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      Commercial Physician & Provider Manual

    • Physician Responsibilities
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    • Product Coverage
    • Overview of Products
    • Overview of Plan Types
    • Overview of Coverage: CT
    • Overview of Coverage: MA
    • Overview of Coverage: NY
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    • Member Eligibility
    • Member Eligibility
    • Identification Cards
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    • Ending the Physician/Patient Relationship
    • Member Rights & Responsibilities
    • Medical Management Programs
    • Program Description
    • Pre-service Review: Inpatient Admissions
    • Pre-Authorization Requirements
    • Mental Health & Substance Abuse Services
    • Bone Marrow & Organ Transplants
    • Maternity Program
    • Special Care Case Management Program
    • Kidney Stone Prevention
    • Cancer Support Program
    • Transplant Case Management Program
    • Concurrent Review
    • Post-Service Review
    • Reconsideration Process
    • Provider Appeals
    • Health Management Programs
    • An Overview
    • Clinical Practice Guidelines
    • Quality Improvement Programs
    • Pharmacy Program
    • ConnectiCare Drug List
    • Pharmacy & Therapeutics Committee
    • Over-the-Counter Medications
    • Pre-Authorization Requirements
    • Specialty Prescription Drugs
    • Generic Substitution Program
    • Managed Drug Limitations
    • Benefit Exclusions
    • Utilization Reporting
    • Administrative Procedures
    • Physicians' Orders
    • Referrals
    • Claims
    • Electronic Funds Transfer
    • Filing Limit
    • Refunds/Overpayments
    • Adjustments/Corrected Claims/Resubmissions
    • Administrative Appeals
    • Billing of Members
    • Coordination of Benefits
    • Billing Claims Payment Policy
    • Introduction
    • Common Billing Scenarios
    • Common Coding Appeals
    • Modifiers: CPT & HCPCS Level II
    • In Office Laboratory & Radiology
    • Credentialing Recredentialing
    • Program Overview (Practitioners & HDOs)
    • Recredentialing (Practitioners only)
    • Reassessment Program (HDOs only)
    • Site Visits (Practitioners only)
    • Standards for Performing Medical Record Review (Practitioners only)
    • Leave of Absence Policy (Practitioners only)
    • Locum Tenens Policy (Practitioners only)
    • Physician Compliance
    • Compliance (Practitioners & HDOs)
    • Termination & Appeals (Practitioners & HDOs)
    • Appendix: CT
    • Appendix: MA
    • Appendix: NY
    • Glossary










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    • Commercial - Quality Improvement Programs

      Program Overview

      ConnectiCare does not advertise, market, or promote any specific products or services to members or practitioners when discussing a member’s health condition.

      ConnectiCare’s Quality Improvement Program (QIP) was developed to improve the physical and mental well-being of its members, and to promote the delivery of high quality care and service. We embrace the continuous improvement model to ensure that the care and services provided to our members meet or exceed established local, state, and national managed care standards.

      The Quality Assurance Committee (QAC), comprised of members of the Board of Directors and network physicians, is the governing body of the QIP. The overall responsibility for the development and functioning of the QIP resides with ConnectiCare’s chief medical officer and the Quality Management Committee (QMC). The QMC under the direction of the senior medical director and the director of Quality Improvement have the responsibility for planning, designing, implementing and coordinating QI activities.

      Participating physicians may be involved in some or all of the following QI activities:

      • Activities that promote continuity and coordination of care between medical specialties or medical and behavioral health specialties.
      • Surveys on various QI activities such as how you care for patients with depression or your satisfaction with ConnectiCare.
      • Receipt of a list of members who have care opportunities.
      • Receipt of a list of members on certain medications with recommendations for follow up.
      • ConnectiCare’s physician advisory committee.
      • Recredentialing activities, which may include a site visit and/or a review of medical records of your ConnectiCare patients.
      • Medical record review for HEDIS® or QARR reporting requirements.
      • Receipt of educational materials or guidelines on ConnectiCare’s clinical quality, health management or preventive health programs.
      • A ConnectiCare-sponsored education seminar or symposium.

      ConnectiCare has many programs to help maintain or improve the health of our members, including:

      • Breast and Cervical Cancer Screening
      • Chlamydia Screening
      • Colorectal Screening
      • Depression Medication Adherence Program
      • Depression: Screening & Management
      • Follow-up After a Mental Health Hospitalization
      • Influenza Immunizations
      • Postpartum Depression Screening

      For more information on how we are performing against standards, click here or call us at (860) 674-5850 or 1-800-828-3407.

      View our preventive health guidelines, which are based on nationally accepted guidelines and with input from various participating physicians, as part of our Quality Improvement Program.  To request a hard copy, call (860) 674-7029.

      * HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). ConnectiCare participates, along with many other health plans, in the New England HEDIS ® Coalition. Participants in the Coalition make a commitment to measure their health plan’s performance in the delivery of selected services in the broad categories of preventive medicine, prenatal care, acute disease and chronic disease.

      PPM/4.11

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.