Office Visit

It is important for ConnectiCare to keep our provider network information current. Up to date provider information allows ConnectiCare to accurately generate provider directories, process claims, and communicate with our network of providers. Providers must notify ConnectiCare in writing at least 30 days in advance, when possible, of changes, such as:

• Change in practice ownership or Federal Tax ID number
• Practice name change
• A change in practice address, phone or fax numbers
• Change in practice office hours
• New office site location
• Primary Care Providers (PCP) Only: If your practice opens or closes to new patients
• When a provider joins or leaves the practice

Send changes by email to cci-providerfileoperations@molinahealthcare.com. If you have questions, call Provider Services at 800-828-3407.

ConnectiCare contracts with our payment vendor, the SSI Group, who partners with ECHO Health, Inc. (ECHO) for electronic funds transfer (EFT) and electronic remittance advice (ERA).

Many adults over the age of 65 have co-morbidities that often affect their quality of life.  As this population ages, it’s not uncommon to see decreased physical function and cognitive ability and an increase in pain. Regular assessment of these additional health aspects can help to ensure this population’s needs are appropriately met.

• Advance care planning – Discussion regarding treatment preferences, such as advance directives, should start early before the patient is seriously ill.
• Medication review – All medications the patient is taking should be reviewed, including prescription and over-the-counter medications or herbal therapies.
• Functional status assessment – This can include assessments, such as functional independence or loss of independent performance.
• Pain screening - A screening may comprise of notation of the presence or absence of pain.

Including these components in your standard well-care practice for older adults can help to identify ailments that can often go unrecognized and increase their quality of life.

Helping your patients prepare for Advance Directives may not be as hard as you think. Any persons 18 years or older can create an Advance Directive. Advance Directives include a living will document and a durable power of attorney document.

A living will is written instruction that explains your patient’s wishes regarding health care in the case of a terminal illness or any medical procedures that prolong life. A durable power of attorney names a person to make decisions for your patient if he or she becomes unable to do so.

The following links provide you and your patients with free forms and information to help create an Advance Directive:

• caringinfo.org
• nlm.nih.gov/medlineplus/advancedirectives.html

For the living will document, your patient will need two witnesses. For a durable power of attorney document, your patient will need valid notarization.

A patient’s Advance Directive must be honored to the fullest extent permitted under law. Providers should discuss Advance Directives and provide appropriate medical advice if the patient desires guidance or assistance, including any objections they may have to a patient directive prior to service whenever possible. In no event may any provider refuse to treat a patient or otherwise discriminate against a patient because the patient has completed an Advance Directive. Patients have the right to file a complaint if they are dissatisfied with the handling of an Advance Directive and/or if there is a failure to comply with Advance Directive instructions.

It is helpful to have materials available for patients to take and review at their convenience. Be sure to put a copy of the completed form in a prominent section of the medical record. The medical record should also document if a patient chooses not to execute an Advance Directive. Let your patients know advance care planning is a part of good health care.

Care Connections is transforming care delivery for ConnectiCare members by focusing on key HEDIS quality results, improving health outcomes, enhancing member satisfaction, and closing care gaps through shared decision making and collaboration. Care Connections provides a reliable safety net for members, helping them access essential care when they cannot access their primary care provider (PCP), or additional support is needed. 

Population health outreach and care coordination 

Our nurse practitioners (NPs) deliver high quality clinical care and coordination through in-person visits¹ and telehealth visits, ensuring members receive timely, evidence-based interventions that improve their health outcomes, and drive meaningful results: 

• Perform comprehensive health evaluations including physical exams, medication reconciliation, and health risk assessments (HRAs) to identify gaps and prevent complications. 
• Deliver preventive care and education, including screenings, lifestyle counseling, and disease-specific interventions tailored to each member’s health history and current diagnoses. 
• Complete point-of-care testing such as HbA1c, blood pressure, kidney function, and other diagnostics to monitor chronic conditions and guide immediate clinical decisions. 
• Prescribe and refill medications² when clinically appropriate, ensuring continuity for members awaiting PCP appointments or transitioning to new providers. 
• Coordinate directly with PCPs, scheduling appointments on behalf of members, and sharing visit notes to maintain transparency and seamless care.  
• Arrange NP follow-up visits for members with uncontrolled conditions (e.g., diabetes, hypertension) to provide ongoing support and work towards better control. 
• Facilitate referrals to case management and order durable medical equipment (DME) when needed to support recovery and independence. 
• Address social determinants of health (SDoH) by connecting members to community resources for housing, food, transportation, and other unmet needs. 

This hands-on, proactive approach strengthens provider partnerships by reducing missed follow-ups, improving engagement, and closing care gaps. 

Care quality improvement and behavioral health integration      

Care Connections influences key quality measures, including diabetes management, blood pressure control, kidney health evaluation, and colorectal cancer screenings. Behavioral health integration is embedded in our model. We offer bridge therapy visits and crisis support to members until they are connected with behavioral health providers.

Together, we can ensure every member stays connected to a PCP while receiving additional support that drives meaningful outcomes and member satisfaction. Care Connections is your clinic without walls, committed to collaboration and measurable impact.

Member access and experience   

Open scheduling is now available. This strategic initiative empowers providers and care management partners to schedule complementary visits on behalf of the members for preventive visits, chronic condition follow-ups, and other care needs at no cost. Members can also schedule themselves.                                                               

Schedule a Care Connections visit for members who are: 

• Homebound 
• Managing uncontrolled chronic conditions 
• Experiencing frequent avoidable ER or hospital admissions 
• Unable to secure appointment due to provider availability/accessibility
• Facing unmet SDoH or DME needs 
• Unengaged with ongoing gaps in care 
• Recent post-hospital discharge needing a transition of care (TOC) visit 

Care Connections continues to remove barriers to care by offering in-person visits and telehealth options with interpreter services, on a case-by-case basis and in keeping with state regulations. 

Accessing electronic records

Care Connections visit records are available through EpicCare Link—a HIPAA-secure web portal provided by Molina.  For additional information, send an email to clinicalsupport@molinahealthcare.com.

Disclaimers:

1. The services and workflows of Molina Care Connections comply with state-specific regulations and may vary by location and state.  
2. There’s no cost for a Care Connections visit; it’s always a $0 visit. Some labs or medications provided during the visit may be subject to standard cost sharing amounts based on members’ plan benefits.

ConnectiCare provides a Health Risk Assessment (Health Appraisal) for members on their ConnectiCare member portal. Our members are asked questions about their health and health behaviors and receive a report about possible health risks. A Self-Management Tool is also available to offer guidance for weight management, depression, financial wellness, and various other topics. ConnectiCare members can access these tools on member.connecticare.com.

The tools and services described here are educational support for our members. We may change them at any time, as necessary, to meet the needs of our members.

ConnectiCare offers programs to help our members and their families manage a diagnosed health condition. You, as a provider, also help us identify members who may benefit from these programs. Members can request to be enrolled or dis-enrolled in these programs. Our programs include:

• Asthma management
• Diabetes management
• High blood pressure management
• Cardiovascular Disease (CVD) management/Congestive Heart Disease
• Chronic Obstructive Pulmonary Disease (COPD) management
• Depression management
• High-Risk Obstetrician-Gynecologists (OB-GYN) Case management
• Transition of Care (ToC)

For more information about many of our programs, visit Improving the Patient Experience.

If you have additional questions about our programs, please call Provider Services at 800-828-3407 (TTY/TDD at 711 Relay).

ConnectiCare offers you and your patients the opportunity to participate in our Complex Case Management Program. Patients appropriate for this voluntary program are those who have the most complex service needs. This may include your patients with multiple medical conditions, high level of dependence, conditions that require care from multiple specialties, and/or have additional social, psychosocial, psychological, and emotional issues that exacerbate the condition, treatment regime, and/or discharge plan.

The purpose of the Complex Case Management Program is to:

• Conduct a needs assessment of the patient, patient’s family, and/or caregiver
• Provide intervention and care coordination services within the benefit structure across the continuum of care
• Empower our members to optimize their health and level of functioning
• Facilitate access to medically necessary services and ensure they are provided at the appropriate level of care in a timely manner
• Provide a comprehensive and ongoing care plan for continuity of care in coordination with you, your staff, your patient, and the patient’s family

If you would like to learn more about this program, speak with a Complex Case Manager, and/or refer a patient for an evaluation for this program, please send an email to
cci-hmpreferrals@molinahealthcare.com.

ConnectiCare is dedicated to providing quality care for our members during planned or unplanned transitions. A transition is when members move from one setting to another, such as when a ConnectiCare member is discharged from a hospital. By working together with providers, ConnectiCare makes a special effort to coordinate care during transitions. This coordination of specific aspects of the members’ transition is performed to avoid potential adverse outcomes.

To ease the challenge of coordinating patient care, ConnectiCare has resources to assist you. Our staff, including nurses, are available to work with all parties to ensure appropriate care.

To appropriately coordinate care, ConnectiCare will need the following information in writing from the facility within one business day of the transition from one setting to another:

• Discharge plan when the member is transferred to another setting
• A copy of the member’s discharge instructions when discharged to home

This information should be uploaded to our Availity Essentials provider portal.

Primary care providers (PCPs) provide outpatient behavioral health services within the scope of their practice and are responsible for coordinating members’ physical and behavioral health care.

Behavioral Health services are a direct access benefit and are available with no required referrals; however, PCPs are responsible for assisting in coordinating access and treatment, if needed. If you or the member need assistance with obtaining behavioral health services, please contact Member Services Department at 800-251-7722 for Marketplace members, and 800-224-2273 for Medicare members. ConnectiCare’s Nurse Advice Line is also available to members 24 hours a day, seven days a week, 365 days per year for mental health or substance abuse needs. The services members receive will be confidential.

ConnectiCare requires that providers offer ConnectiCare members hours of operation no less than hours offered to commercial members in other plans.

All providers who join the ConnectiCare provider network must comply with the provisions and guidance set forth by the Department of Health and Human Services (HHS), the Office for Civil Rights (OCR), State law, and Federal program rules which prohibit discrimination. For additional information please refer to:

• Access Health CT Plan Documents
• SOLO Plan Documents
• Medicare Forms and Documents

Additionally, participating providers or contracted medical groups/IPAs may not limit their practices because of a member’s medical (physical or mental) condition or the expectation for the need of frequent or high-cost care.

Providing quality care to our members is important; therefore, ConnectiCare has established standards for medical record documentation to help assure the highest quality of care. Medical record standards promote quality care through communication, coordination and continuity of care and efficient and effective treatment.

ConnectiCare’s medical record documentation standards include:

• Medical record content
• Medical record organization
• Information filed in medical records
• Ease of retrieving medical records
• Confidential patient information
• Standards and performance goals for participating providers

Below are commonly accepted standards for documentation in medical records and must be included in each medical record:

• History and physicals
• Allergies and adverse reactions
• Problem list
• Medications
• Documentation of clinical findings and evaluation for each visit
• Preventive services/risk screening

For more information, please call Provider Services at 800-828-3407.

Featured at connecticare.com/providers:

• Clinical Practice and Preventive Health Guidelines
• Health Management Programs
• Quality Improvement Programs
• Member Rights & Responsibilities
• Privacy Notices
• Provider Manual
• Current Formulary
• Cultural Competency Provider Trainings

If you would like to receive any of the information posted on our website in hard copy, please call Provider Services at 800-828-3407.

We can provide information in our members’ primary language. We can arrange for an interpreter to help you speak with our members in almost any language. We also provide written materials in different languages and formats. If you need an interpreter or written materials in a language other than English, please call Provider Services at 800-828-3407. You can also call TTD/TTY:711, if a member has a hearing or speech disability.

Preventive Health Guidelines can be beneficial to providers and their patients. Guidelines are based on scientific evidence, review of the medical literature, or appropriately established authority, as cited. All recommendations are based on published consensus guidelines and do not favor any particular treatment based solely on cost considerations.

These guidelines are meant to recommend a standard level of care and do not preclude the delivery of additional preventive services depending on the individual needs of the patient.

To view all guidelines, visit Preventive Care. To request printed copies of Preventive Health Guidelines, please call Provider Services at 800-828-3407.

Clinical practice guidelines are based on scientific evidence, review of the medical literature, or appropriately established authority, as cited. All recommendations are based on published consensus guidelines and do not favor any particular treatment based solely on cost considerations. The care recommendations are suggested as guides for making clinical decisions. Clinicians and their patients must work together to develop individual treatment plans that are tailored to the specific needs and circumstances of each patient.

ConnectiCare has adopted the following Clinical Practice and Behavioral Health Guidelines, which include but are not limited to:

• Acute Stress and Post-Traumatic Stress Disorder (PTSD)
• Anxiety/Panic Disorder
• Asthma
• Attention Deficit Hyperactivity Disorder (ADHD)
• Autism
• Bipolar Disorder
• Children with Special Health Care Needs
• Chronic Kidney Disease
• Chronic Obstructive Pulmonary Disease
• Depression
• Diabetes
• Heart Failure in Adults
• Homelessness - Special Health Care Needs
• Hypertension
• Opioid Management
• Perinatal Care
• Pregnancy Management
• Schizophrenia
• Sickle Cell Disease
• Substance Use Treatment
• Suicide Risk
• Trauma-Informed Primary Care
• Weight Management

To view all guidelines, visit Clinical Practice Guidelines. To request a copy of any guideline, please call Provider Services at 800-828-3407.

ConnectiCare must protect its members by assuring the care they receive is of the highest quality. One protection is assurance that our providers have been credentialed according to the strict standards established by the state regulators and accrediting organizations. Your responsibility, as a ConnectiCare provider, includes full disclosure of all issues and timely submission of all credentialing and re-credentialing information.

ConnectiCare also has a responsibility to its providers to assure the credentialing information it reviews is complete and accurate. As a ConnectiCare provider, you have the right to:

• Strict confidentiality of all information submitted during the credentialing process
• Nondiscrimination during the credentialing process
• Be notified of information obtained during the credentialing process that varies substantially from what is submitted by you
• Review information submitted from outside primary sources (e.g., malpractice insurance carriers, state licensing boards) to support your credentialing application, except for references, recommendations or other peer-review protected information
• Correct erroneous information
• Be informed of the status of your application upon request by calling the Credentialing Department
• Receive notification of the credentialing decision within <<60>>days of the committee decision or shorter timeframes as contractually required
• Receive notification of your rights as a provider to appeal an adverse decision made by the committee
• Be informed of the above rights

For further details on all your rights as a ConnectiCare provider, please review the 2026 Marketplace Provider Manual and 2026 Medicare Provider Manual. You may also call Provider Services at 800-828-3407.

One of ConnectiCare’s utilization management (UM) department’s goal is to render appropriate UM decisions consistent with objective clinical evidence. To achieve this goal, ConnectiCare maintains the following guidelines:

At ConnectiCare, the drug formulary - sometimes referred to as a Preferred Drug List (PDL) - and pharmacy services procedures are maintained by the National Pharmacy and Therapeutics (P&T) Committee. This committee meets on a quarterly basis or more frequently, if needed.

The P&T Committee is responsible for development and updating drug formularies that promote safety, effectiveness, and affordability, where state regulations allow. The committee objectively reviews new Food and Drug Administration (FDA) approved drugs, drug classes, new clinical indications for existing drugs, new line extensions and generics, new safety information and also new clinical guidelines and practice trends that may impact previous formulary placement decisions. Additional committee oversight includes prior authorization, step therapy, quantity limits, generic substitutions, medical exception protocols to allow coverage for non-formulary drugs, other drug utilization management activities that affect access, and providing drug utilization evaluations and intervention recommendations to ConnectiCare. Drug formulary activities are inclusive of prescriber-administered specialty medications as a medical benefit as well as pharmacy benefit services.

The drug formularies reviewed and approved by the P&T committee are updated quarterly and include an explanation of quantity limits, age restrictions, therapeutic class preferences, and step therapy protocols. View the 2026 Marketplace Formulary  and 2026 Medicare Formulary. 

Providers may request a formulary exception for coverage of a drug outside of the restrictions of the drug formulary. A formulary exception should be requested to obtain a drug that is not included on a member’s drug formulary, or to request to have a utilization management requirement waived (e.g., step therapy, PA, quantity limit) for a formulary drug. Select medications on the drug formulary or drugs not listed on the formulary may require PA. PA is a requirement that a prescriber obtains advance approval from ConnectiCare before a specific drug is delivered to the member to qualify for payment coverage, sometimes called precertification or prior approval.

The P&T Committee is also responsible for promoting member safety. In the event of a Class II recall or voluntary drug withdrawal from the market for safety reasons, affected members and prescribing practitioners are notified by ConnectiCare within 30 calendar days of the FDA notification. An expedited process is in place to ensure notification to affected members and prescribing practitioners of Class I recalls as quickly as possible. These notifications will be conducted by fax, mail, and/or telephone.

ConnectiCare’s Quality Improvement Program provides the structure and key processes that enable the health plan to carry out our commitment to ongoing improvement in members’ health care and service. The Quality Improvement Committee assists the organization to achieve these goals. It is an evolving program that is responsive to the changing needs of the health plan’s customers and the standards established by the medical community, regulatory and accrediting bodies.

The key quality processes include but are not limited to:

• Implementation of programs and processes to improve members’ outcomes and health status
• Collaboration with our contracted provider network to identify relevant care processes, develop tools and design meaningful measurement methodologies for provided care and service
• Evaluation of the effectiveness of programs, interventions, and process improvements and determination of further actions
• Design of effective and value-added interventions
• Continuous monitoring of performance parameters and comparing to performance standards and benchmarks published by national, regional, or state regulators, accrediting organizations, and internal Molina threshold
• Analysis of information and data to identify trends and opportunities, and the appropriateness of care and services
• Oversight and improvement of functions that may be delegated: Claims, UM, and/or Credentialing
• Confirmation of the quality and adequacy of the provider and Health Delivery Organization network through appropriate contracting and credentialing processes

The Quality Improvement Program promotes and fosters accountability of employees, network, and affiliated health personnel for the quality and safety of care and services provided to ConnectiCare members.

The effectiveness of Quality Improvement Program activities in producing measurable improvements in the care and service provided to members is evaluated by:

• Organizing multi-disciplinary teams, including clinical experts, to analyze service and process improvement opportunities, determine actions for improvement, and evaluate results
• Tracking the progress of quality activities and goals through appropriate quality committee minutes and reviewing/updating the Quality work plan quarterly
• Revising interventions based on analysis, when indicated
• Evaluating member satisfaction with their experience of care through the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) survey
• Reviewing member satisfaction with their experience with behavioral health services through survey questions and/or evaluation of behavioral health-specific complaints and appeals
• Conducting provider satisfaction surveys with specific questions about the UM process, such as determining the level of satisfaction with getting a service approved, obtaining a referral, and case management

ConnectiCare would like to help you to promote the important care activities you have undertaken in your practices. If you would like to have your projects and programs highlighted on the ConnectiCare website, please call Provider Services at 800-828-3407.

If you would like more information about our Quality Improvement Program or initiatives and the progress toward meeting quality goals, you can visit Quality Improvement. If you would like to request a paper copy of our documents, please call Provider Services at 800-828-3407.

Patient Safety activities encompass appropriate safety projects and error avoidance for ConnectiCare members in collaboration with their primary care providers.

ConnectiCare’s Patient Safety activities address the following:

• Continued information about safe office practices
• Member education; providing support for members to take an active role to reduce the risk of errors in their care
• Member education about safe medication practices
• Cultural competency training
• Improvement in the continuity and coordination of care between providers to avoid miscommunication
• Improvement in the continuity and coordination between sites of care such as hospitals and other facilities to assure timely and accurate communication
• Distribution of research on proven safe clinical practices

ConnectiCare also monitors nationally recognized quality index ratings for facilities from:

• Leapfrog Quality Index Ratings (leapfroggroup.org)
• The Joint Commission Quality Check® (qualitycheck.org)

Providers can also access The Joint Commission (jointcommission.org) for additional information on patient safety.

ConnectiCare wants to inform its providers about some of the rights and responsibilities of our members.

ConnectiCare members have the right to:

• Receive information about ConnectiCare, its services, its practitioners and providers, and member rights and responsibilities
• Be treated with respect and recognition of their dignity and their right to privacy
• Help make decisions about their health care
• Participate with practitioners in making decisions about their health care
• A candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage
• Voice complaints or appeals about ConnectiCare or the care it provides
• Make recommendations regarding ConnectiCare member rights and responsibilities policy

ConnectiCare members have the responsibility to:

• Supply information (to the extent possible) that ConnectiCare and its practitioners and providers need to provide care
• Follow plans and instructions for care that they have agreed to with their practitioners
• Understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible
• Keep appointments and be on time (If members are going to be late or cannot keep an appointment, they are instructed to call their practitioner.)

For the complete ConnectiCare Member Rights and Responsibilities Statement, visit Eligibility and Benefits. Written copies and more information can be obtained by contacting the Provider Services at 800-828-3407.