For Providers

Tools and Resources

Provider FAQ for 2025 Care N’Care changes

Benefits and Eligibility

Customer Service
844-806-8216 (M-F 7:30 a.m. – 5:00 p.m.)

How to get assistance with the Availity Provider Portal?
Availity Provider Portal users, please contact Availity at 1-800-282-4548.

Authorization and Referrals

Notice
Acuity Connect access is now read-only. For questions about authorizations or claims, call 844-806-8216 to speak with Provider Services.

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 required an authorization for 2024 dates of service.

Prior Authorization Code Lookup

  • HMO Plans:  In 2024 Care N’ Care no longer required referrals for processing of claims. Some providers may still have required an internal referral from the referring provider for treatment planning.

  • PPO Plans:  Care N’ Care does not require referrals for members in PPO plans.

SWHR UM is no longer accepting prior authorization requests or referrals.  If you have questions about authorizations, referrals, or claims, please call 844-806-8216 to speak with Provider Services.

If you have questions about authorizations, referrals, or claims, please call 844-806-8216 to speak with Provider Services.

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

New registrations for EFTs are closed after 2024.

New registrations for ERAs are closed after 2024.

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

Note: In-Network Disputes do not require medical records or supporting documentation to be included along with your dispute. If it’s determined after reviewing your filed dispute, medical records or supporting documentation is needed then Care N’ Care will contact you with this request.

Mailing Address:
Care N’ Care Insurance Company
Attention Appeals & Grievances Department
1603 Lyndon B. Johnson Freeway, Suite 300
Farmers Branch, TX 75234

Providers have 65 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
  • 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).

Note: In-Network Appeals do not require medical records or supporting documentation to be included along with your appeal. If it’s determined after reviewing your filed appeal, medical records or supporting documentation is needed then Care N’ Care will contact you with this request.

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

How to obtain Out-of-Network (OON) Appeal status?

You are leaving cnchealthplan.com

"