1-800-562-6833 You are now leavinga ConnectiCare website. - Fri. 8 a.m. - 5 p.m. If payment is not received within the 30-day time frame, the overpayment amount will be taken back through future claims payment. ConnectiCare encourages providers to take advantage of many online and automated tools that can expedite and simplify transactions. 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. 800-881-2739 (TTY: 711) 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? Mammography screening. Submit claims electronically. 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. Changehealthcare.com If you're new, and have a registration code, click Register below to begin. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. 1-800-333-1733 CT & MA Members: 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. Please include the effective date of the change and contact Provider Services to notify them of the change. You must bill the other health plan insurance/insurer first, when ConnectiCare is secondary carrier. Please enter your last name. Florence, SC 29502 - 2112. The line is available 24 hours a day to members, providers, employees, and government officials. If a ConnectiCare SOLO or Exchange member is also enrolled in a Medicare plan, Medicare will be the primary plan. My company has a lot of open positions! Also, this information is not intended to imply that services or . 9 a.m. to 2 p.m. Saturday. Please refer to your MembershipAgreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. The new myConnectiCare portal makes it easier to find care, view and understand your benefits, see how your claims were paid, and much more. Any information provided on this Website is for informational purposes only. Please see below for a list of clearinghouses with connectivity to ConnectiCare. Maintains provider records in ConnectiCares automated claims payment system and makes necessary changes to provider information, such as address, tax ID number, etc. Review the Explanation of Payment to determine why the claim was denied or why only partial payment was made. See Patient Ratings & Read Reviews of other Connecticut doctors. She specializes in Internal Medicine, has 9 years of experience, and is board certified. We'll send your username to the email address we have on file for you. Once you receive payment from all carriers, determine if there is any remaining billable balance. 175 Scott Swamp Road If you have any concerns about your health, please contact your health care provider's office. 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), Subscribers spouse without other group health insurance, Subscribers spouse with other carrier group health insurance, Dependent child when both parents have insurance, and are not separated or divorced, Determined by the COB Birthday Rule* (unless the Gender Rule** applies). It is not medical advice and should not be substituted for regular consultation with your health care provider. Medicare and Medicaid-eligible members designated as Qualified Medicare Beneficiary Switch to: providers . If parents share the same birthday, the primary carrier is the health plan that has been in effect longer. Please consult your IPA or PHO. Provider Appeals Coordinator . For example, when physicians bill for a preventive visit in addition to an office visit, on the same date of service, only one copayment should be collected. Check info. Adjustments may not be requested for services denied due to claims payment policies. You may direct any questions regarding claims to Provider Services at 877-224-8230. A computer printout from a providers own office system is not acceptable proof of timely filing of claims. Please send all mail (excluding payments) to: Order of benefit determination 877-224-8221TTY: (711) Secure Messaging If you are a Medicare customer, you can also call 1-800-224-2273,(TTD: 711). (ConnectiCare may also ask that you provide us with a spec sheet from your bank or a copy of a voided check.) To speak with a representative about programs for chronic conditions. Providers may also use PNT Data for online services (realtime claim and eligibility transactions). If additional documentation is requested by ConnectiCare, the documentation must be provided within 30 calendar days of the request. ConnectiCares 180-day filing limit (from date of service) applies. * Yes No If a ConnectiCareSOLO member is also enrolled in a Medicare plan, Medicare will be the primary plan. ConnectiCare currently offers group health plans in a subset of western Massachusetts counties Optum is in the process of expanding its provider network to be ready for the expansion in BHCA services effective 7/1/19, for new and renewing groups: o Optum has identified BHCA providers state-wide If you have any questions after reading this manual, please contact Provider Services at 877-224-8230. Top 10 ConnectiCare Provider Specialties in Connecticut: Internist (821 providers) Nurse Practitioner (NP) (683 providers) This is a protected messaging feature available only after you log in through your secure ConnectiCare Online Services account. ConnectiCare cannot pull a check or an EOP for a provider to pick up. Email: kofraud@emblemhealth.com. ConnectiCare commercial plan is primary, Medicare is secondary, the retiree policy is tertiary. Spouse of active employee is under 65 and eligible for Medicare due to total disability. . Coordination of benefits (COB) is a way of determining the order in which benefits are paid and the amounts that are payable when a member is covered under more than one group health plan. An EDI connection is established with ConnectiCare through a clearinghouse. When forwarding a refund please be sure to: Complete aStandard Provider Refund Form Note: From time to time ConnectiCare will coordinate with other vendors. Any information provided on this Website is for informational purposes only. 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? Box 4000, Farmington, CT 06034-4000, Preauthorizations Or Call Now (888) 666-8161. Box 4000 The primary focus is on assessment, triage, and follow up. For claim status inquiries, please sign in to our secure portal. Reviews and assesses the qualifications of practitioners/providers applying for participation in our network and periodically thereafter. For questions, please reach out to the clearing house to whom you submitted your claims. Change Healthcare | 877-363-3666 | changehealthcare.com Information Our portals may only be accessed using a supported browser such as the latest versions of Google Chrome or Microsoft Edge. You are in the right place. Refunds must be received within thirty (30) days of receipt of notice, unless alternative arrangements are made in writing and accepted by ConnectiCare. Available 8 a.m. to 8 p.m. Monday - Friday, 9 a.m. to 2 p.m.Saturday. We recommend that the copayment not be collected at the time of service. 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 Overview of Dr. Arellano. 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. Let us know. The bill of service for these members must be submitted to Medicaid for reimbursement. Through your secure provider website account, your EOP is available online 3 days following the claims payment date. Available 8 a.m. to 8 p.m., seven days a week, 1-877-224-8221 This is accomplished through comprehensive telephonic assessment of the member's medical and functional status and development of a care plan to include health coaching and care coordination. 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. Computer Innovations | 203-272-1554 |salfusco40@aol.com Services that require a copayment include, but are not limited to, office visits, pain management services, and diagnostic/therapeutic procedures. Receive reimbursement through direct deposit. Members should not receive a statement or be billed, unless the service has been denied with an explanation code that allows the member to be billed. Hours are Mon. What impact does the American Rescue Plan Act (ARP) have on health insurance coverage? 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. is a Surgeon in El Paso, TX. **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. (The copayment amount/applicable services, as stated on the ID card, are governed by the membersEvidence of Coverageor other legal documents, as applicable.) Producers can use this feature to send confidential information using the messaging system maintained within our secure servers. No. Brokers can use this feature to send confidential information using the messaging system maintained within our secure servers. Please see below for a list of clearinghouses with connectivity to ConnectiCare. 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; Any information provided on this Website is for informational purposes only. Refunds/overpayments by members: Administers preauthorization of imaging services, as appropriate, for all product lines. Monday Saturday 8 a.m. - 8 p.m. Medicare Supplement Sales Step 1. 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. Parent with legal custody is remarried. 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). If you have any concerns about your health, please contact your health care provider's office. This is a protected messaging feature available only after you sign in to your secure ConnectiCare account. You should not take the primary copayment up front since this amount will be paid to you under the secondary plan. (Does not apply to the private fee-for-service plans. There is a 1-year adjustment limit from the date of the original Explanation of Payment. ConnectiCare reserves the right to charge providers a $15 per claim fee for high-volume (20 or more claims) bulk billing errors for electronically submitted claims. Login. You must indicate the other health plan insurance on the bill you submit to ConnectiCare. Interpreter service is available at each location. A hub for resources to help you care for our Medicare members. The Group ID only allows numerical digits 0 through 9. ConnectiCare Online access to benefits, eligibility and claims information for ConnectiCare members, as well as referrals for Passage plans. Visit a ConnectiCares Center for help making decisions about doctors, understanding your coverage, and achieving your wellness goals. Aug 2019 - Present3 years 4 months. * Birthday Rule: Primary carrier is the health plan/insurer of the parent whosemonth and day of birthoccurs earlier in the calendar year. ConnectiCare as Secondary Carrier: 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. Or Call Now (888) 666-8161. Get care 24/7 for non-emergency conditions like cold & flu, sinus infections, allergies and more. You must indicate the other health plan insurance on the bill you submit to ConnectiCare. Please check the privacy statement of the website where this link takes you. ConnectiCare will pay up to the members responsibility under the primary carrier or ConnectiCares contracted amount, whichever is lower. Automate your patient account reconciliation process. Read! Compare plans, find a doctor, get forms, and more. First 30 months ConnectiCare commercial plan, then Medicare. For more information, contact Provider Services at 877-224-8230. You will no longer receive via mail a paper copy of your explanation of payment (EOP). If the appeal is the result of incorrect coding, the provider will receive notification to submit a corrected claim. If you have additional questions regarding EFT, please call 800-828-3407. Currently, ConnectiCare has relationships with several different clearinghouses. Following are some generally applicable rules for determining which plan is primary or secondary. Appeals and Grievances: Coronavirus (COVID-19) Updates for Providers Register for Secure Provider Portal Provider Login Register for a Webinar CarePartners of Connecticut distributes its Provider Update newsletter by email. Monday Friday 8 a.m. - 6 p.m. 1-888-946-4658 We . He graduated from Texas Endosurgery . Password *. Who should a provider contact if Send the refund to: ConnectiCare VIP Medicare Advantage Claims Refund Corrected claims (review of a claims billing error) The provider requests that ConnectiCare reconsider a claim based on incorrect, new, or missing data that was not submitted with the original claim. Clinical documentationshould notbe submitted with corrected claims. manage your account or pay your bill here. Certain antepartum care: amniocentesis, biophysical profile, fetal ultrasound examinations, and fetal stress/non-stress test; Providers may also use PNT Data for online services (realtime claim and eligibility transactions). Please refer to your MembershipAgreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Find a doctor, dentist, specialty service, hospital, lab, and more. ConnectiCare providescoding resource informationon our website. If you submit procedure codes which are not on your contract/fee schedule, the claim will be denied. 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. Membershipagreement, Certificate of coverage, benefit Summary, or minimally invasive.. Directory to make sure we have the right to utilize third-party vendors to claim Focus is on assessment, triage, and drug list, including drug treatment protocols ( You can submit claims electronically in order to receive EFT for all types of claims that have yet. Visit is an online provider newsletter published regularly as a resource to ConnectiCare in News and media, corporate giving and government officials, as appropriate can expedite and simplify transactions of those and. Certain where to direct your call, start here ID number, etc! Needs who would most benefit from direct intervention in their case, before their condition!, eligibility, and claims information for you and your practice as referrals for Passage plans plan,! Not apply to the ConnectiCare member portal, where you can afford amount! 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