For Providers

Tools and Resources

Benefits and Eligibility

IVR (Automated Service)
844-806-8215

HIPAA Eligibility Transactions
(270/271 Benefits & Eligibility Files): For set up, your IT & clearinghouse must contact Change Healthcare (CNC clearinghouse vendor).

Customer Service
844-806-8216 (M-F 7:30 a.m. – 5:00 p.m.)

Availity Registration
Providers can now register for the new Provider Portal service with Availity at availity.com/provider-portal-registration.

How to get assistance with the Availity Provider Portal?
Availity Provider Portal users, please contact Availity at 1-800-282-4548.

2024 Benefit Highlight Brochure (PPO/HMO) :: English or Español

2024

  • Care N’ Care Choice Premium (PPO) Summary of Benefits ::  English or Español
  • Care N’ Care Choice Plus (PPO) Summary of Benefits ::  English or Español
  • Care N’ Care Choice (PPO) Summary of Benefits ::  English or Español
  • Care N’ Care Choice MA-Only (PPO) Summary of Benefits ::  English or Español
  • Care N’ Care Classic (HMO) Summary of Benefits :: English or Español
  • Southwestern Health Select (HMO) Summary of Benefits :: English or Español

2024

  • Care N’ Care Choice Premium (PPO) Evidence of Coverage :: English or Español
  • Care N’ Care Choice Plus (PPO) Evidence of Coverage :: English or Español
  • Care N’ Care Choice (PPO) Evidence of Coverage :: English or Español
  • Care N’ Care Choice MA-Only (PPO) Evidence of Coverage :: English or Español 
  • Care N’ Care Classic (HMO) Evidence of Coverage :: English or Español
  • Southwestern Health Select (HMO) Evidence of Coverage :: English or Español

2024

Authorization and Referrals

Acuity Connect Registration
817-632-3033

Care N’ Care’s Utilization Management, Pre-Authorization and Referrals are coordinated by Southwestern Health Resources (SWHR).

Providers are highly encouraged to utilize the Prior Authorization Code Lookup search tool to verify if specialty drugs, codes and services require an authorization.

Prior Authorization Code Lookup

Providers can search their network status under Find a Provider.

  • HMO Plans: Care N’ Care no longer requires referrals for processing of claims. Some providers may still require an internal referral from the referring provider for treatment planning.
  • PPO Plans: Care N’ Care does not require referrals for members under PPO.
  • Providers may submit referrals to Utilization Management (UM) as informational.
  • There are 2 options to submit Pre-Authorizations and Referrals which is by Acuity Connect portal or via fax.
  • Providers are highly encouraged to register for Acuity Connect portal.
  • If provider has no access to Acuity Connect, then the appropriate pre-authorization form can be filled out and fax as indicated on form.
  • Providers are encouraged to submit pre-authorizations and referrals prior to rendering services.
  • UM Department strives to review all completed referrals and pre-authorization requests in a timely manner. Providers are to receive the outcome of their requests no later than 14 calendar days.
  • Confirmation of the decision will be returned to the provider the method it was received either by Acuity Connect or fax.

Providers can call UM & CM Customer Service at 855-359-9999.

Claims Information

  • Provider Portal
  • Claims Customer Service: 844-806-8216 (M-F 7:30 a.m. – 5:00 p.m.)

66010

Care N’ Care Insurance Company
Attention Claims
P.O. Box 4375
Scranton, PA 18505

*Note: Providers must enroll for ERA’s in order to receive EFT at Change Healthcare.

Please send a letter on company letterhead informing Care N’ Care of the refund to include:

  • Name of Provider, TIN, NPI
  • Name of Member and ID number
  • DOS
  • Claims number
  • Amount

Mailing Address:
Care N’ Care Insurance Co Inc
P.O. Box 674534
Dallas, TX 75267-4534

Please send a letter on company letterhead informing Care N’ Care of the refund to include:

  • Name of Provider, TIN, NPI
  • Check number, check date and amount

Mailing Address:
Care N’ Care Insurance Company
Attention Claims
P.O. Box 4375
Scranton, PA 18505

Providers have 60 days from the date of notification of the claims decision to file a written dispute to Care N’ Care to include:

  • A written dispute request on company letterhead
  • Copy of the original claim form
  • Copy of remittance notification of denial

Note: In-Network Disputes do not require medical records or supporting documentation to be included along with your dispute. If it’s determined after reviewing your filed dispute, medical records or supporting documentation is needed then Care N’ Care will contact you with this request.

Mailing Address:
Care N’ Care Insurance Company
Attention Appeals & Grievances Department
1603 Lyndon B. Johnson Freeway, Suite 300
Farmers Branch, TX 75234

Providers have 60 days from the date of notification of the claims decision to file a written dispute to Care N’ Care to include:

  • A written appeal request on company letterhead
  • Copy of the original claim form
  • Copy of remittance notification showing the claim in question
  • A signed Waiver of Liability Form, promising to hold the member harmless regardless of the outcomes as required by the Centers for Medicare and Medicaid Services (CMS).

Note: In-Network Appeals do not require medical records or supporting documentation to be included along with your appeal. If it’s determined after reviewing your filed appeal, medical records or supporting documentation is needed then Care N’ Care will contact you with this request.

OON Appeals may be faxed or mailed to Appeals & Grievances Department:

  • Fax: 817-810-5214 (Attention to: Appeals & Grievances Department)
    Mailing Address:
  • Care N’ Care Insurance Company
    Attention Appeals & Grievances Department
    1603 Lyndon B. Johnson Freeway, Suite 300
    Farmers Branch, TX 75234

Waiver of Liability Statement

How to obtain Out-of-Network (OON) Appeal status?

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