Authorization Request
Network Providers seeking authorization to treat HNCT members should log in to submit Outpatient Treatment Request (OTR) forms online.
Non Network Providers seeking authorization of outpatient services for Health Net of Connecticut (HNCT) members may click on a link to one fo the online forms shown below:
Online Outpatient Treatment Request(OTR) Forms for Health Net of Connecticut (HNCT) members
E-Outpatient Treatment Registration Form A
OTR A forms are the initial outpatient treatment requests used for obtaining authorization and to register a member for their initial 10 sessions with a practitioner.
E-Outpatient Treatment Request Form B
OTR B is the outpatient treatment request form used for providing clinical information when requesting pre-certification of sessions between 11 and 30.
E-Outpatient Treatment Request Form C
OTR C is the outpatient treatment request form used for providing clinical information when requesting pre-certification for 31 or more sessions.
If you have any problems filling and submitting the e-forms please contact us.
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