ConnectiCare | Office Visit - July 2018
ConnectiCare
July 2018 Office Visit

July 2018 – In this issue

New preauthorization requirements for diagnosis and treatment of obstructive sleep apnea
New quantity limits and other formulary updates as of Sept. 1
Medical records reviews of your ConnectiCare commercial patients to start this month
Health Outcomes Survey and your Medicare Advantage patients
Has any of your information changed? Let us know.
ConnectiCare in the community
Recent provider headlines

New preauthorization requirements for diagnosis and treatment of obstructive sleep apnea

Our new medical policy for diagnosis and treatment of obstructive sleep apnea (OSA) requires preauthorization for these services on or after Sept. 1, 2018:

Sleep studies
OSA treatment, including, but not limited to dental devices, CPAP (continuous positive airway pressure) and BiPAP (bilevel positive airway pressure) machines


There are no changes to our existing coverage of supplies, such as masks and tubing, used with the equipment above. You will not need preauthorization for these supplies.

The new policy applies to all ConnectiCare commercial and Medicare Advantage plans. It will not apply to treatment before Sept. 1.

The policy will soon be published on the medical criteria page of our provider website. Check back for details.

You can start faxing preauthorization requests to 860-674-5893 (commercial) or 866-706-6929 (Medicare), or call 800-923-2882 (commercial) or 800-508-6157 (Medicare) after Aug. 1 for dates of service on or after Sept 1. We will review requests for medical necessity and location of service. Make sure to include all supporting clinical patient information.

Also starting Sept. 1, we will implement a new medical necessity and level of care review for all attended (in-lab sleep facility) polysomnography for patients age 19 or older who have high pre-test probability of OSA. These requests will need medical director review and must meet the criteria and note other atypical or complicating symptoms that could impair the test’s accuracy, such as:

Severe heart failure (EF ≤ 15 or NYHA Class IV)
Chronic obstructive pulmonary disease (COPD) and restrictive pulmonary disorders: (FEV1 <30 or PCO2 >45)
Atrial fibrillation
Significant tachyarrhythmia or bradyarrhythmia cases where unattended monitoring is technically inadequate or fails to establish the diagnosis of OSA in patients with high pre-test probability.

New quantity limits and other formulary updates as of Sept. 1

Commercial plan formulary updates for Sept. 1, 2018, include quantity limits for some drugs and supplies as well as designation of a preferred medication for rosacea treatment.

New quantity limits affect the following drugs and supplies:

Attention deficit hyperactivity disorder (ADHD) drugs
Diabetic test strips
Lyrica
Respiratory inhalers


Please refer to the quantity limits list on connecticare.com for details. The new quantity limits apply to new and existing prescriptions.

We have sent letters to alert members who may be affected by the changes. The letters said that we’ll cover drugs/supplies above the limits if their doctors get our approval first.

Also on Sept. 1, our preferred drug for treatment of rosacea will be:

Metronidazole 0.75% Topical Cream
Metronidazole 0.75% Topical Gel
Metronidazole 1% Topical Gel


Your patients will not need preauthorization to use the above drugs. But all other creams and gels used for treating rosacea will need our preauthorization before your patients can get a new or refill a prescription.

Remember, your offices can fax pharmacy preauthorization requests to us at 1-800-249-1367.

Medical records reviews of your ConnectiCare commercial patients to start this month

Health Data Vision, Inc. (HDVI) may contact your office from now through December to retrieve and review the medical records of patients who have ConnectiCare commercial plans.

The Centers for Medicare & Medicaid Services (CMS) conducts an annual audit to verify accuracy of diagnosis data that health plans submit to the Department of Health and Human Services (HHS). We are required to submit supporting medical records on a limited population covered by the audit. HDVI will call your offices to coordinate a convenient chart retrieval method and set the date when records are needed.

Please respond to HDVI’s request for records promptly. Notice of the need for these reviews and your required compliance are included in your contractual agreement with ConnectiCare.

As our partner and “business associate,” as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HDVI is fully HIPAA-compliant and is 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 provider services department at 1-800-828-3407.

Health Outcomes Survey and your Medicare Advantage patients

Members of Medicare Advantage plans, including ConnectiCare, are asked to take the Health Outcomes Survey (HOS). The survey is intended to assess plans’ ability to maintain or improve members’ physical and mental health over time. Your interactions with Medicare Advantage members influence the results.

The survey is administered each spring to a random sample of our Medicare members. This same group of members is surveyed again two years later, asking them to evaluate their own health over a period of time and recall the discussions they have had with their doctors.

Your interactions with patients affect their responses to the HOS questions. That’s why, as we told you last month, we’re encouraging our Medicare members to “Ask away” – ask you any question or concerns they may have, nothing is too small or too embarrassing to discuss.

Six of the measures covered under the HOS are included in the annual Medicare Star ratings:

Evaluation of physical health
Evaluation of mental health
Bladder control
Physical activity
Falls risk
Bone health in women


In future issues of Office Visit, we will share information about the above measures and offer recommendations that will help you discuss the topics with your patients.

Has any of your information changed? Let us know.

Check our provider directory to make sure we have the right information for you and your practice. Our members rely on our provider directory to find doctors like you quickly and easily.

Relevant changes include your:

tax ID number
national provider identification (NPI)
address
phone number
office hours
ability to accept new patients

Submit any changes by filling out our provider information update form and sending it back to us as noted on the form.

ConnectiCare in the community

Check out our Facebook page to see what we’ve been doing to help our local community through our support of Junior Achievement and our “Good Deeds” program.

Recent provider headlines

Check out the latest Provider News & Headlines:

Xarelto will be a preferred drug on Medicare Advantage formulary
Our case management team is available to help you care for your patients
Updated in-office laboratory and radiology procedures document

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