WebCall the Provider Assistance Center Mon–Fri 8:00 am – 5:00 pm Toll free 1-800-842-8440 or write to Gainwell Technologies, PO Box 2991, Hartford, CT 06104 Program information is available at www.ctdssmap.com WebConnecticut Department of Social Services - ConneCT ConneCT Home > Login ¿Habla español? Print Page Help Login Please Note: If you do not have a ConneCT account, but you already have an Access Health …
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WebComplete the Medical Authorization Portal Access Request Form Register for the Medical Authorization Portal If you have additional questions contact CHNCT support at: Email: [email protected] Phone: 1.877.606.5172 for Technical Portal support, Monday through Friday 9:00 a.m. - 4:00 p.m. WebProvider Forms Find all forms available for provider use below. Some forms may also be found in related sections of the provider website. Common Resources Outpatient Prior Authorization Request Form Escalation Referral Form Inpatient Surgery/ Procedure Request Form Wheeled Mobility Letter of Medical Necessity Form Forms WebJan 11, 2024 · Hours M-F: 8am-4:30pm; Benefits Center line hours: 7:30am-4pm; Area(s) Served: CT Fees: Please contact provider for fee information. Application Process: Call or visit website for additional information. Eligibility Requirements: Please call service provider or visit website to learn more about eligibility requirements. Payment/Insurance … taco truck wenatchee wa