Magellan Rx to manage preauthorization review for IVIG, SCIG and Remicade products

ConnectiCare has contracted with Magellan Rx Management (Magellan Rx) to manage the review of preauthorization requests for the following specialty drugs:

This is effective Jan. 1, 2018, for all our Medicare Advantage and commercial plans, including individual and group plans purchased through the state insurance exchange, Access Health CT.

Magellan Rx, the pharmacy benefit management division of Magellan Healthcare, has more than 12 years of experience in specialty pharmacy and medical drug benefit management, and has clinical pharmacists and physicians available to ConnectiCare providers as resources.

If you have commercial or Medicare patients who are scheduled to receive any of the drugs listed above on or after Jan. 1, 2018, you must obtain preauthorization for those treatments from Magellan Rx. Through this preauthorization program, Magellan Rx may also direct commercial members to an alternative site of service, when appropriate.

To make sure your patients’ treatments continue without interruption, you can start submitting preauthorization requests to Magellan Rx starting Dec. 26, 2017. You can submit:

If providers do not obtain preauthorization for IVIG, SCIG, Remicade or all Remicade’s biosimilar products from Magellan Rx after Jan. 1, 2018, claims may be denied.

Claims and appeals processes are not changing: please continue to submit claims, claims questions and appeals to ConnectiCare.

Part B drug benefit for Medicare members will require preauthorization in 2018

We will require preauthorization for some drugs covered under the Part B drug benefit for Medicare Advantage members starting Jan. 1, 2018. This policy is consistent with the preauthorization process now in place for ConnectiCare commercial plans, including individual and group policies.

Here’s a list of drugs that will require preauthorization and where you will submit requests.

Depending on the drug, preauthorization requests will be reviewed by us or by one of our partners, New Century Health (NCH) or Magellan Rx Management (Magellan Rx).

• New Century Health — Submit requests by:

• Magellan Rx Management — Submit:

• ConnectiCare — Submit requests in writing by using this form and then:

2018 formulary changes for Medicare Advantage plans

We’ve written to Medicare Advantage members with Part D coverage who may be affected by changes in how drugs are covered starting Jan. 1, 2018. We urged them to talk to their doctors about any possible prescription changes they may need before the new year.

Please support your patients who may be affected by:

The changes to the formulary effective Jan. 1, 2018, will be:

Medical criteria for Dexilant will change after Jan. 1; new preauthorization requests required

We are updating our medical criteria for Dexilant (dexlansoprazole) on Jan. 1, 2018, for all our individual members with commercial plans bought on and off the state insurance exchange, Access Health CT.

We have notified members affected by this change and suggested they reach out to their doctors to get new preauthorization requests for Dexilant submitted to ConnectiCare after Jan. 1, 2018.

We will only cover Dexilant, if doctors document that the patient has tried all of the following alternatives to Dexilant without success:

Without a new preauthorization, we will not cover Dexilant and your patient will be responsible for the full cost of the drug. Doctors can fax a preauthorization request to ConnectiCare at 800-249-1367.

Passage referral plan changes for 2018

Our "Passage" referral plans are now available to more commercial and Medicare Advantage members and more PCPs will be accepting the plans. Here’s the Passage article from the November 2017 Office Visit if you need to refer to it again.

PCPs, please note:
Remember, if you are not designated as a Passage PCP, you should not provide primary care services to members with Passage plans. If you do provide such services, we will deny claims and tell members they are responsible for the costs. (For Passage members with individual plans through Access Health CT, the Connecticut insurance exchange, the claims will be paid under their out-of-network benefits.)

Specialists, make checking referrals a practice:
Check our website, connecticare.com/providers, to see if your Passage patients have a PCP referral for your specialty care. Passage members can see any specialist in the ConnectiCare network as long as they have valid referrals from their Passage PCPs for each specialist.

Expect your patients with Passage plans to ask you to confirm that their referrals remain valid before they have visits. Without referrals, we will deny claims for specialists’ consultation services and tell members they are responsible for the costs.

Referrals are not required when Passage members need hospital and/or ancillary care services, such as radiology and lab work.

Updated ID cards for your patients with plans purchased through Access Health CT

We’ve updated our 2018 ID cards for your patients with individual and small group plans purchased through Access Health CT, the state insurance exchange. Here’s the latest design:

New 2018 codes

Each year billing codes are updated by the American Medical Association. Please refer to the 2018 manuals for Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) as resources.

We’re updating our system for new 2018 codes. Claims submitted with new codes for covered services will be noted on the explanation of payment (EOP) statements with an explanation code of Z0 that states “New code, rate not yet established, will be adjudicated by March 31, 2018.” This applies to commercial and Medicare plans.

We will automatically adjust claims with new, covered codes that are submitted between January and March 31, 2018. Providers do not need to resubmit claims. When the adjustments are made and claims paid, EOPs will inform providers that the payment includes adjustment of the new codes that paid $0 upon initial submission.