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.
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.
See our utilization management policy in Connecticut.