Important information for providers

We recognize that you are doing all you can to care for your patients and protect the public health. Below you will find an overview of all the provider news and resources on the coronavirus (COVID-19) outbreak. 


As we update our policies and practices in response to the coronavirus (COVID-19) pandemic, we will do our best to keep you informed. Please refer to this page for the latest news and the most up-to-date information.

Recognizing the ongoing and critical need to limit the spread of the coronavirus (COVID-19), we will extend our temporary program of reimbursing in-network providers for telehealth visits through March 15, 2021.

This policy is intended to reflect the requirements of applicable federal, state and agency laws, regulations and directives (“Applicable Law”) and will remain in effect for the period required by Applicable Law. ConnectiCare reserves the right to amend and/or revoke this policy at any time to the extent such amendment or revocation reflects any changes in Applicable Law.

Please refer to these documents for details:

The policy applies to members of all ConnectiCare commercial and Medicare Advantage plans.


Passage plan referrals

Our commercial members with Passage plans will need Passage PCP referrals to seek specialist care after Sept. 9, 2020.

(08.27.2020)

Billing guidelines for COVID-19 testing

ConnectiCare is waiving members’ cost-share for COVID-19 testing as well as the diagnostic visit associated with that testing if Centers for Disease Control and Prevention (CDC) guidelines are met. Please refer to Payment Policy: COVID-19 Billing Guidelines (Commercial/Medicare Advantage for more information.

Use chest radiography & computed tomography for suspected COVID-19 infection
Our partner, Magellan Healthcare, is recommending following American College of Radiology (ACR) Recommendations for the Use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection. Here’s Magellan Healthcare Specialty Update for more information.

National Imaging Associates, Inc. (NIA): Submit authorization requests online
Our partner National Imaging Associates, Inc. (NIA) is asking our provider community to use its website, RadMD.com, to obtain authorizations, upload clinical documentation, and verify authorization requests as often as possible. Please read this announcement from NIA.

NIA manages the preauthorization management of the following services for ConnectiCare:

  1. Cardiac imaging program and implantable devices
  2. Outpatient interventional spine pain management for certain procedures
  3. Outpatient advanced imaging
  4. Inpatient and outpatient spine surgery programs

Free mental health support available through behavioral app for commercial patients
During these stressful times, we want to let you know that Optum, the company that manages and administers ConnectiCare’s behavioral health program, now has an app available called “Sanvello” that will help your commercial patients learn clinical techniques to help them dial down the symptoms of stress, anxiety and depression.

If you see any commercial patients who may benefit from this, please let them know that they can access this app for free under their ConnectiCare commercial plan. Tell them to download the app from Google Play or iTunes or from Optum’s website, liveandworkwell.com, using their medical insurance member identification (ID) number for free access to the premium version.

(03.27.2020)

During the peak of the coronavirus (COVID-19) outbreak, we temporarily streamlined authorization processes to help hospitals and health care systems care for our members. As hospitalizations due to COVID-19 continue to drop, we are confident our hospitals and health care systems care for our member. As hospitalizations due to COVID-19 continue to drop, we are confident our hospitals and health care systems will be able to care for our members as they have prior to the peak of the outbreak. As a result, ConnectiCare will restore most authorization processes starting July 1, 2020.

We will be returning to the normal process for:

  1. Preauthorization approvals*
  2. Home health care services
  3. Skilled nursing facilities (SNF), long-term acute care hospitals (LTACH) and acute rehabilitation
  4. Passage primary care provider (PCP) referrals

These updates cover ConnectiCare network providers caring for members of both commercial and Medicare Advantage plans, unless noted otherwise. These do not apply to ConnectiCare plans in Massachusetts.

Extensions of previously approved preauthorization requests
Beginning July 1, we will no longer extend previously approved preauthorization requests by 90 days. Approvals have been extended before July 1 are not affected. 

This applies to:

  1. Inpatient elective admission requests
  2. Outpatient procedures/requests
  3. Out-of-network requests
  4. Infertility services (commercial plans only)
  5. Durable medical equipment

Please note, any service or surgery canceled without a reschedule date or rescheduled outside of the authorization date range will require a new preauthorization from ConnectiCare as of July 1.

You can submit preauthorization requests by:

  Commercial patients Medicare Advantage patients
Fax: 1-860-674-5893 (preauthorization)
1-860-409-2437 (home care)
1-866-706-6929 (preauthorization)
1-860-678-5291 (home care)
Phone: 1-800-562-6833 extension 8552 1-800-508-6157 extension 8553

Home health care services and requests
Also after July 1, ConnectiCare will review and approve initial and re-authorization requests for home health care services for date spans that meet the need for the services. This applies to the following requests:

  1. Physical therapy
  2. Occupational therapy
  3. Speech therapy
  4. Medical social worker
  5. Home health aide
  6. Skilled nursing visit
  7. IV therapy

Hospital discharges to SNFs, LTACHs and acute rehabilitation facilities again require preauthorization

Discharges of ConnectiCare members from hospitals to SNFs, LTACHs or acute rehabilitation facilities after July 1 will need preauthorization before the date of discharge. Please submit preauthorization requests to us or our partner, CareCentrix, as noted in the chart below:

Admission to: ConnectiCare CareCentrix
LTACHs 1-800.508.6157 (Fax)
1-860-678-5282 (Phone)
N/A
SNFs N/A 1-844.359.5388 (Fax)
1-866.501.4665 (Phone)
Acute rehabilitation N/A 1-844.359.5388 (Fax)
1-866-501-4665 (Phone)


*Preauthorization approval is not a guarantee of coverage. Coverage is dependent on member eligibility at the time service is rendered and the member has not exceeded benefit maximums under his/her plan. Any services rendered over the benefit maximums for a member’s plan year will fall under the member’s financial responsibility.

(06.10.2020)

Only weeks ago, your waiting room was filled. Today you’re calling up the next patient on your laptop screen because of the coronavirus (COVID-19) pandemic.

Telehealth has allowed you to continue caring for your patients. It can do even more, by helping you close gaps in care and acquire the data needed for both commercial and Medicare Advantage health plan risk adjustment programs.

Here’s a tip sheet that you can use to help you with quality measures and risk adjustment.

(04.30.2020)

ConnectiCare will follow Medicare guidelines in the federal coronavirus (COVID-19) stimulus bill (known as the “CARES Act”) to:

  • Add 20% to the COVID-19 inpatient reimbursement for both in-network and out-of-network care given to Medicare Advantage members.
  • Temporarily suspend the 2% provider payment reduction fee known as “Medicare sequestration” from May 1, 2020 through Dec. 31, 2020.

This only applies to our members with Medicare Advantage plans.

Adding 20% to COVID-19 inpatient reimbursement
In accordance with the Centers for Medicare & Medicaid Services (CMS) methodology, ConnectiCare will add 20% to the MS-DRG-based inpatient reimbursement (operating component only) for patients who were discharged with a COVID-19 diagnosis after Jan. 27, 2020. ConnectiCare will identify and reprocess any claims that should have included the additional reimbursement. Providers do not need to resubmit the claims. Providers must follow the coding and billing requirements from CMS. This will apply to both in-network and out-of-network providers.

  • For in-network providers, the increase will be applied, as appropriate, to payments to providers whose contracted reimbursement is based on the CMS inpatient prospective payment system.
  • For out-of-network providers, the increase will be applied for Medicare Advantage members based on CMS requirements.

Temporary suspension of the Medicare sequestration fee
We will temporarily suspend the 2% Medicare sequestration fee for in-network providers based on the terms of your participation agreement with ConnectiCare. This temporary suspension applies to payments with dates of services or discharges from May 1, 2020 through Dec. 31, 2020.

(05.28.2020)

ConnectiCare resumed its high-dollar, pre-payment forensic reviews as well as the post-payment diagnosis-related group (DRG) and implant audits on June 20, 2020. This applies to claims paid to facilities. Our partner, Equian, will retrospectively review the high-dollar claims that had qualified for pre-payment review and were paid during the coronavirus (COVID-19) crisis period.

(07.06.2020)

Massachusetts providers

Here is some important coronavirus (COVID-19) information for our Massachusetts providers. We have:

  1. Temporarily suspended preauthorization and concurrent review for inpatient services for Massachusetts hospital admissions for members covered under Massachusetts, policies for a period of 60 days beginning April 6, 2020. We ask hospitals to notify us of a patient’s hospitalization within 48 hours of admission, and when a patient has been discharged.
  2. Temporarily extended the timelines for appeals for 90 days beginning April 6, 2020.
  3. Provided coding and billing guidance and policies for the COVID-19 pandemic.
  4. Implemented an expedited credentialing process. Providers should clearly indicate that the credentialing request for the physician and/or location is related to COVID-19 care.

We are also following standard business processes to meet prompt payment standards and are taking steps to minimize pending of claims.

Make sure to use our “Find a facility” search on our online provider directory to look for in-network skilled nursing facilities, rehabilitation hospitals, long-term acute care hospitals and home health care agencies in Massachusetts.

The above information complies with the guidelines issued by Massachusetts authorities in response to the COVID-19 pandemic.

(05.06.2020)

ConnectiCare will temporarily remove prior authorization and concurrent review requirements for all inpatient hospital admissions in Massachusetts. This temporary policy is effective immediately. We will let providers know when this policy will end.

Both in- and out-of-network hospitals in Massachusetts do not, until further notice, need to submit preauthorization requests for ConnectiCare members admitted as inpatients, and ConnectiCare will not apply its concurrent review process for inpatient admissions.

This temporary waiver covers all types of hospital inpatient admissions; it is not limited to coronavirus (COVID-19) cases.

With these actions, ConnectiCare is complying with guidelines issued by authorities in Massachusetts in response to the COVID-19 pandemic. ConnectiCare reserves the right for retrospective review.

Plan notification is requested
We do ask hospitals in Massachusetts to notify us using the fax or phone numbers below, of:

  1. a patient’s hospitalization within 48 hours of admission, and
  2. when a patient has been discharged.

ConnectiCare will then process these notifications for immediate determination without delay.

  Commercial patients 
Fax: 1-860-674-5282
Phone: 1-800-562-6833

 

(04.27.2020)

This bulletin is to make you aware and inform you of requirements from the state of Massachusetts for patient care during the coronavirus (COVID-19) outbreak. The requirements cover telehealth visit and suspension of preauthorization requirements for hospital discharges. There are no prior authorization requirements for medically necessary coronavirus (COVID-19) treatment delivered via telehealth by in-network providers.

ConnectiCare temporarily expanded our telemedicine program as part of the pandemic response. If you are providing telehealth to our members living in Massachusetts, please follow the billing guidelines included in this document: Temporary Payment Policy: Supplemental Telehealth Guidelines — Commercial/Medicare Advantage.

The state of Massachusetts also requires you to:

  1. Review relevant medical history and records with new patients before their initial telehealth appointments.
  2. Review medical history and available medical records with existing patients during their telehealth services.
  3. Ensure before each telehealth appointment your ability to deliver services at the same standard as in-person care and in compliance with provider licensing requirements, programmatic regulations, and performance specifications related to the service (e.g., accessibility and communication access).
  4. Determine before any telehealth service if you can or cannot meet the appropriate standard of care or other requirements to provide the service via telehealth. If you cannot, then you must notify the patient and advise the patient to instead seek appropriate in-person care.
  5. Ensure, as much as reasonably possible, the same rights to confidentiality and security to the patient as an in-person care visit and inform patients of any relevant privacy considerations before providing the telehealth services.
  6. Follow patient consent and patient information protocols consistent with those followed for in-person care visits.
  7. Inform patients of the location of the provider (i.e., distant site) furnishing the telehealth service and obtain the patient location (i.e., originating site).
  8. Tell patients how they can access in-person care with a clinician in event of an emergency or otherwise.
  9. Maintain certain other policies and documentation standards as set forth in Massachusetts Bulletin 2020-04 issued by the Commissioner of Insurance Division on March 16, 2020, which can be found on the Division’s website.

90-day suspension of preauthorization for discharge to home health, rehabilitation and skilled nursing facilities
ConnectiCare has communicated changes to preauthorization, home health services, post-acute care facilities and Passage referrals during the coronavirus (COVID-19) outbreak. The changes are in compliance with the following requirements from the state of Massachusetts:

Preauthorization* requirements for inpatient hospital discharges to home health care, rehabilitation centers and skilled nursing facilities (SNF) will be suspended for 90 days.

  1. For hospital discharges to home health care services:
    1. Plans may review home health care services for medical necessity concurrently and retrospectively.
    2. Plans are permitted to require notification of admission to home health services. Notice of admission to home health care services after hospital discharge is required within 48 hours of the first home health care visit.
    3. Plan of care for home health services must be established and approved in writing by a physician.

  2. For hospital discharges to inpatient rehabilitation centers and SNF:
    1. Plans may review inpatient rehab services for medical necessity concurrently and retrospectively.
    2. Plans are permitted to require notification of admission. Notice of hospital discharge to SNF or rehab hospital is required within 48 hours of admission.
    3. Plans should provide hospitals with an up-to-date list of all in-network rehab facilities and SNF to facilitate discharges.
    4. Hospitals should use their best efforts to transfer insureds to in-network providers.

      Please note, if a patient is discharged to an out-of-network (OON) rehab and SNF, plans must negotiate a rate with the OON facility within 48 hours of notification. If no agreement is reached, the health plan should reimburse for Medicaid enrollees at the Medicaid rate, and for commercial members at the Medicare reimbursement rate.

Thank you for all that you are doing to care for your patients and protect the public health. As state guidelines are updated, we will do our best to keep you informed.

(04.01.2020)

While we believe the information in this communication is accurate as of the date published, it is subject to correction or change during the rapidly evolving response to the COVID-19 outbreak.