ConnectiCare | Office Visit - July 2019
June 2019 Office Visit

July 2019 - In this issue

In-home palliative care services available to your patients
New medical policies for ocular photoscreening and otoacoustic emissions testing
Medical record reviews for your ConnectiCare commercial patients to start in August
Has any of your information changed? Let us know.
Recent provider headlines

In-home palliative care services available to your patients

If you have ConnectiCare patients who would benefit from in-home palliative care services, you can refer them to Aspire Health, the nation’s largest provider of non-hospice, community-based palliative care.

ConnectiCare covers the full cost of Aspire Health’s services provided to our commercial and most Medicare Advantage members.*

You and other health care providers may refer patients who are ConnectiCare members by calling Aspire Health at 1-844-232-0500. Aspire Health also applies its proprietary algorithm to identify ConnectiCare members who could benefit from palliative care and reaches out to them by mail with information.

Since launching in 2013, Aspire Health has collaborated with doctors to care for more than 50,000 patients with advanced illness. Dr. Tara Friedman is the senior medical director in Connecticut.

Aspire Health teams include clinicians — doctors, nurse practitioners, nurses — plus social workers, chaplains and patient care coordinators. They provide experienced, compassionate “eyes and ears in the home” of patients with serious illness. They are on-call for patients and their families 24 hours a day, seven days a week. Aspire Health clinicians can prescribe medications and provide needed support to manage symptoms, such as pain, difficulty breathing, fatigue, nausea and difficulty sleeping.

Aspire Health will notify your office when a patient has accepted the offer of palliative care. Its robust data collection system allows Aspire Health to track and send you reports on patients’ status and quality metrics. Further, its system produces a summary of every visit and sends it to your office. Aspire Health will follow your preferences and protocols for communicating about patients and coordinating their care.

*Please note, this new program does not cover our members with ConnectiCare Medicare Advantage Passage Dual (HMO SNP) plan.

New medical policies for ocular photoscreening and otoacoustic emissions testing

The medical policies below apply to our commercial plans and go into effect Sept. 1, 2019:

Medical policy: Ocular photoscreening (commercial plans)
Instrument-based ocular screening using photoscreening will be covered as medically necessary for vision screening for the following:
o As a preventive screening for children 1 to 3 years of age
o Individuals 4 years of age and older who are developmentally delayed and are unable or unwilling to cooperate with routine visual acuity screening
Medical policy: Otoacoustic emissions testing (commercial plans)
This new policy includes guidelines for the following covered indications for CPT code 92558:
o Neonatal hearing screening as a preventive service using otoacoustic emissions (OAEs) is proven and/or medically necessary for infants who are 90 days or younger.
o Evoked otoacoustic emissions is considered medically necessary to screen children 3 years of age and younger who did not have the initial neonatal screening and/or cannot be effectively measured or monitored through audiometry.

Please refer to the policies for more details.

Medical record reviews for your ConnectiCare commercial patients to start in August

Cognisight, LLC may contact your office from August through December to retrieve and review the medical records of patients who have ConnectiCare commercial plans.

The Centers for Medicare & Medicaid Services (CMS) conducts the annual audit to verify accuracy of diagnosis data that health plans submit to the Department of Health and Human Services (HHS). We are required to submit supporting medical records on a limited population covered by the audit. Cognisight will call your offices to coordinate a convenient chart retrieval method and set the date when records are needed.

Please respond to Cognisight’s request for records promptly. Notice of the need for these reviews and your required compliance are included in your contract with ConnectiCare.

As our partner and “business associate,” as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Cognisight is fully HIPAA-compliant and is required to protect, preserve and maintain the confidentiality of any protected health information (PHI) obtained from clinical records provided by medical practices.

We appreciate your help. If you have questions, please call our provider services department at 1-800-828-3407.

Has any of your information changed? Let us know.

Check our provider directory to make sure we have the right information for you and your practice. Our members rely on our provider directory to find doctors like you quickly and easily.

Relevant changes include your:

Tax ID number
National provider identification (NPI)
Phone number
Office hours
Ability to accept new patients

Submit any changes by filling out our provider information update form and sending it back to us as noted on the form.

Recent provider headlines

Check out the latest Provider News & Headlines:

Preauthorization policies updated, effective Aug. 1, 2019
Policy updates on observation stay and after-hours, weekend care
Change in quality improvement organization
Reminders about services requiring preauthorization through Magellan Healthcare

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