers. Assignments are divided geographically as we recognize that representatives are an important link between providers and ConnectiCare. 1-860-674-5700 and ask for Network Account Manager

Pharmacy Services

Manages the pharmacy program and drug list, including drug treatment protocols.

1-877-444-7037

Preauthorization Program

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

1-800-508-6157
Fax: 1-866-706-6929

Preventive health

Offers educational programs for members on a variety of preventive health topics.

1-888-867-7987

Provider File

Maintains and updates provider demographic records such as address, tax ID number, NPI etc. Changes to records must be submitted in advance and in writing to the attention of Network Operations:

Fax: 860-674-2849
175 Scott Swamp Road, Farmington, CT 06032-3124
E-mail: Send directly to your Network Account Manager

Confirmation and accuracy of change can be verified by viewing the online Provider Directory or calling Provider Services.

 

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. They are available Monday - Thursday, 8:30 a.m. - 5 p.m., and 9 a.m. - 5 p.m. on Friday.

1-877-224-8230

Radiology Pre-authorization Program

Administers pre-authorization of imaging services, as appropriate, for all product lines. Web authorizations are available at www.radmd.com.

1-877-607-2363

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.

1-888-4KO-FRAUD
(1-888-456-3728)
E-mail: kofraud@emblemhealth.com

Utilization management

Contact ConnectiCare with notification of urgent/emergent admissions by phone or fax. Notification is required for medical necessity review and benefit determination.

1-800-508-6157
Fax: 1-860-674-5727

 

 

Medicare PPM/12.12

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your  plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.