ConnectiCare | Office Visit - October 2019
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Medicare Advantage plans will not require specialist referrals in 2020
We’ve made the following changes to our Medicare Advantage plans effective Jan. 1, 2020:
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Passage Plan 1 (HMO) members will no longer need referrals for specialist care. We will still require members to have Passage PCPs, who coordinate their care.
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Our dual special needs plan in 2020 will move from our Passage product suite to become Choice Dual (HMO D-SNP), with expanded options for primary care providers, increased allowances for over-the-counter (OTC) purchases, transportation benefits and routine eyewear. We’ve also added coverage for an annual physical exam (in addition to the annual wellness exam) and comprehensive dental coverage. D-SNP members will no longer need referrals for specialist care.
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Updates to our commercial and Medicare Advantage drug lists
We will send letters next month to our members with commercial and Medicare Advantage plans letting them know about 2020 changes to ConnectiCare formularies.
These letters will include drugs that you may have prescribed. The changes, effective Jan. 1, 2020, may include updates to preauthorization or step therapy requirements, quantity limits, tier changes or formulary status.
Ask your patients if they received a letter and talk to them about the changes. If your patient needs to stay on the current therapy, please reach out to our Pharmacy Services department to request an exception before Jan. 1, 2020. For your Medicare Advantage patients, call 1-877-224-8230. For patients with commercial plans, call 1-800-828-3407.
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Medication synchronization: Help make it easier for your patients to get their medications
One way to help support medication adherence among your patients is to encourage them to opt into a pharmacy’s medication synchronization (med sync) program.
In a med sync program, a pharmacist looks at all medications a patient may take and schedules prescription refills so they can all be picked up from the pharmacy on a single day each month. This can help your patient:
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Avoid missing doses
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Cut down on calls for multiple prescription refills
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Make fewer trips to the pharmacy
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Have the chance to meet monthly with a pharmacist to discuss their medications
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These programs are available through many local, regional and national pharmacies, like CVS, Walgreens and Rite Aid. Please check with your pharmacies for details about their med sync programs and how your patients can participate. You should also talk to the pharmacists to find out how their program works. It’s usually like this:
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Once a patient agrees to participate, pharmacy staff looks at the patient’s monthly medications and comes up with a plan that coordinates the refills so all can be picked up on a single day each month or even every 90 days if allowed by the patient’s health plan.
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The pharmacy staff will call the patient and confirm in advance the pickup date of the medications and discuss any changes that need to take place before prescriptions are filled.
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The pharmacy will fill each prescription and create a single package for pickup on the scheduled date.
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On the day of pickup, patients can speak with pharmacist and get their medication questions answered.
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A med sync program may be most helpful to patients who are older, have transportation issues, are new to chronic drug therapy or are taking multiple, ongoing monthly medications. It’s also a great solution for patients who are not adherent with their medication regimens.
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Coding information about physical exams for Medicare Advantage members
In 2020, obstetricians and gynecologists seeing a ConnectiCare Medicare Advantage member should only perform and bill the Medicare-covered annual pap/pelvic exam. Obstetricians and gynecologists should refer patients to their primary care providers (PCPs) for the preventive annual physical exam.
On and after Jan. 1, 2020, ConnectiCare will only cover CPT codes from 99381 through 99397 if the services were performed by PCPs. Ob/gyns will only be reimbursed for CPT code G0101 to stay consistent with reimbursement guidelines of the Centers for Medicare & Medicaid Services.
Here are some details about the G0101 submission code for pap/pelvic exam and pap collection:
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You may bill a separate E/M (evaluation and management) code only if you provided a separately identifiable E/M service
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$0 in-network
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A copay or co-insurance may apply if a member uses an out-of-network benefit, if available
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Every calendar year for those at high risk (visits do not need to be 12 months apart)
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Every two calendar years for women not considered high risk (visits do not need to be 24 months apart)
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A well-woman exam should include at least seven of the following criteria:
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Inspection and palpation of breasts for masses or lumps, tenderness, symmetry or nipple discharge
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Digital rectal examination including sphincter tone and presence of hemorrhoids or rectal masses
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Examination of external genitalia: for example, general appearance, hair distribution or lesions
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Examination of urethral meatus: for example, size, location, lesions or prolapse
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Examination of urethra: for example, masses, tenderness or scarring
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Examination of bladder: for example, fullness, masses or tenderness
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Examination of vagina: for example, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele or rectocele
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Examination of cervix: for example, general appearance, lesions or discharge
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Specimen collection for Pap smears and cultures
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Alzheimer’s Awareness Month: Support group held monthly at ConnectiCare center in Manchester
November is Alzheimer’s Awareness Month. Let your patients’ families know about the monthly support group held by the Alzheimer’s Association Connecticut Chapter at the ConnectiCare Center in Manchester.
The support group, free and open to the public, is held from 4:30 to 5:30 p.m. every third Wednesday at 1487 Pleasant Valley Road, Manchester. The group is led by a trained facilitator and provides a safe place for caregivers, family and friends of persons with dementia to:
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Develop a support system
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Share information and solutions
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Talk about their situations, feelings and concerns
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If you have a patient who has dementia or is caring for someone with dementia, please encourage them to seek help from a local support group. You can share this flyer with them.
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ConnectiCare center news: Norwalk location now open
A new ConnectiCare center is open in Norwalk at 64 North Main St. to help members sign up for health insurance and get answers to questions about their plan benefits. ConnectiCare now has six centers statewide to help new and renewing members during open enrollment, Nov. 1 through Dec. 15, 2019.
For center locations and hours, go to visitconnecticare.com. We recommend members or potential members make appointments through the website to prevent waiting.
We held a re-opening celebration at our ConnectiCare center in Waterbury, 835 Wolcott St., last month. We have improved the center to better serve our members, your patients, with a wider array of programs and events.
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