Instructions Upon Completion of the Enrollment Wizard

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Upon completion of the on-line Web portal enrollment/re-enrollment application, providers are issued an Application Tracking Number (ATN) that may be used to track the status of their application. Please do not submit a paper copy of the completed Web application to Gainwell Technologies, or complete a paper application after a Web application has been submitted to Gainwell Technologies. If a correction is required to the Web application after it has been submitted, that correction should be submitted on the provider’s letterhead to the address below.

You may have been notified upon completion of your application that you must submit some follow on documents. Those documents only, and not the application itself, must be sent to Gainwell Technologies at the following address in order for your application to be finalized. The ATN must be included on the top of each of these documents. Failure to submit the follow on documents may result in the denial of your application.

Gainwell Technologies
Provider Enrollment Unit
P.O. Box 5007
Hartford, CT 06102-5007

To review the list of follow on documents that are required for your provider type/specialty, click on the link below and locate your type/specialty.

Follow on Document Requirement by Provider Type and Specialty

Next Steps

Upon completion of an application and receipt of any necessary follow on documentation, Gainwell Technologies performs a final validation of the submitted information. If any information is missing, invalid, or Gainwell Technologies is unable to process the application, the provider will be notified via letter of the correction or additional information required. Providers will not be able to correct or modify completed applications using the Wizard but will need to submit paper corrections.

Once all information has been provided and is correct, Gainwell Technologies will submit the completed application to the Department of Social Services Quality Assurance Unit for approval. The Department of Social Services returns an approval or denial to Gainwell Technologies, who then notifies the provider of the final status of the application.

Approvals

The Provider Enrollment Approval Notice notifies the provider of acceptance or successful re-enrollment in the Connecticut Medical Assistance Program(s), as well as the taxonomy/provider type/specialty of the enrolled provider and a list of members within the provider’s organization, if applicable.

The Provider Enrollment Approval Notice supplies information on Electronic Data interChange options for submitting and receiving electronic program information, like claim submission and remittance advices.

Denials

If an enrollment/re-enrollment application is denied, a Provider Enrollment/Re-enrollment Rejection Notice is sent to the provider. This letter outlines the reason(s) the application was denied. A provider receiving a denial from Department of Social Services' Quality Assurance Unit must follow the instructions for responding to the denial as outlined in the letter. In order to reapply to the Connecticut Medical Assistance Program, a provider must once again follow the enrollment process described previously.

Re-enrollment

Providers are assigned a re-enrollment due date based on the date the last application was executed. Re-enrollment periods vary by provider type and are displayed in Section 3.4 of the Provider Manual. Refer to Section 3.4 for additional information on re-enrollment procedures.

Providers are notified via a letter when it is time to re-enroll. If providers do not respond to requests to re-enroll, Gainwell Technologies will generate and mail to the provider a reminder letter before dis-enrolling the provider from the Connecticut Medical Assistance Program.

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