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Benefits and Eligibility

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Availity Provider Portal Login

Benefits & Eligibility Verification
Claims Status & Details
Plan Specific Information

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 PPO/HMO :: English or Español

2023 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

2023

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

2023

  • 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

2023

Authorization and Referrals

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Acuity Connect Portal

Pre-Authorization Portal

Acuity Connect Registration
817-632-3033

Prior Authorization Codes

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 members require a referral from their PCP to Specialist.
  • PPO members do not require a referral however, a referral can be submitted as informational.

Pre-Authorization forms can be faxed to UM Department.

  • 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

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
  • 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

Waiver of Liability Statement

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

Additional Information and Tools

Provider FAQs Quick Reference Guide 2024 Medication Lookup 2023 Medication Lookup 2024 Online Request - Part D Coverage Determination 2023 Online Request - Part D Coverage Determination Provider Office Contact Information Form Find a Provider 2024 Pharmacy Information 2023 Pharmacy Information

1603 Lyndon B. Johnson Freeway, Suite 300
Farmers Branch, TX 75234

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Page last updated: November 21, 2023

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