Forms and resources for health care professionals

Solutions

Provider dispute resolution form

Challenge, appeal or request reconsideration of a claim.

Quick reference guide

Get an overview of key information for the Connecticut market.

Affirmative statement

See our utilization management policy in Connecticut.

Referral authorization form

Use this form to refer a patient to another provider.

Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) form

Find helpful information to complete your ERA application and enroll in EFT for the Connecticut market.

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