Downloads

2026 Commercial Metrics– Updated January 2026
Screening for Social Determinants of Health (SDOH) Guide - February 2024
Value-Based Contract Metric Specifications Guide– Updated February 2023
Connecticut Children’s Care Network Group Agreements– Updated February 2023
Care Network Quarterly QI Visits Overview – Updated January 2026
Connecticut Children’s Office for Community Health Overview
We’re Here to Help: Care Coordination Support for Patients (English) - January 2026
We’re Here to Help: Care Coordination Support for Patients (Spanish) - January 2026

Payer Formularies

Direct Insurance Contacts

When there is a pattern that affects all Care Network practices, the Care Network team can submit an inquiry to determine the underlying cause and facilitate resolution. However, most health plans have transitioned to online tools as a mechanism to address service inquiries related to individual claims, credentialing, eligibility, benefit plan, formulary and prior authorization/step therapy. Outlined below are the tools used by each major health plan. Please note that the Care Network team does not have access to the provider portals as eligibility is limited to participating providers.

Subject to Change based on Health Plan updates

Payor	Platform	Functionality	Claims Reconsideration
Aetna	Availity Tabs include: Applications Resources News and Announcement	Claims Resources Clinical & Reimbursement policies Code Edit Lookup Tools Contact Us EFT OfficeLink newsletter updates Provider Education resources Provider Manual	Within 180 calendar days of initial decision Use Availity provider website
Anthem	Availity Tabs include: Applications Resources News and Announcement	Alerts Hub Authorization Rules lookup Live chat Claims status Clear Claim Connection (code edits) Digital Post Office Digital Solutions Learning Hub Precertification look-up tool Preference Center (notifications) Provider Enrollment and Network Management Provider Manual Provider Portal Provider Online reporting Remittance Inquiry Secure messages Total Member View	Within 365 days of the issue date of the EOP Use Availity provider website
Cigna	Cigna for Healthcare Professionals	Claims Patients Precertifications Reports Resources Working with Cigna (EFT, Directory updates, etc)	Within 180 calendar days of the initial payment or denial Use Cigna for HCP website Request for Health Care Professional Payment Review
ConnectiCare	ConnectiCare Provider Portal	Training Eligibility/Benefits Member Management Claims Preauthorization Referrals Notifications Attaching documents to transactions Grievances & Appeals Support Policies & Procedures Provider Resources	Within the initial 180 day filing limit if filed electronically Submit Provider Appeal Request Form
United HealthCare	United Provider Portal	Coverage & Payments Tools & Resources Policies and protocols Prior authorization Eligibility & referrals Education & Training Resource Library Network News Digital Tools	Within 12 months of the date of the EOB UHC Digital Tools

Note that Anthem and United require completion of a plan-specific form or spreadsheet that includes claims numbers and additional documentation. These forms must be submitted through an electronic platform (Availity, United provider portal) at the practice level. The Care Network does not have access to these portals as they are only available to participating practices/providers.

Quality Improvement Tools

Downloads

Payer Formularies

Direct Insurance Contacts