January 2017 - In this issue

2017 codes updated
Check benefits and eligibility of your Medicare patients online or through your EDI
Annual HEDIS data collection to start in February
Make sure we have current information for our provider directory
Have new ConnectiCare patients? Tell them about our seminar on Jan. 30
Recent provider headlines

2017 codes updated

A number of changes to 2017 codes went into effect at the start of the new year. Some codes were added and some have been deleted. Below are some changes you need to know:

• Modifier FX: A 20 percent reduction will be applied to all commercial and Medicare claims when radiology codes are billed with this modifier for "X-ray taken using film." This policy follows the guidelines of the Centers for Medicare and Medicaid Services.
• In-office laboratory and radiology policy: New codes have been added to the policy and codes have also been deleted as follows:
  • Mammography: We're adding the three new codes of 77065, 77066 and 77067 under the specialties of obstetrics/gynecology and reproductive medicine. These codes will be added to both the commercial and Medicare in-office lab and radiology policies.
  • Drug testing: We're adding new codes 80305 and 80306 to replace deleted codes G0477 and G0478 under the pain management specialty. This applies to both commercial and Medicare policies.
• Epidural codes: The new epidural codes of 62320, 62321, 62322, 62323, 62324, 62325, 62326 and 62327 will require preauthorization starting Jan. 1, 2017, for both commercial and Medicare plans. These codes will replace the following codes that have been deleted: 62310, 62311, 62317 and 62318.

We will soon update our online documents and policies to reflect the changes noted above.

Need to check benefits and eligibility of your Medicare Advantage patients? Go online or go through your EDI system

Benefit and eligibility checks for your ConnectiCare Medicare Advantage patients are now available through our website, connecticare.com, or your Electronic Data Interchange (EDI) system.

Both benefits and eligibility information for ConnectiCare Medicare Advantage members are once again available through PNT Data (formerly called Post-n-Track). Providers can also use our ConnectiCare website for benefits and eligibility checks.

As a reminder, please use the following values in submissions for ConnectiCare Medicare members for dates of service after Jan. 1, 2017:

• The member identification (ID) numbers on newly issued cards (Ex. M9988877701) (See samples of new cards.)
• Sender ID number 783750001
• Payer ID number 78375

Annual HEDIS data collection to start in February

Our annual HEDIS medical record review will begin next month. HEDIS, which stands for Healthcare Effectiveness Data Information Set, is a nationally recognized tool that allows health plans, like ConnectiCare, to measure performance of the services and care our members receive.

We use the results from the HEDIS annual review to improve the quality of care for our members, and strengthen our educational programs for providers and members.

As part of the review, one or more of your patients may be randomly selected. If this is the case, we may ask your office to provide the patients' medical records through:

• a scheduled visit to your office
• a faxed request
• access to the patient's electronic medical record (EMR)
• an electronic exchange of information via a secure file transfer (FTP) site

Please note, under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule, data collection for HEDIS is permitted, and the release of this information requires no special patient consent or authorization. Please be assured members' personal health information is maintained in accordance with all federal and state laws. Data is reported collectively without individual identifiers.

We appreciate your cooperation and your timely response to our requests. We will do what we can to work quickly and efficiently with you and your office staff to get the information needed.

Make sure we have current information for our provider directory

It's the start of a new year, a good time to check our provider directory to make sure we have the right information for you and your practice.

It's an essential source of information for our members, who rely on it to find doctors quickly and easily.

Relevant changes include your:

• tax ID number
• national provider identification (NPI)
• address
• phone number
• office hours
• ability to accept new patients

Submit any changes with our provider information update form.

Have new ConnectiCare patients? Tell them about our Jan. 30 educational seminar about their new health plans

We will be hosting an educational seminar at 7 p.m. Jan. 30 at our ConnectiCare center in Manchester, 1487 Pleasant Valley Road, to help ConnectiCare members learn how to get the most of their new health plans. During the seminar, we'll help members find the online tools that can help them keep their costs down, navigate their prescription drug costs and understand the different places where they can get care.

Your patients can even get one-on-one help, too, by making an appointment for a private consultation before or after the seminar.

Tell your patients to go to visitconnecticare.com for details.

Recent provider headlines

Check out the latest Provider News & Headlines:

• New "Passage" referral plans for commercial and Medicare members
• Breast tomosynthesis screening, 3-D mammography, will be covered by fully-insured commercial plans starting Jan. 1
• Changes to the Medicare Advantage payments process
• Newly designed ConnectiCare ID cards for all members: Claims processing information for Medicare Advantage members
• New 2017 codes
• CMS rule for providers prescribing Medicare Part D drugs, now effective in 2019

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