COVID-19 update for ConnectiCare providers: preauthorization, home health care services, Passage referrals

04/01/2020

Thank you for all that you are doing to care for your patients and protect public health. We know the focus at this time is to make sure our hospital and health care systems can care for those who are sick with the coronavirus (COVID-19). That means other non-emergent surgeries and procedures may need to be delayed and/or canceled.

To help you focus on caring for your patients, we are taking steps to temporarily streamline authorization processes. Please see our updates below 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 are specific to ConnectiCare providers caring for all of our members with commercial and Medicare Advantage plans, unless noted otherwise.

Previously approved preauthorization requests extended
Effective immediately, preauthorization requests that have already been approved for our members will be extended for an additional 90 calendar days from the original date(s) of service upon request by the provider.

This applies to the following:

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

We also will automatically extend previously approved inpatient elective admission requests for 90 calendar days from the originally scheduled admission date even if a provider does not ask for the extension.

If a surgery is canceled without a rescheduled date, then a new preauthorization request will need to be submitted to ConnectiCare when the surgery is rescheduled.

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
Initial and re-authorization requests for home health care services will be authorized for 90 calendar days with corresponding units/visits to match the date span. This will apply 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
ConnectiCare members who are discharged from hospitals to SNF, LTACH or acute rehabilitation will not require preauthorization approval. Care will be automatically approved through the end of the third business day from the admission to the SNF, LTACH or acute rehabilitation facility.

ConnectiCare or its partner, CareCentrix, must be notified of these transfers to post-acute care facilities before the end of the third business day from admission. Notice needs to be provided to the following:

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)

Concurrent review will occur on the third business day after admission, following the usual process that includes applying criteria specific to admission to post-acute care facilities.

Passage PCP referrals
Effective immediately through May 31, 2020, our commercial Passage plan members will not need Passage PCP referrals to seek specialist care. We will update our provider website to reflect this change.

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 website, connecticare.com/providers, 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.