We have launched new plans called "Passage" for some of our commercial and Medicare Advantage members on Jan. 1, 2017. Passage plans will require members to get primary care provider (PCP) referrals to see any specialists in our ConnectiCare network.
Members with Passage plans have to:
- Designate a PCP from one of three participating physician groups ─ CliniSanitas, Connecticut State Medical Society ─ Independent Practice Association (including Starling physicians) and ProHealth Physicians.
- Get PCP referrals to see any specialists in the ConnectiCare network.
As we announced earlier, we are limiting participation in the plan's PCP network to three primary care groups in 2017, our pilot year.
Our new member ID cards will clearly indicate members who have Passage plans and who will need referrals for specialists' care. See illustrations below:
PCPs: What you need to know about Passage
If you do not belong to one of three participating physician groups, you should not provide primary care services to members with Passage plans. If you do provide such services, we will unfortunately have to deny the claims and tell members they are responsible for the costs. (For Passage members with individual plans through Access Health CT, the Connecticut insurance exchange, the claims will be paid under their out-of-network benefits.)
Specialists: What you need to know about Passage
Referrals are needed for specialist care of any member with Passage plans. Passage members will be able to see any specialist in the ConnectiCare provider network as long as they have valid referrals from their Passage PCPs. Without referrals, we will deny claims for specialists' consultation services and tell members they are responsible for the costs.
You will be able to find out if a member has a proper referral by calling one of our provider services representatives. You can also check with the member's Passage PCP for verification.
Referrals will not be required when Passage members need hospital and/or ancillary care services, such as radiology and lab work.