Frequently Asked Questions
What makes CareConnect different from other health insurance companies?
CareConnect was created by one of the largest health systems in the country, so we are aware of all the challenges you face in serving your patients and managing your practice. Our unique approach to provider relations includes integrating care delivery to make things easier for you, your staff and your patients. That's why we call CareConnect healthier insurance.
Where can I find a list of services that require preauthorization?
For a complete list, please view our Preauthorization Requirements.
How do I submit a claim?
You can submit claims electronically or by mail. For electronic submissions, we use the Emdeon Clearinghouse. Our Payer ID Number — 46227 — should be included on all submissions. For paper submissions, claims should be billed on standard CMS-1500 (professional) or UB-04 (facility) forms and mailed to:
Attn: Claims Department
P.O. Box 830259
Birmingham, AL 35283-0259
Claims must be submitted within 120 days of the date of service for prompt adjudication and payment, unless otherwise noted in your provider agreement.
How can I check claims and eligibility?
You can check member eligibility and claims status in one of two ways—by logging in to the Provider Portal or by using our new automated phone service. Just call 855-706-7545 and press 2 to get the information you need within minutes.
- How can I change my contact or demographic information?
Where can I find a list of approved drugs?
For our current formulary, please visit CareConnect.com/prescription-drugs.
Where can I find a copy of your Provider Manual?
To find the most recent copy of our Provider Manual, view our Provider Manual.
How can another physician in my group join the CareConnect network?
If a provider in your group practice would like to be added to the network, email us at firstname.lastname@example.org with the subject line “Add a provider.” Include a contact name and phone number or email address, the name and address of your group practice, practice TIN and the name of the provider you would like to add to the network. A network services representative will contact you.
How can I appeal a clinical decision?
You can initiate the appeals process by contacting a Customer Service Connector at 855-706-7545 and asking for the Grievance & Appeals Unit. If you prefer, appeals may be faxed to 844-447-2525, emailed to email@example.com, or mailed to:
Attn: Grievances & Appeals Unit
2200 Northern Blvd, Suite 104
East Hills, NY 11548
Appeals must be received within 180 calendar days of the denial.
Does CareConnect offer Disease Management programs? If so, how can I refer a patient?
We offer Disease Management programs for patients with Diabetes or Asthma. To refer a patient, simply call a Customer Service Connector at 855-706-7545 and ask to speak to Medical Management.
What is the CareConnect Physician Advisory Group?
Our Physician Advisory Group consists of physician leaders from the CareConnect network. The Advisory Group meets on a quarterly basis to receive business updates, discuss network issues, identify areas for collaboration, and review/approve evidence-based clinical practice guidelines and medical policies.
- Which evidence-based clinical practice guidelines does CareConnect adhere to?