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Important Coronavirus (COVID-19) Information

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Coronavirus (COVID-19)

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.

The Latest on the Temporary Telehealth Policy and Passage PCP Referrals

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 the end of the COVID-19 public health emergency.

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.

(03.22.2021)

Testing / Vaccine Payment and Medical Policies

Here are our policies for COVID-19 testing:

COVID-19 Vaccine and Monoclonal Antibody Infusions Policy, effective Nov. 9, 2020
Medical Policy: Testing for Coronavirus Disease 2019 (COVID-19) (Commercial & Medicare Advantage), effective Feb. 11, 2021 (RETIRED as of 11/10/2021)
Payment Policy: COVID-19 Billing Guidelines (Commercial & Medicare Advantage), effective March 16, 2020

(11.10.2021)

Authorization Requirements for SNFs To Be Restored March 8, 2021

In December 2020, we temporarily streamlined authorization processes for skilled nursing facilities (SNFs) so hospitals and health care systems can promptly transfer patients to lower levels of care, when appropriate, without asking for prior approval. This was part of ConnectiCare’s response to the coronavirus (COVID-19) outbreak.

Beginning March 8, 2021, preauthorization will again be required before ConnectiCare members can be discharged to SNFs. This applies to all our members with commercial and Medicare Advantage plans.

Please submit preauthorization requests to our partner, CareCentrix, before the date of hospital discharge. Notice needs to be provided by:

Fax: 866-501-4665
Phone: 844-359-5388

(03.02.2021)

ConnectiCare Restored Most Authorization Processes, Starting July 1, 2020

We returned to the normal process for:

Preauthorization approvals*
Home health care services
Long-term acute care hospitals (LTACH) and acute rehabilitation
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 that have been extended before July 1 are not affected.

This applies to:

Inpatient elective admission requests
Outpatient procedures/requests
Out-of-network requests
Infertility services (commercial plans only)
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:	860-674-5893 (preauthorization) 860-409-2437 (home care)	866-706-6929 (preauthorization) 860-678-5291 (home care)
Phone:	800-562-6833 extension 8552	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:

Physical therapy
Occupational therapy
Speech therapy
Medical social worker
Home health aide
Skilled nursing visit
IV therapy

Hospital discharges to LTACHs and acute rehabilitation facilities again require preauthorization

Discharges of ConnectiCare members from hospitals to 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	860-678-5282 (Fax) 800.508.6157 (Phone)	N/A
Acute rehabilitation	N/A	866-501-4665 (Fax) 844-359-5388 (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.

(12.09.2020)

Using Telehealth for Quality Measures and Risk Adjustment

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)

Medicare Advantage and the CARES Act

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

Add 20% to inpatient reimbursement for both in-network and out-of-network COVID-19 care given to Medicare Advantage members.
Effective with admissions occurring on or after Sept. 1, 2020, claims eligible for the 20% increase in the MS-DRG weighting factor will also be required to have a positive COVID-19 laboratory test documented in the patient’s medical record. Positive tests must be demonstrated using only the results of viral testing (i.e., molecular or antigen), consistent with Centers for Disease Control and Prevention (CDC) guidelines. The test may be performed either during the hospital admission or no less than 14 days prior to the hospital admission.

This only applies to our members with Medicare Advantage plans.

Adding 20% to COVID-19 inpatient reimbursement
In accordance with Centers for Medicare & Medicaid Services (CMS) methodology, ConnectiCare will add 20% to the MS-DRG-based inpatient reimbursement (operating component only) for Medicare Advantage patients who were discharged with a COVID-19 diagnosis after Jan. 27, 2020.

Effective with Sept. 1, 2020 admission dates, CMS requires that a positive COVID test result be documented in the medical record for inpatient claims to be eligible for the 20% increase.

For all out-of-network and in-network hospitals

Inpatient admission MS-DRG claims having COVID DX Code U07.1 as a primary diagnosis will process with the COVID Add-On. We may audit paid claims, and we may ask the hospital to provide medical records to validate the presence of a positive COVID test.
Inpatient admission MS-DRG claims having COVID DX Code U07.1 as a secondary diagnosis will process without the COVID Add-On.
- Claims will have a remittance message informing the provider that, if the COVID DRG Add-On is warranted, the provider is to submit medical records validating the documentation of a positive COVID lab test within 14 days of the admission date.
- The claim will be adjusted to pay the COVID Add-On amount once ConnectiCare validates an eligible positive COVID test.

(Update: 09/07/2022) Temporary suspension of the Medicare sequestration fee

The suspension of the 2% Medicare sequestration fee for in-network providers will continue for claims with dates of service through the end of 2021.

For 2022 claims, on your Explanations of Payment, you will see a note telling you that the Federal Sequestration Reduction was applied as we follow this updated CMS guidance based on the date of service:

Jan. 1 – March 31: No payment adjustment
April 1 – June 30: 1% payment adjustment
July 1 and thereafter: 2% payment adjustment

(09.07.2022)

Pre-Payment Forensic Reviews and Audits To Resume June 20

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)

Partner Updates

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:

Cardiac imaging program and implantable devices
Outpatient interventional spine pain management for certain procedures
Outpatient advanced imaging
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)

Massachusetts Providers

Important Information for Our Massachusetts Providers

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

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.
Temporarily extended the timelines for appeals for 90 days beginning April 6, 2020.
Provided coding and billing guidance and policies for the COVID-19 pandemic.
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)

Preauthorization Temporarily Waived for Massachusetts Hospital Admissions

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:

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

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

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

(04.27.2020)

Guidelines To Deliver Medically Necessary Health Services via Telehealth

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 visits 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:

Review relevant medical history and records with new patients before their initial telehealth appointments.
Review medical history and available medical records with existing patients during their telehealth services.
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).
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.
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.
Follow patient consent and patient information protocols consistent with those followed for in-person care visits.
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).
Tell patients how they can access in-person care with a clinician in event of an emergency or otherwise.
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 (SNFs) will be suspended for 90 days.

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.

For hospital discharges to inpatient rehabilitation centers and SNFs:
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 SNFs 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.

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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.