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)

FAQ’s Claims Process

Alerts

CMS New Medicare ID Cards

Forms

Tools

RAF

Frequently Asked Questions (FAQ’s)

Follow Us

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Tools & Resources

Care N’ Care’s Utilization Management and Pre-Authorizations are coordinated by SilverBack a sub-division of Southwestern Health Resources (SWHR).

How to Submit Pre-Authorization Requests:

How to Register for Acuity Connect Web Portal (Pre-Authorization Web Portal)

Pre-Authorization Requests

General Information

Plan Material Needed

Individual Provider

Group/Ancillary/Facility

Demographic Information

Contact Person

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