ConnectiCare | Office Visit - March 2021
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Tell Us How You Feel About Connecticare
ConnectiCare values our partnership with providers. We’d like to hear from you to help us with our shared mission of creating healthier futures for our communities. Please respond to our Provider Satisfaction Survey with your honest feedback on how we can better serve you. We will use the results to help us to continue to transform how we serve our partners and our communities. The survey will only take a few minutes of your time but will have a lasting impact. There is also an opportunity to join an advisory committee that will help inform our company as we continue our transformation. Enter your contact information at the end of the survey if you’re interested.
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Contraceptive Coverage In Mass. – 12-Month Refills Allowed
Massachusetts law allows fully-insured, commercial health plan coverage of a 12-month supply refill of oral contraceptives. After prescribing an initial prescription for oral contraceptives, you may prescribe up to a 12-month supply of oral contraceptives for your patient to receive all at once. Learn more.
Beginning May 1, Connecticare To Provide Care Management To Kidney Patients
We are transitioning the care management of our members living with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) to our Care Management team by May 1, 2021, with the implementation of the ConnectiCare Chronic Kidney Disease (CKD)/End Stage Renal Disease (ESRD) program.
Our team of care managers, social workers, and pharmacists may be in touch with your office as we coordinate patient care. For more information or to make a referral, call us as at 800-447-0768, Monday through Friday, 9 a.m. to 5 p.m.
The CKD/ESRD program will provide eligible members with holistic, seamless, and clinically robust wrap-around support throughout all stages of their health care journey. We’ll identify members with complex needs and provide them with individualized care management interventions.
Our CKD/ESRD program aims to slow the progression of illness and reduce unnecessary utilization. The program seeks to improve condition management and navigation of the healthcare system through a structured approach to person-centered assessment, care planning, and delivery of interventions.
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MEDICARE
Medicare Site of Service – New form
ConnectiCare’s Medicare Advantage Site-of-Service preauthorization policy went into effect March 1, 2021. Please use this new form when submitting preauthorization requests.
Do not bill dual eligible and QMB members with full Medicare benefits
If Medicare-Medicaid dual eligible individuals have their Part A and Part B cost-share fully covered by their Medicaid plan, or if they are Qualified Medicare Beneficiaries (QMB), they are not responsible for their Medicare Advantage cost-share for covered services. You can use ePaces to check whether the member has full or partial Medicaid benefits. Please do not balance bill these members for any other costs. If you received Medicare and Medicaid payments for services given to these members, it must be accepted as payment in full.
Medicare Outpatient Observation Notice (Moon)
All hospitals and critical access hospitals are required by CMS to provide Medicare beneficiaries, including Medicare Advantage enrollees, with the Office of Management and Budget (OMB)--approved Medicare Outpatient Observation Notice (MOON). The MOON and instructions for completing it are available on the Centers for Medicare & Medicaid Services (CMS) website.
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ACA Member Medical Record Reviews Began This Month
From March through August, you may receive requests from Cognisight, LLC to review the medical records of your patients who have ConnectiCare commercial insurance plans (Access Health CT – ACA). If you receive a request for medical records, please provide them as soon as possible.
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Claims Coding Edits Effective May 25, 2021
Please refer to the table below for claims edits that will go into effect on May 25, 2021. These edits will apply to both commercial and Medicare Advantage plans. For a complete listing of coding edits, please download our Coding Edits Reimbursement Policy.
Line of business (LOB): ConnectiCare Commercial (CCIC), ConnectiCare Medicare (CCIM)
Claim type: Facility (F), Professional (P)
Providers can access all our policies on connecticare.com/providers.
CPT® is a registered trademark of the American Medical Association.
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ConnectiCare is a brand name used for products and services provided by ConnectiCare Insurance Company Inc., and its affiliates, members of the EmblemHealth family of companies.
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