Starting Jan. 1, 2020, ConnectiCare will only process the inlier payment of an in-patient stay for our Medicare Advantage claims. The outlier portion of the claim will be denied until we receive an itemized bill from the provider. Payment for the applicable outlier amount will be released after ConnectiCare reviews the itemized bill. This process will only apply to claims that meet the applicable dollar threshold that triggers the review.
Changes to claims payment for Medicare Advantage inpatient stays