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New Provider Portal is Live!
We have completed the rollout of our new provider portal. Learning how to use its new features will be the key to your success.
To support you in this effort, we’ve created the following training materials and guides:
- Training Guides and Videos (EmblemHealth) (ConnectiCare)
- Frequently Asked Questions (EmblemHealth) (ConnectiCare)
What You’ll Need
To sign in to the new portal, you will need:
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An active, current, and unique email address.
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You can no longer share email addresses with other users. Each portal account user must have their own email address. A unique email address is needed to set up each account’s password the first time. You will also need your email if you ever need to retrieve or reset your username and password.
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You must assign a Provider Portal Administrator/Office Manager for your practice or organization. They will conduct important portal business on your practice’s behalf.
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A supported web browser such as Google Chrome (recommended) or Microsoft Edge. . The new portal will not work with Internet Explorer.
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Make sure to request approval from your manager to submit preauthorizations within the new system.
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We look forward to supporting you and getting your feedback in the coming months.
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New Post-Acute Care Process for ConnectiCare Starting Sept. 1
Beginning Sept. 1, 2021, post-acute care for ConnectiCare members will be managed by ConnectiCare instead of CareCentrix. By bringing this service in-house, we strive to provide better care for our members, and better serve the providers who need to connect these members with appropriate care. Providers will continue to work with the nurses who have been their contacts while the member was in the bed. Our care managers will also be able to reach out to members, or their families, while they are still in a hospital bed. Click here to see the letter and FAQ.
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Health Care Transparency in Cost and Quality Information
Effective Dec. 27, 2020, the Consolidated Appropriations Act, 2021 includes provisions designed to expand transparency in cost and quality information for health care consumers and employer groups.
As a result, our provider network contracts no longer restrict EmblemHealth from:
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Disclosing provider-specific cost or quality-of-care information or data, through a consumer engagement tool or any other means, to referring providers, employer groups, members, or individuals eligible to become members; and
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(ii) Electronically accessing and sharing, in accordance with applicable privacy regulations, de-identified claims and encounter information or data with a business associate for plan administration and quality improvement purposes.
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Be sure to share this regulatory update with your business leadership and/or privacy team, as appropriate.
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HEDIS Medical Record Request
EmblemHealth and ConnectiCare are conducting our annual review of our members’ records to evaluate compliance for documentation standards. This is a requirement of the New York State Department of Health (NYSDOH), the Connecticut State Department of Public Health, and the Centers for Medicare & Medicaid Services (CMS). Providing member medical records is part of your contractual agreement with us. If you receive a request from us, review and send us the required information within 10 business days of the date of the letter.
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Raising Immunization/Vaccination Awareness
August is National Immunization Awareness Month (NIAM). We encourage you to ensure your patients are up to date on recommended vaccines. Research has consistently shown that health care professionals are the most trusted sources of vaccine information.
NIAM is a good time to remind your patients of the importance of getting vaccinated. To support COVID-19 vaccine awareness, EmblemHealth and ConnectiCare recently developed a COVID-19 vaccine hesitancy campaign to reach populations who remain reluctant to get vaccinated.
Provider resources can be found on our website at connecticare.com/choosehealth and on the CDC website.
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COMMERICAL BUSINESS UPDATE
EmblemHealth Offers Bridge Program to Fully Insured Members
We wish to remind you that EmblemHealth Plan, Inc., and EmblemHealth Insurance Company now offer existing large group benefit plan designs with access to the Bridge Program’s combined five networks as an alternative to the traditional single-network access.
We created a new Bridge webpage to help you differentiate the ASO self-funded Bridge Program plans administered by EmblemHealth Insurance Company from the new, fully insured plans, and help you understand which administrative guidelines to follow. All plans will continue to follow the same Bridge Program payment protocols.
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Some ConnectiCare Members Under a New State Program Will Have No Cost-share
As of July 1, 2021, some ConnectiCare members who meet specific eligibility and income requirements will not have to pay their deductibles, copays or coinsurance for medically necessary, covered services – thanks to the state’s new Covered Connecticut Program.
Under the program, which the Connecticut legislature approved last month, the state will pay for the monthly premiums and cost-shares of qualifying Connecticut residents who are parents and/or caretaker relatives of children who are eligible for HUSKY A (Connecticut’s Medicaid program that covers children, their parents and pregnant women). These residents must have qualifying Silver Level plans purchased through the state insurance exchange, Access Health CT.
This means, ConnectiCare providers should not charge any cost-shares to these members. Submit your claims directly to ConnectiCare for processing.
Make sure to sign in to connecticare.com/providers to check your patients’ benefits and eligibility and see if they are under the Covered Connecticut Program. We’re in the process of sending out new member ID cards (sample below) to the ConnectiCare members who qualify for the program. Please note, their member ID numbers will remain the same.
We will publish more updates as they become available, but, for now, you can see more about the program on the Connecticut state website.
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COVID-19 National Emergency – COBRA Election Time Frame Impact to Providers
In light of federal COBRA regulations implemented to help individuals during the COVID-19 pandemic, some of our former members may, in the future, have the ability to make a COBRA continuation coverage election, pay outstanding premiums, and receive COBRA continuation coverage on a retroactive basis. When the COVID-19 national emergency ends and the time frames for electing retroactive COBRA continuation coverage are finalized, we will inform affected providers how we will accommodate their claims for services rendered.
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Do Not Bill Members with Full Medicaid or QMB (ConnectiCare)
If Medicare-Medicaid dual eligible individuals have their Part A and Part B cost-share fully covered by their Medicaid plan, or are Qualified Medicare Beneficiaries (QMB), they are not responsible for their Medicare Advantage cost-share for covered services. Connecticut providers can contact CT Department of Social Services at 800-842-8440 or visit their website. Please do not balance bill these members for any other costs. Any Medicare and Medicaid payments for service given to these members, must be accepted as payment in full.
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Do Not Bill Members with Full Medicaid or QMB (EmblemHealth)
If Medicare-Medicaid dual eligible individuals have their Part A and Part B cost-share fully covered by their Medicaid plan, or 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. Any Medicare and Medicaid payments for services given to these members, must be accepted as payment in full. For more detail, see our 2021 Medicare Advantage Guide.
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Enhanced Clinical Editing Processes
Starting on Sept. 1, 2021, EmblemHealth will be expanding our partnership with Cotiviti, Inc. for periodic post-payment reviews of paid medical claims. The post-payment reviews to be conducted are: Retrospective Accuracy datamining (RA) and Clinical Claim Validation DRG review (CCV). These are the same/similar reviews that are currently being conducted by Optum on behalf of EmblemHealth. Click here for more information.
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EmblemHealth Preauthorization List Updated
On June 30, 2021, we reposted the EmblemHealth Preauthorization List (Version 3.6.5) in Clinical Corner. While you can always check the EmblemHealth Utilization Management Preauthorization Lists page for the current preauthorization rules, we recommend using the Preauthorization Check Tool in the provider portal. It is easy to use and will give you clear, member-specific guidance.
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EmblemHealth Medical Policy Updates
All EmblemHealth Medical Policies are available for download in Clinical Corner on our provider website. The following are the recently revised policies:
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Capsule Endoscopy
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Fecal Microbiota Transplant (FMT) for Recurrent Clostridium Difficile Infection
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Infertility Services — Commercial
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Insulin Delivery Devices and Continuous Glucose Monitoring Systems
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Testing for Coronavirus Disease 2019 (COVID-19)
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Reminder: ConnectiCare Oncology Drug Dose Rounding Initiative Starting Aug. 1
ConnectiCare has partnered with New Century Health (NCH) to optimize treatment of your oncology patients and help reduce their out-of-pocket requirements. Starting Aug. 1, 2021, NCH will roll out the new dose rounding initiative for ConnectiCare members on select drugs.
According to the Hematology/Oncology Pharmacy Association (HOPA), the rounding of drug doses to the nearest vial size is an important initiative that has many benefits for both the patient and the practice.
NCH has developed user-friendly portal enhancements to make this easy for your practice. If you don’t have access to the NCH online portal, register at my.newcenturyhealth.com.
If you have questions or you want to coordinate a meeting to discuss this in more detail, contact NCH Network Operations at 888-999-7713, option 6. You may also reach out to EmblemHealth: 866-447-9717, ConnectiCare Commercial: 860-674-5850, or ConnectiCare Medicare: 877-224-8230.
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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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