Filling out forms and applications can be tedious. We can ensure that the process is smooth and is completed in a timely manner. Prior to completing and submitting any documents, please contact us at 203.949.4194 to ensure the submission of accurate and complete information.
Please be sure to read all instructions prior to completing this form
Attention: When adding a provider to your PCMH roster by completing a PCMH/GP Change form, claims previously paid for which enhanced rates are due will require you to complete a claim adjustment for each claim in question via HP’s Secure Web portal. Please note, these claims will be included in a future monthly HP re-processing project and will pay the enhanced rate at that time if you choose not to individually adjust these claims via the Secure Web portal at this time.
To update your information, please select your HUSKY Health Program type. Once you select your program, you will need to login to access and review your personal information.
To see whether you belong to HUSKY A, B, C, D, or LB simply look at your HUSKY ID Card. The big, bold letter is your HUSKY program.