What do you want to submit?
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Where in the portal should you submit it?
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Changes to my practice that cannot be done in the Provider Profile.
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Use the Ask a Question button in the Provider Profile to send a message to Provider Customer Service or go to My Messages under the User Profile Icon menu to get to the Message Center.
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Preauthorization request or concurrent review’s supporting documentation.
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The optimal time to submit documents is when first requested.
To add more documents later, use the Reference ID to find the initial preauthorization request or notification and attach documents there.
Note: We have increased the file size to 25MB per attachment for preauthorization requests.
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Care Plan updates or questions.
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Look up member’s eligibility. On Member Details page, use Send a Comment or Question button.
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Claim’s question.
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Look up the claim and use the Ask a Question button.
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Claim denial’s request for documents (e.g., medical records, operative reports, notes, invoices, test results, etc.).
Note: The portal cannot support the submission of corrected claims at this time.
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Find the claim and use the Ask a Question button.
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A Grievance. (Claim issue that does not involve a medical necessity determination.)
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First - Look up the Claim. Use the Ask a Question button to submit an initial claim inquiry.
The response will be returned to you through the Message Center.
Next - If you still do not agree with the determination, you may respond to the message requesting that the claim be reviewed again as a Grievance.
The decision will be final.
Or
Use My Messages under the User Profile Icon menu to get to the Message Center.
Select the Category: Grievance and Appeal
Select sub-category: Post-service
The response will be returned to you through mail or email.
The decision will be final.
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More than five documents about a claim.
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To send additional documents related to the same claim, find the message in My Messages, use the Follow-up button, and attach up to five more documents. Repeat until all documents are uploaded.
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A standard appeal. (To address an adverse determination made based on a medical necessity denial.
Do not use the provider portal for Expedited Appeal requests. Instead, use the:
EmblemHealth Expedited Fax Line: 866-350-2168
or
ConnectiCare Expedited Fax Line: 800-867-6674
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Use My Messages under the User Profile Icon menu to get to the Message Center.
Select the Category: Grievance and Appeal
Select sub-category: Pre-service or Post-service
Tips:
- Attach supporting documentation including medical records.
- Include contact name and phone number of person we can speak to.
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General question for Provider Customer Service.
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Use the Message Center to send us your questions.
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