Providers Overview

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Providers

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What you need to know.

Provider Enrollment

SWCAA greatly values the dedication and hard work of our Providers. Please note that provider enrollment is no longer facilitated by the Access Agency.

All Providers seeking to enroll or re-enroll in a Connecticut Medicaid Waiver Program—including the Home Care Program for Elders, the Acquired Brain Injury (ABI) Waiver, and the Personal Care Attendant (PCA) Waiver—must follow the link below and select “Provider Enrollment” to access the official instructions.

SWCAA is unable to conduct business with any Provider who does not complete enrollment and re-enrollment as required by the State of Connecticut Medical Assistance Program.

Enrollment Assistance
For questions regarding enrollment, please contact GT Independence at1-877-659-4500, the entity responsible for provider enrollment and maintenance.

Provider Rotation & Referrals
Once enrollment is confirmed, Providers are added to SWCAA’s provider rotation list.
Clients choose their preferred providers first.
Provider rotation is used only when a client does not have a preference.
SWCAA cannot guarantee a minimum number of referrals.
Referral frequency may vary and, in some categories with fewer clients, there may be extended periods without referrals.

Important Update
SWCAA is currently not receiving updated provider information from GT Independence.
If you are a new provider, please complete the form below and attach:
Proof of enrollment with GT Independence, and
Proof of enrollment with Gainwell.
Once all materials are gathered, email the completed form and attachments to:
swcaaupdates@swcaa.org

SWCAA’s Role in Provider Payment

SWCAA plays a defined and limited role in the Prior Authorization workflow. Our responsibilities center on client assessment, care planning, and ongoing monitoring—not billing or system management.

How the PA Process Works
Referral: A Care Manager contacts a Provider based on Client preference, or
Rotation across more than 300 contracted providers.
Authorization: The Care Manager enters the PA into SWCAA’s internal system.
Upload: Information is electronically uploaded to Gainwell within 48 hours.
Transfer: Gainwell forwards PA details to Sandata within another 48 hours.
Activation: Sandata enables scheduling and EVV-related functions.

Important Clarifications & Misconceptions

SWCAA IS NOT

  • The State of Connecticut
  • Able to access Sandata or EVV
  • Able to view your agency’s information in Sandata
  • Able to view Provider billing or claim status in the Gainwell portal
  • Notified of billing denials unless a Provider reports them

SWCAA DOES

  • Provides verbal authorizations
  • Enters PA information into the portal within 7 days, as required
  • Assists clients in gathering documents for eligibility reviews
    • (Note: SWCAA does not determine eligibility and cannot expedite State decisions.)

SWCAA DOES NOT

  • Issue provider payments
  • Interact with or access the Sandata EVV system
  • View paid or denied provider claims
  • Authorize provider enrollment
  • Determine client eligibility

Provider Best Practices
Use a central, non-employee–specific email for scheduling issues (e.g., agency@domain.org) to maintain continuity.
Inform SWCAA immediately when a client is unavailable, including hospitalization, SNF stays, vacations, or any service breaks. Do not bill for dates when services were not delivered.
Notify care managers of any changes in condition or client safety concerns.
Review the PA in the www.ctdssmap.com portal for accuracy.
When contacting Sandata/EVV, always provide the PA number from the DSS portal.
Send encrypted emails to swcaabillings@swcaa.org. If you do not have encryption, request an encrypted message from SWCAA Billing.
Email billing concerns one week prior to the billing cycle.
Notify SWCAA Billing of any ongoing eligibility issues lasting more than 90 days.
Use the SWCAA Staff Directory for point-of-contact reference.

SWCAA Billings & Error Resolution

When to Contact SWCAA Billing

SWCAA Billings should be contacted only for specific Prior Authorization (PA) or billing-related issues that fall within our role as the Access Agency. Below are the appropriate scenarios for using swcaabillings@swcaa.org.

  1. PA Not Visible in DSSMap/Gainwell After 7 Days
    • If the PA does not appear in the www.ctdssmap.com portal more than 7 days after verbal authorization than submit a completed Provider Issue Request to swcaabillings@swcaa.org via encrypted email.
  2. PA is Visible and Accurate, but Billing Failed
    • If the PA appears correctly in Gailwell & Sandata with a valid PA number, but your claim is denied than email swcaabillings@swcaa.org with a completed Provider Issue Request including:
      • Billing error description
      • Date ranges
      • Supporting details
  3. Eligibility Related Billing Errors
    • If Billing errors appear to be related to eligibility, try the following steps first:
      • Search using full-month date ranges
      • If no State or Waiver Benefit Plan is listed, contact the client’s Care Manger (use the staff directory page)
  4. PA Visible but Different from Verbal Authorization
    • Contact the Care Manager immediately. Adjusting a PA impacts all claims tied to that authorization.

How to Use SWCAA Billing Forms

  1. Download the SWCAA Billing Form (Provider Issue Request).
  2. Complete all fields (example available on your site).
  3. Send the completed form via encrypted email to:
    📧 swcaabillings@swcaa.org

Encryption Instructions

  • If you already use encrypted email → send directly.
  • If you do NOT have encrypted email:
    • Send a message to swcaabillings@swcaa.org with “encryption request” in the subject line.
    • SWCAA will reply with an encrypted message that you can respond to securely.

🚫 When Not to Contact SWCAA Billing

For issues outside SWCAA’s control, please use the correct contacts below:

  1. PA Missing in Sandata but Visible in DSSMap
    • Email: ctevv@dxc.com
  2. Missing Clients or Unknown Clients in Sandata
    • Send a secure email to ctevv@dxc.com
  3. Sandata System or Functionality Issues
    • Sandata Customer Care: 1-855-399-8050 or ctcustomercare@sandata.com
  4. Assistance with Billing Submission
    • Gainwell Help Desk: 1-800-842-8440

Important Contact Information

GAINWELL

Tech Issues: 1-800-842-8440 or Billing Issues: 1-800-688-0503

GT INDEPENDENCE

Customer Care: 1-877-659-4500

SANDATA

Customer Care: 1-855-399-8050