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Medicare news: Organization determination requests for non-covered services

07/26/2017

Providers who want to order services that are not covered under ConnectiCare Medicare Advantage plans should follow a process known as "organization determination."

To obtain an organization determination from ConnectiCare, providers can:

Call: 1-800-508-6157
Fax: 1-866-706-6929
Write: ConnectiCare
          ATTN: Medicare Utilization
          P.O. Box 4050
          Farmington, CT 06034-4050

If we deny a provider's organization determination request, we will issue an integrated denial notice (IDN) to both provider and member. The IDN will include information on how to appeal.

ConnectiCare will not pay for – and the provider cannot bill the member for – any non-covered service if the organization determination process isn't followed.

If ConnectiCare issues an IDN, however, the provider may hold the member responsible for the cost of a service.

For more information, or answers to your questions, please contact Medicare provider services at 1-877-224-8230.