CommercialJune 30, 2023
Important State of Connecticut Employer Group, Connecticut Partnership Plan changes
Effective July 1, Quantum Health has contracted with the State of Connecticut employer group as their health care navigation and care coordination service. Quantum Health will support the State’s membership with their healthcare and benefits needs, including the State’s Health Enhancement Program (HEP). Anthem will remain responsible for claims adjudication and certain utilization management services as described below.
Quantum Health is the point of contact for member and provider inquiries.
Quantum Health will be the point of contact for members and healthcare providers to verify:
- Benefit coverage information
- Eligibility inquiries
- Claim inquiries
- Prior-authorization submission and review
- Note: As of this publication, Anthem will continue to review and accept submission for medical and prior authorizations. Additional notice will be provided when the transition to Quantum Health is finalized for prior authorizations.
You will find Quantum Health’s contact information on the back of the new member ID card being distributed in June. A sample is provided below.
Anthem will remain the point of contact for providers for the following:
- Medical Specialty Pharmacy prior authorizations
- Note: Phone number located on ID card
- Behavioral Health Utilization Management and Case Management
- Note: Phone number on ID card will route you to Quantum Health and your call will be redirected to Anthem
- Quantum Health will re-direct provider questions/inquiries to Anthem for Medical and Behavioral Health Services for the following:
- Provider Contracting
- Remittances
- Fee Schedule
- Value Based Programs
- Network status
- Demographic information updates
If you have any questions, please contact your Provider Representative.
Sample State of Connecticut Member ID Card
Based on the information outlined above, there is a change in the Member Services and Medical Provider Services phone numbers. These two new phone numbers are located on the back of the Medical Member ID card.
For your convenience, we’ve included a list of State of Connecticut Employer group and State Partnership Plan member identification card alpha prefixes below.
State of Connecticut Employer Group and State Partnership Plan Member Identification Card Prefix List
Network Name | Product Type | State Health Benefit Plan | Alpha Prefix | State Partnership Alpha Prefix |
State Preferred | PPO | State Preferred | XGS | N/A |
State BlueCare | HMO – Point of Service (PCP referral not required) | Expanded Access | XGR | SHP |
State BlueCare | HMO – Point of Enrollment (PCP referral not required) | Standard Access | XGT | N/A |
State BlueCare | HMO – Point of Enrollment (PCP referral required) | Primary Care Access | XGL | N/A |
State BlueCare Prime (Narrow Network)* | HMO – POS | Quality First Select Access | X6G | X5P |
State BlueCare** | HMO – Point of Service (PCP referral not required) | Expanded Access | N/A | SHP |
* Effective July 1, 2023, the State BlueCare Prime (Alpha prefix X5P), also known as Quality First Select Access, is now offered as a benefit option for State Partnership Plan membership.
** UCONN Post Doctorate and Graduate Assistants plan is not a tiered plan.
CTBCBS-CM-028217-23
PUBLICATIONS: July 2023 Provider Newsletter
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