Tools & Resources
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
Benefits Information
Benefit Highlight Brochure :: Download PDF in English or Español
Evidence of Coverage
- Evidence of Coverage Choice Premium (MAPD-PPO) :: Download PDF in English or Español
- Evidence of Coverage Choice Plus (MAPD-PPO) :: Download PDF in English or Español
- Evidence of Coverage Choice (MAPD-PPO) :: Download PDF in English or Español
- Evidence of Coverage for Choice MA-Only (MA-PPO) :: Download PDF in English or Español
- Evidence Of Coverage Classic (MAPD-HMO) :: Download PDF in English or Español
Additional Benefits
Pre-Authorization & UM Referral Submissions
Care N’ Care’s Utilization Management and Pre-Authorizations are coordinated by SilverBack a sub-division of Southwestern Health Resources (SWHR).
For provider referrals and pre-authorizations.
How to Submit Pre-Authorization Requests:
- Fax 888-965-1964
- Acuity Connect Web Portal
- PPO health plan referrals serve as a courtesy notification. They are not requested for PPO plans, but encouraged to help better manage the patients healthcare.
- HMO plans require referrals
- PPO and HMO plans are required to submit pre-certifications and must be submitted prior to date of service.
How to Register for Acuity Connect Web Portal (Pre-Authorization Web Portal)
- Contact 844-632-2095
- Acuity Link
Pre-Authorization Requests
Pre-authorizations and referrals are required prior to seeing members or rendering services. Please submit requests to SilverBack sub-division of SWHR Utilization Management through Acuity Connect or fax. If you have any question for SWHR Utilization Management, please call at 855-359-9999.
Claims Information
Claims Status & Inquiries
Provider Customer Service: 844-806-8216
New Claims Payer ID: 66010
New Mailing Address:
Care N’ Care Claims
P.O. Box 4375
Scranton, PA 18505
Clearinghouse
Change Healthcare: 866-506-2830
Change Healthcare Website: Click Here
EFT (Electronic Funds Transfer) Enrollment
Change Healthcare: 866-506-2830 (option 2)
EFT Enrollment Registration: Click Here
Change Healthcare EFT Website: Click Here
*Must enroll for ERA’s in order to receive EFT at Change Healthcare
ERA’s (Electronic Remittance Advice) Enrollment
Change Healthcare: 866-506-2830 (option 4)
Change Healthcare ERA Website: Click Here
New Care N’ Care Member ID Cards & ID Numbers
In the month of May, members will receive their new Care N’ Care member ID cards to include a new member ID number. Providers are encouraged to verify benefits & eligibility. If need to, providers can bill with the old member ID number to submit claims until the new ID number is obtained.
How to send a refund check payable to Care N’ Care?
Care N’ Care Finance
1701 River Run, Suite 402
Fort Worth, TX 76107
How to return a check in error?
Care N’ Care Claims
P.O. Box 4375
Scranton, PA 18505
In-Network Disputes
Providers can contact Provider Customer Service at 844-806-8216.
Second level, submit in writing to Care N’ Care:
- A dispute request on your company letterhead
- Copy of original claim form
- Remittance notification of denial
- Clinical/supporting documentation that supports the providers reason for reimbursement
- Mailing Address: Care N’ Care Provider Claims Disputes
1701 River Run, Suite 402
Fort Worth, TX 76107
Out-of-Network Non-Contracted Provider Appeals
Providers can contact Provider Customer Service at 844-806-8216.
If a claim has been processed but you disagree with the outcome, you must file your written appeal request within 60 calendar days from the remittance notification date. Your request must include the following:
- An appeal request on company letterhead;
- A copy of the original claim form;
- Remittance notification showing the claim in question;
- Any clinical records or documentation that supports the provider’s arguments for reimbursement;
- And, a signed Waiver of Liability Form promising to hold the member harmless regardless of the outcome as required by the Centers for Medicare and Medicaid Services (CMS).
Your appeal may be mailed or faxed to:
Care N’ Care Appeals & Grievances
1701 River Run, Suite 402
Fort Worth, TX 76107
Fax: 817-810-5214 (Attention: Appeals & Grievances)
Alerts
- Message to Care N’ Care Members Affected by Severe Winter Weather
- SNF and HH Prior Authorizations
- Portal Maintenance
- Portal Maintenance and MLK Holiday Hours
- Holiday Hours
- Prior Authorizations
- EMS Access
- Memorial Day Holiday Hours
- KX Modifier Thresholds
- COVID-19 Resource HUB Now Live
- COVID-19 Member Coverage & Related Claims Information
RAF
- Managing Risk and Quality (Download PDF)
- Diabetic Complications (Download PDF)
- Substance Use Disorders (Download PDF)
- Top 10 Documentation & Coding Errors (Download PDF)
- 6 Factors Influencing Health (Download PDF)
- Neurologic Disease (Download PDF)
- Neoplasms Lymphoma Leukemia (Download PDF)
- Evaluation and Management (Download PDF)
- Respiratory Disease (Download PDF)
- Cardiovascular Disease (Download PDF)
- Coding Updates (Download PDF)
- Diabetes (Download PDF)
- Mood Disorders (Download PDF)
- Medicare G Codes (Download PDF)
- Risk Adjustment 101 (Download PDF
Frequently Asked Questions (FAQ’s)