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ConnectiCare is committed to helping our members stay healthy, get well, and receive health care services in a timely manner. Providers are expected to have procedures in place to see patients within the following time frames and provide 24-hour accessibility as outlined.
We evaluate our contracted providers’ compliance with these access and availability standards through audits.
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APPOINTMENT WAIT TIMES |
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Type of Appointment |
Time Frame Requirement |
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Urgent care |
Within 48 hours |
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Non-Urgent appointments for primary care |
Within 10 business days |
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Non-Urgent appointments for specialist care |
Within 15 business days |
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Non-Urgent for non-physical mental health |
Within 10 business days |
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Non-Urgent for ancillary services |
Within 15 business days |
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24 HOUR ACCESSIBILITY STANDARDS |
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Effective January 1, 2027, ConnectiCare will no longer offer Medicare Advantage plans. This change impacts the following Medicare plans: ConnectiCare will continue to provide benefit coverage for members who continue to meet eligibility requirements until December 31, 2026. Providers must submit claims according to the timeliness standards outlined in the provider contract or the 2026 Medicare Provider Manual.
Beginning January 1, 2027, the ConnectiCare provider portal at provider.connecticare.com (Vlocity) will close. This is the portal that providers use to conduct business with ConnectiCare for Commercial (employer group) members in 2026, and for members in all lines of business prior to January 1, 2026. To submit claims for dates of service prior to January 1, 2026, providers should continue to use the existing Payer ID and mail: Line of Business Mail Commercial (employer group), Marketplace (on and off Exchange) and Medicare ConnectiCare Claims To file claim appeals, disputes, or complaints for dates of service prior to January 1, 2026, providers should fax or mail:
P.O. Box 36010
Louisville, KY 40233
Line of Business Fax Mail Commercial (employer group) and Marketplace (on and off Exchange) (855) 276-7538 ConnectiCare Appeals & Grievance Medicare (562) 499-0610 ConnectiCare Appeals and Grievances To submit overpayment refunds for dates of service prior to January 1, 2026, providers should mail: Line of Business Mail Commercial (employer group), Marketplace (on and off Exchange) and Medicare ConnectiCare Note: this provider portal closure does not affect the Availity Essentials portal that ConnectiCare providers currently use to conduct business with us for Marketplace (on and off Exchange) and Medicare members.
P.O. Box 36120
Louisville, KY 40233-6120
P.O. Box 22816
Long Beach, CA 90801
P.O. Box 416947
Boston, MA 02241-6947
Providers are prohibited from balance billing ConnectiCare members for covered services beyond the member’s applicable copayment, coinsurance and deductible amounts. Providers are responsible for verifying eligibility and obtaining approval for services that require prior authorization. Providers agree that under no circumstance shall a ConnectiCare member be liable to the provider for any payment owed that is ConnectiCare’s legal obligation. Examples of balance billing include:
Providers must ensure ConnectiCare has accurate practice and business information. Accurate information allows us to better support and serve our members and providers. Maintaining an accurate and current Provider Directory is a state and federal regulatory requirement and a National Committee for Quality Assurance (NCQA) requirement. Invalid information can negatively affect members’ access to care, member/primary care provider (PCP) assignments and referrals. Current information is also critical for timely and accurate claims processing. Providers must validate their information on file with ConnectiCare at least once every ninety (90) days for correctness and completeness. Failure to do so may result in your REMOVAL from the ConnectiCare Provider Directory. Provider information that must be validated includes, but is not limited to:
How to submit this information Delegated and other providers that typically submit rosters must submit a complete roster that includes the above information to cci-providerfileoperations@molinahealthcare.com. All other providers must log in to their CAQH account to attest to the accuracy of the above information for each health care provider and/or facility in your practice contracted with ConnectiCare. If the information is correct, please select the option to attest. If it is incorrect, providers can make updates through the CAQH portal. Providers unable to make updates through the CAQH portal should contact Provider Services at (800) 828-3407 for assistance. As specified in your Provider Agreement, providers must also notify ConnectiCare of any changes to provider information on file as soon as possible, but at a minimum thirty (30) calendar days in advance, of any changes in any provider information on file with ConnectiCare. Send changes by email to cci-providerfileoperations@molinahealthcare.com. Changes include but are not limited to:
ConnectiCare provider manuals are customarily updated annually but may be updated more frequently as needed. Visit 2026 Marketplace Provider Manual and 2026 Medicare Provider Manual to access the most current provider manuals.
In alignment with requirements from the Centers for Medicaid & Medicare Services (CMS), ConnectiCare requires PCPs and key high-volume specialists, including cardiology, oncology/hematology, and pain management to receive training about ConnectiCare’s Special Needs Plans (SNP) Model of Care (MOC). The SNP MOC is the plan for delivering coordinated care and care management to members with special needs. Per CMS requirements, managed care organizations (MCOs) are responsible for conducting their own MOC training, which means multiple insurers may ask you to complete separate training. Visit SNP MOC Provider Training for training materials and attestation forms. The completion date for this year’s training is December 31, 2028. If you have any additional questions, please contact ConnectiCare Provider Services representative at (800) 828-3407.
The National Health Care Anti-Fraud Association (NHCAA) estimates that at least 3% of the nation’s health care costs, amounting to tens of billions of dollars, are lost to fraud, waste and abuse. That money would otherwise cover legitimate care and services for people in our communities who need it most. To address the issue, federal and state governments have passed a number of laws to improve overall program integrity, including required audits of medical records against billing practices. Like others in our industry, ConnectiCare must comply with these laws and proactively ensure that government funds are used appropriately. ConnectiCare’s Special Investigation Unit (SIU) aims to safeguard Medicare, Medicaid and Marketplace funds. You and the SIU The SIU uses leading data analytics software to proactively review claims and identify statistical outliers within peer (specialty) groups and services/coding categories. Our system employs more than 2,800 algorithms to identify billing outliers and patterns, over- and underutilization and other unusual trends in billing behavior. The system pulls information from multiple public data sources and historical databases to identify and track fraud, waste and abuse. It also allows us to track provider compliance with correct coding, billing and the provider contractual agreement. As a result, providers may receive a notice from the SIU if they have outliers that require additional review or are chosen by random selection. If your practice receives a notice from the SIU, please review the notice and follow any instructions, such as providing requested medical records and other supporting documentation. If you have questions, contact the SIU team using the number provided in the notice. “ConnectiCare appreciates the partnership it has with providers in caring for the medical needs of our members,” says Scott Campbell, who oversees ConnectiCare’s SIU operations. “Together, we share a responsibility to be prudent stewards of government funds. It’s a responsibility that we all should take seriously because it plays an important role in protecting programs like Medicare and Medicaid from fraudulent activity.” ConnectiCare appreciates your support and understanding of the SIU’s important work. We hope to minimize any inconvenience the SIU audit might cause you or your practice. To report potential fraud, waste and abuse, call the ConnectiCare AlertLine toll-free at (866) 606-3889, 24 hours a day, 7 days a week. You can also make a report online at any time at MolinaHealthcare.Alertline.com.
For patients at very high fracture risk, completing a course of anabolic therapy is not the end of osteoporosis treatment. Current guidelines recommend anabolic agents such as teriparatide, abaloparatide or romosozumab for selected patients because these therapies can rapidly increase bone mineral density (BMD) and reduce fracture risk. However, anabolic therapy is only the first phase of treatment. The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) recommend transitioning patients to an antiresorptive therapy following completion of anabolic treatment to preserve BMD gains and maintain fracture protection. Evidence indicates that treatment sequence matters. Anabolic agents stimulate new bone formation and can substantially improve BMD in patients at very high fracture risk. Without subsequent antiresorptive therapy, however, BMD gains may decline over time. Sequential treatment with an antiresorptive agent helps preserve BMD improvements and is intended to maintain the fracture-risk benefit achieved during anabolic therapy, supporting a more durable treatment response. Despite established recommendations, real-world studies suggest that many patients do not receive timely antiresorptive therapy after completing anabolic treatment. ConnectiCare has also seen delays among its members between the end of anabolic therapy and the start of antiresorptive treatment, indicating a potential gap in care. These findings reinforce the importance of proactive transition planning as anabolic therapy nears completion. Establishing the next treatment step before the final dose may help minimize interruptions and maintain continuity of osteoporosis care. Provider action Optimizing osteoporosis therapy requires both appropriate initial treatment and a coordinated transition plan. To reduce treatment gaps, providers should identify the follow-on antiresorptive therapy before the anabolic course is completed, address potential access or authorization barriers and communicate the plan to the patient and care team. Timely follow-on therapy may help preserve therapeutic BMD gains and maintain fracture protection. Providers can play an important role in reducing treatment gaps by planning the transition before anabolic therapy is completed and reinforcing the importance of follow-on therapy with patients. References
