Authorization requirements to be restored July 1, 2020

06/10/2020

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 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 (SNFs), long-term acute care hospitals (LTACHs) and acute rehabilitation facilities

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.


Extension 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:

  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 authorized 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:

  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 800.508.6157 (Fax)
860.678.5282 (Phone)
N/A
SNFs N/A 844.359.5388 (Fax)
866.501.4665 (Phone)
Acute rehabilitation N/A 844.359.5388 (Fax)
866.501.4665 (Phone)


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 our secured provider website for the latest news and the most up-to-date information.

 

*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.

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.