In the event that you should receive an overpayment of claims, duplicate payments or payment for claims that were reimbursed inaccurately, we request that you refund the appropriate amount back to ConnectiCare. Obtain information faster. Denied Services: Refunds/overpayments by members: Manages the pharmacy program and drug list, including drug treatment protocols. Thank you! Adjustments (review of a claims processing error) The provider requests that ConnectiCare reconsider a denied claim or the amount paid based on the original claim submission. Parent with legal custody is remarried. Dr. Paul P. Arellano, M.D. He specializes in Surgery, has 16 years of experience, and is board certified. Denial letter, Explanation of Benefits, or take back notice from another carrier that was submitted within six (6) months of the date of denial, Provider Appeals Coordinator As the baby formula shortage continues, there are certain precautions you should take. Provide an explanation of why you are sending the refund. The member: Must notify ConnectiCare of other coverage and will be responsible for payment of all non-covered services; and Our members rely on our provider directory to find doctors like you quickly and easily. ConnectiCare will pay up to the members responsibility under the primary carrier or ConnectiCares contracted amount, whichever is lower. Available 8:30 a.m. to 5 p.m., Monday Thursday, 9 a.m. through 5 p.m. on Friday. This is the most efficient, cost-effective means of claim submission. If you have additional questions regarding EFT, please call 800-828-3407. If a ConnectiCareSOLO member is also enrolled in a Medicare plan, Medicare will be the primary plan. Health insurance. Interpreter service is available at each location. While the paper statement generally follows 3-5 days following remittance of your check, you'll receive your ERA within a day or two of claims reimbursement. 203-272-1554 Note: From time to time ConnectiCare will coordinate with other vendors. 9 a.m. to 2 p.m. Saturday. We have contracted with vendors who review the data for errors or omissions and forward it to us once it is error-free. New Century Health - Medical Oncology Policies, Provider resource: 2020 changes to Medicare Advantage plans, Dual special needs plan member information available through provider website, Reminders about caring for our Medicare Advantage members, Changes to claims payment for Medicare Advantage inpatient stays, Update on Medicare Beneficiary Identifiers (MBIs). 175 Scott Swamp Road, Farmington, CT 06032-3124, Email: Send directly to your Network Account Manager. Consult with your primary care provider for routine checkups, ongoing wellness needs and referrals (ages 18+). O4 Main Nav Items. Medicare Advantage Plan. This will allow you to verify whether the member has coinsurance requirements. If you submit procedure codes which are not on your contract/fee schedule, the claim will be denied. Go to radmd.com to view clinical guidelines, begin the authorization process, track pended preauthorization requests, or verify authorizations. He specializes in Surgical Oncology and Surgery, and has 14 years of experience. There is a 1-year adjustment limit from the date of the original Explanation of Payment. Or Call Now (888) 666-8161. Medicare and Medicaid-eligible members designated as Qualified Medicare Beneficiary Claims are adjudicated according to the providers contractual agreement and the members benefits. Box 494 Canton, MA 02021-0494. Click on a location to view our Saturday hours during open enrollment. CCI Consumer Community. It is not medical advice and should not be substituted for regular consultation with your health care provider. Details: You can also request a printed copy of the ConnectiCare provider directory by sending an email to: [email protected] If . (888-456-3728) You must indicate the other health plan insurance on the bill you submit to ConnectiCare. Denial letter, Claim Summary or Explanation of Benefits (EOB) from another carrier that was submitted within six (6) months of the date of denial, ConnectiCare plan. Tricare for life Claims address. 1-877-224-8230 Child whose parents are divorced or legally separated. Please do not use this address to send confidential information, such as Member ID, Social Security Numbers or private medical information. Small Group New Business1-860-678-5281 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 high-risk pregnancy. Hours are Mon. In the event that we notify you in writing that ConnectiCare has identified a payment error in an amount exceeding the amount due to you, you will be responsible for making the applicable refund. Secure Messaging If you submit procedure codes which are not on your contract/fee schedule, the claim will be denied. . Spouse (over 65) of active employee who is under 65. If you have any concerns about your health, please contact your health care provider's office. For inquiries about home health services, 1-800-723-2986 Our plans are designed to provide you with personalized health care at prices you can afford. 1-800-562-6833 Your ConnectiCare health benefits give you access to virtual care by U.S. board-certified providers. The ConnectiCare Provider Portal provides health providers with personalized access to patient ConnectiCare records online. Dual ConnectiCare Coverage: ConnectiCare will coordinate benefits under the secondary plan, after the first ConnectiCare plan has paid. You may direct any questions regarding claims to Provider Services at 877-224-8230. By showing providers with higher ProfilePoints . Box 416947 One of the largest non-profit health plans. (The filing limit for some self-funded groups may vary.) When forwarding a refund please be sure to: Complete aStandard Provider Refund Form How can providers check claims status? US and US Territories. When submitting theProvider Appeal Request Form, you must provide proof of timely filing. Change Healthcare | 877-363-3666 | changehealthcare.com Computer Innovations | 203-272-1554 | salfusco40@aol.com Capario | 800-586-6870 | sales@capario.com | capario.com Interested? Will I receive EFT for all types of claims? Following are some generally applicable rules for determining which plan is primary or secondary. 1-800-224-2273 Our portals may only be accessed using a supported browser such as the latest versions of Google Chrome or Microsoft Edge. Currently, ConnectiCare has relationships with several different clearinghouses. Submit claims electronically. You are now leavinga ConnectiCare website. Boston, MA 02241-6947. . If you have any concerns about your health, please contact your health care provider's office. Inquiries about the status of an application should be directed to this unit. Maintains provider records in ConnectiCares automated claims payment system and makes necessary changes to provider information, such as address, tax ID number, etc. Broker Services1-860-678-5281 Please see below for a list of clearinghouses with connectivity to ConnectiCare. Submit to: ConnectiCare If you have any concerns about your health, please contact your health care provider's office. (The copayment amount/applicable services, as stated on the ID card, are governed by the membersEvidence of Coverageor other legal documents, as applicable.) PNTData.com **Gender Rule: For dependent children covered by each parents policy when the parents are not divorced or separated, theplan of the fatheris primary over the mothers plan. Box 416608, Boston, MA 02241-6608 Dr. Derrick D. Cox, MD is a Surgeon in El Paso, TX. Available 9 a.m. to 5 p.m. Monday Friday, Premium Billing & Collections ConnectiCare Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. 177 were here. At ConnectiCare Centers, you can get help understanding and using your plan from one of our friendly associates. Please enter your last name and email address below. Practice Management System Software. An EDI connection is established with ConnectiCare through a clearinghouse. Florence, SC 29502 - 2112. Fax: 860-674-2849. Certain antepartum care: amniocentesis, biophysical profile, fetal ultrasound examinations, and fetal stress/non-stress test; SOLO Pre-Screen1-860-678-5204 Acceptable documentation includes: Electronic vendor statement (Acceptance Report by Providers) showing that the data was successfully received by ConnectiCare (i.e., #R022) I have more questions. 877-363-3666. ConnectiCares payer ID number for electronic claims submission: 78375 It offers providers the flexibility of having direct access to the information they need from ConnectiCare. Conducts new office orientations, educational and problem-solving visits, and general and specialty workshops for participating providers. The medical directors of participating IPAs and PHOs may consult with practitioners for the first line of appeal for any clinical decisions. Read the latest news and updates for ConnectiCare providers. Available 9 a.m. to 5 p.m. Monday Friday. Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Intake: 800-349-5365. Coordinates preauthorization of those services and procedures that require prior review by ConnectiCare. ConnectiCare encourages providers to take advantage of many online and automated tools that can expedite and simplify transactions. Provides useful information on topics such as community wellness programs, products, health management programs and more. Submitting. Once you receive payment from all carriers, determine if there is any remaining billable balance. Claims are not coordinated for workers compensation. At ConnectiCare, we live and work in the same communities we serve, so were able to meet the needs of our members like no one else. Find, Compare, and Connect With Dentists who accept ConnectiCare Insurance in Connecticut. Check info. Please check the privacy statement of the website where this link takes you. It is not medical advice and should not be substituted for regular consultation with your health care provider. We . . Contact Us - Solidarity HealthShare How Sharing Works Why Solidarity Resources Get a Quote Enroll Now (844) 313-4999 Member Login Contact Us Frequently Asked Questions Sharing Guidelines Blog Contact Us Are you a member of Solidarity HealthShare? Providers may also use PNT Data for online services (realtime claim and eligibility transactions). 1-860-674-5757 or 1-800-251-7722 (TTY: 711) Available 8 a.m. to 8 p.m. Monday - Friday, 9 a.m. to 2 p.m. Saturday Individual Plan Coverage 1-800-723-2986 For members who want information about coverage under a ConnectiCare SOLO or Access Health CT individual health plan. Dental. Medicare providers under their ConnectiCare contract are required to see all ConnectiCare Medicare Advantage plan members including those who are dual eligible for Medicare and Medicaid. Any information provided on this Website is for informational purposes only. When submitting a claim to ConnectiCare as secondary carrier, you must also include the claim summary or explanation of benefits (EOB) from the other health plan. Please contact your Network Account Manager to find out more. ConnectiCare commercial plan is primary and Medicare is secondary. If parents share the same birthday, the primary carrier is the health plan that has been in effect longer. Available 8 a.m. to 6 p.m. Monday - Friday, Medicare Provider Services If a member is entitled to receive medical/health benefits under another group insurance plan, the benefits under the ConnectiCare plan will be coordinated with benefits under the other plan(s), up to 100% of the members responsibility. What impact does the American Rescue Plan Act (ARP) have on health insurance coverage? Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. Laboratory codes and/or venipuncture, if no other service is billed; and 4. You may receive an acceptance or rejection report, highlighting any problems encountered. Verify authorizations for radiology services. Tricare for life Phone Number. 1-800-333-1733 is an Internist (Primary Care Doctor) in Deerfield Beach, FL. If you are NOT currently enrolled in a ConnectiCare Medicare Advantage Plan. (TTY: 711) Please include the effective date of the change and contact Provider Services to notify them of the change. Manage Spine Surgery and Interventional Pain Management Program. It is not medical advice and should not be substituted for regular consultation with your health care provider. Our plans are designed to provide you with personalized health care at prices you can afford. Dedicated Direct Telephone Line 1-800-333-1733 Broker Fax Numbers Send a copy of the Explanation of Payment Login. Go to Pay My Premium for details. ConnectiCare The process for submitting adjustments, corrected claims, and resubmissions is the same, as outlined below: If submitting a request for a corrected claim, also attach a copy of the corrected claim form (CMS 1500 or UB-04). under their ConnectiCare plan. Case managers are available for other management questions, 8 a.m. 5 p.m., Monday through Friday (Please leave a voicemail message ater hours). 877-469-3263 What impact does the American Rescue Plan Act (ARP) have on health insurance coverage? We require that you submit your changes in writing attention to Network Operations, 175 Scott Swamp Road, Farmington, CT 06032-3124. You are now leavinga ConnectiCare website. Small Group Renewals1-860-678-5272 Please check the privacy statement of the website where this link takes you. 175 Scott Swamp Road 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. If you're new, and have a registration code, click Register below to begin. Determines order of payment responsibility when a member is covered by more than one health plan or insurer. You should not take the primary copayment up front since this amount will be paid to you under the secondary plan. Note: Pursuant to Connecticut COB rules and federal law, ConnectiCare does not coordinate benefits under a ConnectiCareSOLO individual plan with other group plans or other individual plans. ConnectiCare commercial plan is primary (as long as the employer group has over 100 employees); Medicare is primary if the employer has less than 100 employees. If you have any concerns about your health, please contact your health care provider's office. Top 10 ConnectiCare Provider Specialties in Connecticut: Internist (821 providers) Nurse Practitioner (NP) (683 providers) Or, call 877-523-6837 for appointments or assistance. The electronic remittance advice (ERA) is sent out to our clearinghouses within one day of claims reimbursement. A hub for resources to help you care for our Medicare members. Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Currently, ConnectiCare has relationships with several different clearinghouses. Health plan/insurer of the parent whom the court has care ordered to provide coverage for the child. Some examples of services that generally do not take a copayment are as follows: Care related to pregnancy, after the initial office visit copayment is made; The primary focus is on assessment, triage, and follow up. Shall never be liable for more than their applicable cost-share (e.g., copayments, coinsurance, deductibles, etc.) Receive reimbursement through direct deposit. Secure Messaging If you are interested, click this link. A computer printout from a providers own office system is not acceptable proof of timely filing of claims. Home; Individual & Family; Medicare Advantage; Medicare Supplement Find benefit summaries, lists of covered drugs, and all necessary forms to get the most out of your ConnectiCare coverage. Copayments: If you dispute the overpayment amount, you must notify ConnectiCare in writing within fifteen (15) days of the initial overpayment notice. Box 4000 In this article, you'll find information on how to access the ConnectiCare Provider portal for either hospital or doctor's [] To ensure the Claims Department has adequate information to process claim adjustments and corrected claims in an accurate and timely manner, ConnectiCare requires that requests be submitted via theClaim Resubmission Request Form. CT & MA Members: To find out more, contact PNT Data directly at 1-860-257-2030. . For inquiries about services offered through ConnectiCare's dental care plans. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. You can verify whether or not a member is due a refund by referring to your Explanation of Payment and reconciling it against your patient accounts. Medicare Supplement Member Services You are now leavinga ConnectiCare website. The new myConnectiCare portal makes it easier to find care, view and understand your benefits, see how your claims were paid, and much more. For inquiries about mental health or substance abuse services. Clinical documentationshould notbe submitted with corrected claims. Director, Large Group Actuary. If you have any questions after reading this manual, please contact Provider Services at 860-674-5850 or 800-828-3407. You must bill the other health plan insurance/insurer first, when ConnectiCare is secondary carrier. 1-888-946-4658 Dr. Robert Reiter, MD is an Urologist (Genitourinary Doctor) in Los Angeles, CA. 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. Office Visit is an online provider newsletter published regularly as a resource to ConnectiCare providers. Claims: CarePartners of Connecticut P.O. You can submit claims, receive remittance advice, and perform other transactions using EDI. It is not medical advice and should not be substituted for regular consultation with your health care provider. . Where can I find more information about COVID-19 vaccines? They are available Monday through Thursday, 8:30 a.m. - 5 p.m., and 9 a.m. - 5 p.m. on Friday. 1-800-723-2986 We can help you choose and sign up for a plan during open enrollment or if you qualify for special enrollment. Please follow thesesafety guidelinesif you plan to visit one of our locations. Once you receive payment from all carriers, determine if there is any remaining billable balance. We will identify and request reimbursement of overpayments within 18 months of the date the claim was paid. Please refer to your MembershipAgreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Check our provider directory to make sure we have the right information for you and your practice. ConnectiCare has a fraud and abuse hotline that is available to members, providers, employees, and government officials. If you have any concerns about your health, please contact your health care provider's office. Order of benefit determination To begin using EDI, an electronic connection must be established between your office and ConnectiCare. Claims denied as beyond the filing limit by the primary carrier will not be accepted for payment by ConnectiCare. From the provider page on our website, access our radiology program atradmd.comto view clinical guidelines, begin the authorization process, track pended pre-authorization requests, or verify authorizations. Hours are Mon. (New York providers should refer to their contract as the filing limit in some contracts may vary. We work with other partners to deliver quality care to our members. Available 8 a.m. to 5 p.m. Monday - Friday (after hours you may leave a voicemail message). Providers should continue to send claims to the address indicated on the back of the ConnectiCare member ID card. Individual Plan Coverage If you have any concerns about your health, please contact your health care provider's office. SOLO Intake1-860-678-5274 Generally, the remittance and checks are mailed first class within 48 hours following the day on which they are produced. Note: In any case, the member is only responsible for one copayment per day, per billing provider/group in the same specialty, for applicable services provided. Make an appointment at any of our convenient locations. Available 8 a.m. to 8 p.m., seven days a week, 1-877-224-8221 You are in the right place. Notification is required for medical necessity review and benefit determination. Parent with custody is not remarried. If you receive an overpayment from a member that exceeds the cost-share for which they are responsible according to their benefit plan, we request that you refund the appropriate amount back to the member in a timely manner. Thank you! Any information provided on this Website is for informational purposes only. If you have any concerns about your health, please contact your health care provider's office. Gives you access to the provider manual, our onlineProvider Directory, downloadable forms, Pharmacy Central, and more. Monday Saturday 8 a.m. - 8 p.m. Medicare Supplement Sales Participating providers are required to collect copayments from members for services performed in the office setting for which the provider submits a claim. 5. Contact us O4 Utility Nav Items. ConnectiCare will provide decisions on administrative appeals within ninety (90) calendar days after receipt of the appeal request. * Birthday rule: Primary carrier is the health plan/insurer of the parent whosemonth and day of birthoccurs earlier in the calendar year. Visit a ConnectiCares Center for help making decisions about doctors, understanding your coverage, and achieving your wellness goals. The Group ID only allows numerical digits 0 through 9. P.O. Order of benefit determination Please send all mail (excluding payments) to: Click on a location to view our Saturday hours during open enrollment. Will EFT affect the way I receive my explanation of payment (EOP)? Immunization codes; To discuss how to best connect your office with ConnectiCare using EDI, call. Coordinates preauthorization of services and procedures that require prior review by ConnectiCare. Sign in O4 Main Nav. We accept UnitedHealthcare, Anthem and ConnectiCare Medicare Advantage health plans. Payment will not be made until we receive a copy of the claim summary or explanation of benefits (EOB) indicating the amount paid by the primary carrier. Automate your patient account reconciliation process. To sign up for ERA, contact PNT Data (formerly Post-n-Track) at860-257-2030orpntdata.comor Change Healthcare (formerly Emdeon) at877-363-3666orchangehealthcare.com. Confirmation and accuracy of change can be verified by viewing the onlineProvider Directoryor calling Provider Services. Entitlement of member 1-877-224-5979 plan. Find benefit summaries, lists of covered drugs, and all necessary forms to get the most out of your ConnectiCare coverage. Office Visit is an online provider newsletter published regularly as a resource to ConnectiCare providers. Most balance billing occurs when the member has a deductible that needs to be satisfied, such as a Medicare Part B deductible, or a commercial carrier deductible. Farmington, CT 06034-4000. Farmington, CT 06034-4000. Retired spouse of active employee has own retiree policy through previous employer and has Medicare Parts A & B. ConnectiCare commercial plan is primary, Medicare is secondary, the retiree policy is tertiary. Inquiries about the status of an application should be directed to this unit. Manage a team of actuarial professionals responsible for Pricing, Forecasting, Actuarial Analysis and . ConnectiCare strongly encourages the electronic submission of claims as the most efficient, cost-effective means of claim submission. ConnectiCare cannot pull a check or an EOP for a provider to pick up. You are now leavinga ConnectiCare website. As the baby formula shortage continues, there are certain precautions you should take. Assists you in reaching a department or specific employee within ConnectiCare. When you select to receive funds electronically, you can expect to receive your payment directly into your bank account within 48 hours of each claims payable date. You must bill the other health plan insurance/insurer first, when ConnectiCare is secondary carrier. In order to appeal, you must provide a letter explaining why payment is warranted and one of the following examples of acceptable documentation: ConnectiCares Claims Status Report, showing the claim was filed timely Login. ConnectiCare Otherwise, you will be responsible for reimbursing the member once the secondary payment is made. Call us 24/7 at (800) 695-5748 ConnectiCare is a top performing health plan available to the residents of Connecticut. . Go to News and Updates . The bill of service for these members must be submitted to Medicaid for reimbursement.
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