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
2023 Benefits Information
Benefit Highlight Brochure
Benefit Flyer
- Choice Premium (PPO) :: English or Español
- Choice Plus (PPO) :: English or Español
- Choice (PPO) :: English or Español
- Choice MA-Only (PPO) :: English or Español
- Classic (HMO) :: English or Español
- Southwestern Health Select (HMO) :: English or Español
Evidence of Coverage
- Choice Premium (PPO) Evidence of Coverage :: English or Español
- Choice Plus (PPO) Evidence of Coverage :: English or Español
- Choice (PPO) Evidence of Coverage :: English or Español
- Choice MA-Only (PPO) Evidence of Coverage :: English or Español
- Classic (HMO) Evidence of Coverage :: English or Español
- Southwestern Health Select (HMO) Evidence of Coverage :: English or Español
Additional Benefits
- Over-the-Counter Benefit :: English or Español
- SilverSneakers® :: English or Español
- Preventive Dental :: English or Español
- Hearing Aid Coverage :: English or Español
- Eyewear Coverage and Routine Eye Exam :: English or Español
- Customer Experience Team :: English or Español
- Telehealth Benefit :: English or Español
- Acupuncture :: English or Español
- Moms Meal’s :: English or Español
- EXTRA, EXTRA! :: English or Español
Pre-Authorization & UM Referrals
Care N’ Care’s Utilization Management, Pre-Authorization and Referrals are coordinated by Southwestern Health Resources (SWHR).
Pre-Authorization Requirements:
- 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
Network Status:
- Providers can search their network status under Find a Provider.
Referral Requirements:
- HMO members require a referral from their PCP to Specialist.
- PPO members do not require a referral however, a referral can be submitted as informational.
Acuity Connect (Pre-Authorization Portal):
- To register for Acuity Connect portal call 817-632-3033.
- Acuity Connect portal features include: submit pre-authorization/referral requests, attach supporting documentation and view real-time status.
- Acuity Connect Pre-Authorization Portal
Pre-Cert Authorization Forms:
Pre-Authorization forms can be faxed to UM Department.
- Pre-Authorization Form
- Durable Medical Equipment (DME) Pre-Authorization Form
- Home Health (HH) Pre-Authorization Form
- SNF, LTAC, Rehab Pre-Authorization Form
Submit Pre-Authorizations and Referrals:
- 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.
Requests Outcomes:
- 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.
Customer Service:
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- Providers can call UM & CM Customer Service at 855-359-9999.
Claims Information
How to verify Claims Status?
- Provider Portal
- Claims Customer Service: 844-806-8216
Claims Payer ID: 66010
Mailing Address:
Care N’ Care Insurance Company
Attention Claims
P.O. Box 4375
Scranton, PA 18505
Clearinghouse
- Change Healthcare: 866-506-2830
- Change Healthcare Website: Click Here
Electronic Payments EFT (Electronic Funds Transfer)
- Change Healthcare: 866-506-2830 (option 2)
- EFT Enrollment Registration: Click Here
- Change Healthcare EFT Website: Click Here
*Note: Providers must enroll for ERA’s in order to receive EFT at Change Healthcare.
ERA’s (Electronic Remittance Advice):
- Change Healthcare: 866-506-2830 (option 4)
- Change Healthcare ERA Website: Click Here
How to send a refund check payable to Care N’ Care?
- 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 Company
Attention Finance Department
1603 Lyndon B. Johnson Freeway, Suite 300
Farmers Branch, TX 75234
How to return a check in error?
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- 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
In-Network (INN) Disputes
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- 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
- Provide any clinical records or supporting documentation supporting the reason for reimbursement
- 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:
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Out-of-Network (OON) for Non-Contracted Provider Appeals
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- 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
- Provide any clinical records or supporting documentation supporting the provider’s arguments for reimbursement
- 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).
- 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
- Providers have 60 days from the date of notification of the claims decision to file a written dispute to Care N’ Care to include:
- Please send a letter on company letterhead informing Care N’ Care of the refund to include:
How to obtain In-Network (INN) Provider Dispute/Out-of-Network (OON) Appeal Status?
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Provider can fill out the Provider Dispute/Appeal Status Request Form
- The status request forms can be faxed to A&G at 817-810-5214
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Alerts
- Care N’ Care Would Like To Wish Our Providers And Their Staff A Happy And Healthy New Year!
- The Inflation Reduction Act
- Annual Enrollment Period (AEP) runs from October 15th to December 7th with an effective date for January 1, 2023
- Provider Newsletter Q2
- Holiday Closures
- Southwestern Health Select (HMO) From Care N’ Care
- Lexis Nexis
- TMG Provider Portal
- Availity Will Be Care N’ Care’s Preferred EDI And Portal Vendor
- Care N’ Care Insurance Company, Inc. is Moving
- Point of Contact Information
- CNC Partners with Landmark Health
- Message to Care N’ Care Members Affected by Severe Winter Weather
- SNF and HH Prior Authorizations
- Electronic Medical Record Access
- KX Modifier Thresholds
- COVID-19 Resource HUB Now Live
- COVID-19 Member Coverage & Related Claims Information
