Get the up-to-date Standard Provider Refund Form (Commercial) - ConnectiCare 2024 now

Get Form
Standard Provider Refund Form (Commercial) - ConnectiCare Preview on Page 1

Here's how it works

01. Edit your form online
01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to modify Standard Provider Refund Form (Commercial) - ConnectiCare in PDF format online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

Adjusting paperwork with our extensive and user-friendly PDF editor is simple. Make the steps below to complete Standard Provider Refund Form (Commercial) - ConnectiCare online easily and quickly:

  1. Log in to your account. Sign up with your credentials or create a free account to test the product before upgrading the subscription.
  2. Import a form. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
  3. Edit Standard Provider Refund Form (Commercial) - ConnectiCare. Effortlessly add and highlight text, insert pictures, checkmarks, and symbols, drop new fillable areas, and rearrange or remove pages from your document.
  4. Get the Standard Provider Refund Form (Commercial) - ConnectiCare completed. Download your modified document, export it to the cloud, print it from the editor, or share it with others via a Shareable link or as an email attachment.

Make the most of DocHub, the most straightforward editor to rapidly handle your documentation online!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Claim submission For additional information, contact Provider Services at 877-224-8230. You may submit paper claims by completing a CMS 1500 form or UB-04 form, as appropriate. The following information must be indicated on the claim, in the box indicated, in order for ConnectiCare to accept and process the claim.
To determine copayment requirement, call ConnectiCares Eligibility Referral Line at 800-562-6834.
You may also ask us for an appeal through our website at connecticare.com/medicare. Expedited appeal requests can be made by phone at 800-224-2273 (TTY: 711), from 8 am to 8 pm, seven days a week.
ConnectiCare offers both HMO and PPO plans and most of our plans also offer prescription drug coverage and Original Medicare does not. Plans also offer coverage for eyeglasses, annual checkups, chiropractic care, hearing and dental.
Log in to connecticare.com/providers. Check the members ID card. The EmblemHealth logo will be displayed on the front or the back of the ID card, like the samples below. The payer ID for electronic claim filing is 06105.

People also ask

A Resubmission is defined as a claim originally denied because of missing documentation, incorrect coding, etc., which is now being resubmitted with the required information.

Related links