ConnectiCare | Office Visit

ConnectiCare | Office Visit - June 2018

June 2018 – In this issue

Expanding our Magellan Healthcare partnership to include more services
More HCPCS, CPT codes will be needed for some outpatient commercial claims, starting Aug. 1
Updated Evaluation and Management Services payment policy, effective Sept. 1
We’re encouraging Medicare members to "Ask away"
Medical record reviews to start this month
Behavior health training and services available to PCPs
ConnectiCare tools, resources and notifications
Join us for Family Summer Fest on June 23
Yoga in Our City

New services requiring preauthorization through Magellan Healthcare

We will expand our existing partnership with Magellan Healthcare on Aug. 1, 2018, to include preauthorization management of the following elective services:

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Cardiac imaging program and implantable devices, and

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Outpatient interventional spine pain management for these procedures:

o	Spinal epidural injections
o	Paravertebral facet joint injections or blocks
o	Paravertebral facet joint denervation (radiofrequency (RF) neurolysis)
o	Sacroiliac joint injections

Here are the affected codes under the expanded services.

Magellan will work with providers to make sure patients get the care they need, avoid the inconvenience and cost of unnecessary or duplicative services, and reduce their exposure to excess radiation.

Magellan Healthcare applies nationally-accepted criteria for quality and appropriateness of care in its management of authorizations for services. It has managed our outpatient advanced imaging and inpatient and outpatient spine surgery programs for the past few years.

Preauthorization needed for all ConnectiCare members, starting Aug. 1

This expanded program affects all ConnectiCare commercial and Medicare Advantage plans. If you have patients who are in treatment now, please see that they have the necessary preauthorization for these services on or after Aug. 1.

You can submit preauthorization requests to Magellan by calling 1-877-607-2363 or online at radmd.com, starting Aug. 1, 2018. Requests must include patients’ medical records, as well as any other applicable clinical information. Sending the right clinical documentation with original requests will help avoid delays and pended requests.

As part of its review, Magellan will implement a clinical validation of records (CVR) process for CPT codes under the program. This means Magellan will review the patient’s medical records to make sure the clinical criteria are met and support the requested service. If you need an urgent review, please call Magellan Healthcare at the above number. Clinical validation will not be required in these circumstances.

More HCPCS, CPT codes will be needed for certain outpatient commercial claims, starting Aug. 1

We will require HCPCS (Health Care Procedure Coding System) or CPT (Current Procedural Terminology) codes for outpatient UB04 claims billed under three additional revenue codes beginning Aug. 1.

The additional codes are:

•	720 – labor and delivery
•	729 – labor and delivery other
•	769 – treatment room other

If the additional codes are not included, the claim may get rejected.

The National Uniform Billing Committee 2010 Manual allows for this requirement. This will only apply to our commercial plans.

Here’s a full listing of revenue codes which require a HCPCS or CPT code. We will add this document to our online commercial provider manual around Aug. 1.

Updated Evaluation and Management Services payment policy, effective Sept. 1

We’ve updated our payment policy for Evaluation and Management (E/M) Services to include documentation of our E/M coding guidelines. This updated policy will go into effect Sept. 1 for both commercial and Medicare Advantage plans. Download the policy for more details. Please note, the claims submitted under the policy may be subject to post-payment reviews.

We’re encouraging Medicare members to "Ask away"

Our new campaign encourages Medicare Advantage members to "Ask away" when meeting with their doctors ─ nothing is too small or too embarrassing to discuss.

The campaign includes a video of ConnectiCare Chief Medical Officer, Dr. Wayne Rawlins, explaining that doctors have heard it all and truly want to help. Topics we encourage members to discuss with their doctors include:

•	Going to the bathroom frequently
•	Having difficulty exercising or staying active
•	Concerns about their medicine and side effects
•	Or if they have fallen recently or have concerns about falling

After all, a conversation now is better than a complication later. There are lots more to our Ask away campaign. If you want more information, please call us at 1-860-785-7898.

Medical record reviews to start this month

Ciox Health and/or Optum may contact your office from now through December about retrieving and reviewing medical records of patients with ConnectiCare Medicare Advantage plans.

Ciox Health and Optum conduct, on our behalf, chart reviews of services provided in 2017 and 2018. As a health plan, we must submit accurate and complete diagnosis data for each member/patient to the Centers for Medicare & Medicaid Services (CMS).

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 department at 1-877-224-8230.

Behavior health training and services available to PCPs

There’s help for primary care providers seeking behavioral health training, services and tools to help them manage the care of ConnectiCare members. Optum, ConnectiCare’s behavioral health benefit and network manager, offers the services of a provider integration resource specialist, who can:

•	Connect patients to Optum behavioral health resources and as well as resources in the community.
•	Help develop or enhance medical behavioral integration within the primary care setting.
•	Assess the practice’s integration strengths and gaps and provide training and support to address the gaps.
•	Train all providers and staff on behavioral health topics relevant to their patient population.

To find out more or seek integration support services, you can contact Jacqueline O. Berkowitz, LCSW, provider integration resource specialist at jacqueline.berkowitz@optum.com or 860-702-5185.

ConnectiCare tools, resources and notifications

Every year, we let our providers know about the tools and resources that are available to you and share information that is important for you to know. Learn more.

Join us for Family Summer Fest on June 23

Have some fun with your kids while learning about all that our community has to offer! Free admission and open to the public.

When: 11 a.m. to 3 p.m., Saturday, June 23
Where: Daley Field, 1075 Tolland Turnpike, Manchester

Family Summer Fest is sponsored by the Community Child Guidance Clinic with the support of Good Deeds with ConnectiCare volunteers and Leadership Greater Hartford.

Find out more details here.

Yoga in Our City

We’re a proud sponsor of "Yoga in Our City," a program of free yoga classes in public parks in Hartford and, new this year, Bridgeport, New Haven and Waterbury!

Check locations and schedules.