ConnectiCare | Office Visit - April 2019 ConnectiCare | Office Visit - April 2019
April 2019 Office Visit

April 2019 - In this issue

Working to improve critical follow-up care for children with ADHD
Detailed reimbursement policy on Maximum Daily Frequency (MDF)
Reminder to use in-network labs
Recent provider headlines

Working to improve critical follow-up care for children with ADHD

Providers who initiate medication treatment plans for children with attention deficit hyperactivity disorder (ADHD) will begin receiving reminders about appropriate follow-up monitoring and care.

Medication can control symptoms of ADHD, which affects nearly 10 percent of American children. Use of medication, however, requires close monitoring of patients by their doctors, according to the National Committee for Quality Assurance (NCQA).

With the help of our pharmacy benefit manager, we will closely monitor drug claims for first-time prescriptions of ADHD medications to children, ages 6 to 12 years old. Then, our clinical quality care team will send out the following resources to prescribing providers:

Provider overview with details on the ADHD measure
Parent/guardian follow-up visit questionnaire

Included will be a reminder to schedule a face-to-face office visit within 30 days of a young patient filling the prescription, as recommended by the American Academy of Pediatrics.

Follow-up care for children prescribed ADHD Medication is a HEDIS* measurement. The measurement requires physicians who newly prescribe ADHD medication to have a follow-up visit with children, ages 6 to 12 year old, within 30 days of the initial prescription and two follow-up visits within the nine months thereafter.

*The Health Care Effectiveness Data and Information Set (HEDIS) is the quality measurement tool for the NCQA.

Detailed reimbursement policy on Maximum Daily Frequency (MDF)

ConnectiCare follows the Centers for Medicare & Medicaid Services’ Medically Unlikely Edits (MUE) guidelines for Medicare-covered services. For services covered by ConnectiCare commercial plans and not Medicare, please follow the established Maximum Daily Frequency (MDF) limits listed in this Maximum Frequency – Per Day Reimbursement Policy, now available through our provider website.

Reminder to use in-network labs

ConnectiCare has enlisted the help of Quest Diagnostics to remind in-network providers to send patients to in-network labs. Quest will reach out to providers who have referred members to out-of-network facilities for services. This program aims to help our members avoid higher or unexpected costs from out-of-network providers.

Recent provider headlines

Check out the latest Provider News & Headlines:

eviCore to manage preauthorization for genetic testing, effective April 1, 2019
Milliman Care Guidelines will apply to all ConnectiCare’s Connecticut individual and group plans, effective May 1, 2019
Cityblock Health arrives in Waterbury area to help serve ConnectiCare members
Claims edit to go into effect May 29, 2019
Clinical practice guidelines for chronic obstructive pulmonary disease (COPD) updated
Has any of your information changed? Let us know.

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