COVID-19: Telehealth policy and waiver of Passage PCP referrals extended*

Recognizing the ongoing and critical need to limit the spread of the coronavirus (COVID-19), we will extend our temporary program of reimbursing in-network providers for telehealth visits through June 30, 2020.

Do not charge any cost share to our members. We are waiving member cost shares — including copayments, deductibles and coinsurance — that may apply to telehealth visits through June 30. Please refer to this Temporary Payment Policy: Supplemental Telehealth Guidelines — Commercial/Medicare Advantage for details.

This policy applies to members of all ConnectiCare commercial and Medicare Advantage plans.

No referrals for Passage plan members also extended for June
Our commercial members with Passage plans will not need Passage PCP referrals to seek specialist care through June 30, 2020. Our provider website will be updated to reflect this extension.

Please visit our dedicated page on our provider website for the latest ConnectiCare news and information on our response to the COVID-19 outbreak.

Using telehealth for quality measurement and risk adjustment*

Only weeks ago, your waiting room was filled. Today you’re calling up the next patient on your laptop screen because of the coronavirus (COVID-19) pandemic.

Telehealth has allowed you to continue caring for your patients. It can do even more, by helping you close gaps in care and acquire the data needed for both commercial and Medicare Advantage health plan risk adjustment programs.

Here’s a tip sheet that you can use to help you with quality measures and risk adjustment.

Get your claims payments sent directly to your bank accounts

Whether your staff is working in the office or from home, you can now get ConnectiCare Medicare Advantage claims payments without having to open the mail or take checks to the bank. Sign up for electronic funds transfer (EFT) through PNC Bank’s Remittance Advantage.

This free service lets you receive direct deposits to your bank account(s) via EFT payments. You will also get 24/7 online access to view or download your electronic remittance advices (ERAs) to see payment details for your Medicare Advantage claims.

Here’s how to sign up for EFT today:

Please make sure you enroll for all payees associated with your TIN under EmblemHealth/ConnectiCare as payer. Tip: Go to the “search payees” page and filter for EmblemHealth/ConnectiCare as payer to find all the payees you need to enroll.

If you have questions about PNC Remittance Advantage, call their help line at 1-877-597-5489 from 8:30 a.m. to 8 p.m. Monday through Friday or email remit.advantage@pnc.com.

Medical record reviews to start this month

From now through December, Ciox Health and/or Optum may contact your office about retrieving the medical records of your patients who have ConnectiCare Medicare Advantage plans. As you may be aware, the Centers for Medicare & Medicaid Services (CMS) requires health plans to have full and accurate records of all diagnoses.

Recognizing these unusual times, a Ciox representative will contact you with safe options to share the records requested for this project. You will be able to upload your charts remotely to the CioxLink portal (instructions will be sent to you directly) or, if you would like, you can arrange for a remote agent to download your charts from your EMR directly by simply calling Ciox at 1-877-445-9293.

You may also hear from Optum, which is working with us and Ciox. Together, these vendors will review the charts for 2019 and 2020 dates of services on our behalf.

As our partners and “business associates,” as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Ciox Health and Optum are fully HIPAA-compliant and are 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 Medicare provider services enter at 1-877-224-8230.

New and updated medical policies

We have new and updated medical policies for your reference.