Here’s what you need to know about changes to our 2020 ConnectiCare Medicare Advantage plans that will affect your patients and you.
- Expanded Medicare provider network
ConnectiCare members with Choice or Flex plans can visit New York health care professional and medical facilities in the EmblemHealth VIP Prime Network for certain services after Jan. 1, 2020.* Eligible EmblemHealth members will also be able to get certain medical care and services from ConnectiCare providers like you. These members will present EmblemHealth ID cards that also have a ConnectiCare logo. If an EmblemHealth member presents an ID card without a ConnectiCare logo, it’s best to check his/her eligibility on the EmblemHealth website.
The expansion is like that of our commercial provider networks in January 2017. If you treat EmblemHealth members, please refer to emblemhealth.com/providers for medical and pharmacy policies, eligibility requirements and claims submission processes.
*Please note, services for diagnostic exams and eyewear after cataract surgery, behavioral health, dental, chiropractic, occupational and physical therapy are limited to Connecticut providers only. The expanded New York provider network is not available to members with Passage Plan 1 (HMO) and Choice Dual (HMO D-SNP) plans
- New member ID numbers and ID cards
Most ConnectiCare Medicare members will get new, 11-digit member numbers that start with the letter “K.” Member ID numbers for members with dual special needs plans will not change. All Medicare Advantage members will get new ID cards that go into effect Jan. 1, 2020. Please make sure to ask for these ID cards for any 2020 dates of service.
To avoid any delays in claims payments, please use the member ID numbers with the prefix “K” when submitting Medicare claims for services on and after Jan. 1, 2020. Claims for 2020 services with old member ID numbers may be denied and returned for resubmission.
To submit Medicare claims for services that start in 2019 and extend into 2020, here’s what you need to do:
- Professional services claims — Send your submission in two separate claims: services before Jan. 1, 2020, use the old member ID number; services on and after Jan. 1, 2020, use the new member ID number.
- Inpatient claims — Use the old member ID number if the hospital admission starts in 2019 and ends with a discharge date in 2020.
- Outpatient claims — Use the old member ID number for claims that start in 2019 and end in 2020.
- No more referrals
Members with Passage Plan 1 (HMO) will no longer need referrals for specialist care. We will still require members to have Passage PCPs to coordinate their care. Our dual special needs plan in 2020 will move from our Passage product suite to become Choice Dual (HMO D-SNP). Referrals for specialist care will no longer be required.
- More frequent claims payment and statements
We will move from twice-a-week check runs to a daily schedule for our Medicare claims payments for dates of services after Jan. 1, 2020. If you haven’t enrolled in electronic fund transfers, your office may see an increase of paper checks received.
We encourage providers to sign up for electronic funds transfer (EFT) and electronic remittance advice (ERA) through PNC Remittance Advantage. This service, free to ConnectiCare providers, will cut down on trips to the bank to deposit checks, can help with cash flow and reduce the risk of lost or mishandled payments.
Please note, if you sign up for EFT through PNC for Medicare claims payment, you will still get EFT payments through the Bank of America for Medicare Advantage claims with dates of services prior to Jan. 1, 2020, and for our commercial plans.