Cost shares for PCP and mental health clinician visits waived for Medicare Advantage members

ConnectiCare Medicare Advantage members can visit in-network primary care providers (PCPs) and in-network behavioral health clinicians for covered services in person or by telehealth from Aug. 1 through Dec. 31, 2020 without paying cost shares.* Copayments, deductibles, and coinsurance costs — listed in a member’s 2020 Evidence of Coverage — will be waived through the end of 2020.

This does not apply to Medicare members with ConnectiCare Choice Dual (HMO D-SNP). Medicaid covers these cost shares.

Cost-share waivers are part of ConnectiCare’s response to the coronavirus (COVID-19) pandemic. We want to help our Medicare Advantage members stay healthy and safe and encourage them to see their primary care doctors for needed preventive care, medication management, screenings and immunizations, including the flu shot.

We also want members to be able to seek the care of mental health clinicians during the public health crisis. This policy does not cover behavioral treatment at a facility-based inpatient setting or partial hospitalization services.

Medical specialist care
Please note: this temporary policy does not apply to medical specialist care. Medicare Advantage members can continue telehealth visits with medical specialists for covered services without a cost share through Sept. 9, 2020. After that date, members will be responsible for cost shares for medical specialist visits that take place in person or by telehealth.*

Other COVID-19 news

*This assumes the Centers for Medicare & Medicaid Services will continue to allow health plans to adjust benefits mid-year during the public health emergency. As a result, the end date of the waiver is subject to change.

Extension of Temporary Payment Policy: Supplemental Telehealth Guidelines — Commercial/Medicare Advantage

Recognizing the ongoing and critical need to limit the spread of the coronavirus (COVID-19), we will again extend our temporary program of reimbursing in-network providers for telehealth visits through March 15, 2021.

This policy is intended to reflect the requirements of applicable federal, state and agency laws, regulations and directives (“Applicable Law”) and will remain in effect for the period required by Applicable Law. ConnectiCare reserves the right to amend and/or revoke this policy at any time to the extent such amendment or revocation reflects any changes in Applicable Law.

Please refer to these documents for details:

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

New Compass plans available on Jan. 1, 2021 and later

ConnectiCare plans to offer commercial group and individual customers a new line of health plans with preferred primary care providers (PCPs) and hospitals. The new Compass plans, available for start dates of Jan. 1, 2021 and later, are one of the ways we are working to help employers and individuals under age 65 manage their out-of-pocket costs.

Compass plan members who visit “preferred” primary care providers (PCPs) and hospitals will have lower cost shares — copays, coinsurance and/or deductibles — as outlined in their plan documents. Providers in the ConnectiCare commercial network will participate in Compass plans and appear in provider directories published for plan members.

Compass plan preferred providers as of Jan. 1, 2021 will be PCPs who participate in commercial Passage plans and selected hospitals from each county in Connecticut. All specialists and ancillary providers will be preferred providers.

It’s important to note:

More information
Designation of preferred PCPs and hospitals was determined through analysis of cost and objective third-party quality data. For hospitals, cost indices included inpatient and outpatient services and were adjusted for case mix.

Compass preferred-provider designations will be reviewed and revised annually. Compass plans will be available to individuals and families enrolled in ConnectiCare plans sold through Access Health CT and plans available to employer groups. Medicare Advantage plans are not affected.

We created Compass plans in response to market forces. Customers are seeking relief from costs while maintaining quality of care.

New EOP statements to apply to members with new 2020 ID numbers

As part of our partnership with PNC Bank and the ECHO Health payment platform, you will begin to see new explanation of payments (EOP) statements. Here’s a document to help you understand the new format. The new EOP statements will apply to members who have new member ID numbers that start with the letter K.

We began using PNC Bank and the new platform to pay Medicare Advantage claims starting July 15, 2020 and began transitioning commercial claims** on Aug. 1, 2020.

New member ID numbers and cards for ConnectiCare members
We have been issuing new member ID numbers and cards for Medicare Advantage members with effective dates of Jan. 1, 2020 and later. Now we are beginning to issue new member ID numbers and cards to commercial members. We will complete roll-out of the new member ID numbers for all our commercial plans on or about Jan. 1, 2021.

Make sure to check ID cards and ID numbers for all commercial patients and use the new ID numbers for dates of services on and after Aug. 1, 2020.

There are no changes to the claims submission process. To avoid delays in claims payments, please make sure to use the right member ID number for your claim submissions.

Updates to 2020 provider payments
Here’s a quick recap of provider payment changes:

**This only applies to commercial claims submitted after Aug. 1, 2020 for commercial members with new ID numbers that start with the letter “K.” You will still get check and electronic fund transfer (EFT) payments through Bank of America for claims submitted for commercial members with older ID numbers.

2020-2021 flu season information

All ConnectiCare members are covered for the flu vaccine. And here are the vaccine codes we cover:

For most members, there is no copayment, coinsurance or deductible if the only service that is provided during the visit is the administration of a flu shot. If there is an additional, separate reason billed for a visit, applicable copayment, coinsurance and deductible will apply.

If a member receives a flu vaccination from a non-participating provider, we cover the usual-and-customary amount. If a member pays out of pocket, he or she can provide a receipt to us along with a completed Out-of-Plan Reimbursement Form. Medicare members should use this Medicare Out-of-Plan Reimbursement Form.

Express Scripts providing commercial drug utilization management services

This is a reminder that Express Scripts (ESI) is now performing most drug utilization management services for ConnectiCare commercial plan members, including those with plans sold through Access Health CT. This means you must submit requests for preauthorization, quantity limits and step therapy for commercial members to ESI.

This does not apply to Medicare pharmacy utilization management requests or adult chemotherapy and supportive agents. Please follow the usual process for chemotherapy and supportive agents as well as Medicare requests.

Electronic prior authorizations
We know you want to focus on your patients, not administrative tasks. That’s why we made this change and why we encourage you to take advantage of ESI’s Electronic Prior Authorization (ePA) option.

ePA is fast, secure, and simple. It’s the fastest way to get your authorizations approved. You can send 11 requests in the time it takes to fax just one. Any authorized personnel, including nurses and office staff, can use your electronic health record (EHR) or sign in to an online portal. You save time, and patients get their medications faster.

How to submit preauthorization requests with ePA:

Use these phone and fax numbers for preauthorization requests for commercial members.

Medicare Advantage contact information
There is no change in phone or fax numbers for Medicare Advantage preauthorization requests. ConnectiCare will continue utilization management review for Medicare Advantage members. Continue sending preauthorization requests for Medicare Advantage members by phone or fax to:

As a reminder, New Century Health (NCH) will need to preauthorize all oncology-related chemotherapeutic drugs and supportive agents when they’re given to commercial and Medicare Advantage patients in the physician’s office, outpatient hospital or ambulatory setting.

Please see the preauthorization overview chart for a summary of these requirements.