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Forms and resources for health care professionals

O4 Hubs


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.

Affirmative statement

See our utilization management policy in Connecticut.

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.

Referral authorization form

Use this form to refer a patient to another provider.