What’s new for 2021?


Here’s what you need to know for the new year:

  • All commercial members will have new member ID numbers and ID cards: By Jan. 1, 2021, all commercial members with employer-sponsored and individual plans will have new member ID numbers that start with the letter “K” followed by a 10-digit number. View a sample here.

    The new commercial member ID numbers are similar to those of our Medicare Advantage members. Medicare Advantage ID cards do clearly note the member has a Medicare Advantage plan.

    Please make sure to ask our commercial members for these ID cards. To avoid any delays in claims payments, please use the new ID cards for services on and after Jan. 1, 2021. Claims for 2021 services with old member numbers that start with the numeral “9” may be denied and returned for resubmission.

    It’s important to check ID cards and ID numbers for all commercial patients at every visit and sign in to our provider website to verify eligibility.

  • Please be aware that the explanation of payment statements (EOP) for services provided to members with the new K-ID will also change after Jan. 1. Here’s a document to help you understand the new format.

    Provider payments will be made through our partnership with PNC Bank and the ECHO Health payment platform. If you haven’t signed up for electronic funds transfer (EFT) through PNC-ECHO, you will receive your claims payment by virtual credit card. Normal transaction fees apply based on your merchant acquirer relationship. These virtual credit cards expire after 60 days.

  • Expanded pharmacy utilization management program now includes Medicare Advantage plans: Earlier this year, we told you Express Scripts (ESI) will perform most drug utilization management services for all our ConnectiCare members with commercial plans, including plans sold through Access Health CT. We’re expanding that program to include Medicare Advantage plans starting Jan. 1, 2021. This means ESI will review requests for drug preauthorization, quantity limits and step therapy for all our commercial and Medicare Advantage plans in 2021.

    This will not apply to most drug utilization management requests for adult chemotherapy and supportive agents. New Century Health (NCH) will need to preauthorize all oncology-related chemotherapeutic drugs and supportive agents when they’re given to commercial (including Access Health CT) and Medicare Advantage patients in the physician’s office, outpatient hospital or ambulatory setting.

    Preauthorizations approved before Jan. 1
    All preauthorizations for non-chemotherapeutic drugs and supportive agents for Medicare Advantage members issued by ConnectiCare before Jan. 1, 2021 will remain valid until they expire.

    We know this is a lot of information and your offices are busy. Here’s a drug preauthorization overview chart to help you.

  • New step therapy requirements for certain Part B drugs for Medicare Advantage plans: Starting Jan. 1, 2021, we will implement step therapy requirements for our Medicare Advantage line of business for certain categories of Part B drugs.

    Members who received authorization before Jan. 1, 2021 may continue treatment with the non-preferred drugs listed on this chart. Members who start therapy on or after Jan. 1, 2021 must have a trial and therapeutic failure of a preferred alternative drug prior to approval of a non-preferred drug. Please note, preferred products also require preauthorization.

  • Medicare Advantage pharmacy network updates for 2021: We’ve made some changes to our Medicare Advantage pharmacy network. We notified our members about the changes earlier this month. Please support your patients who may be affected by writing new prescription orders, when needed, that they can take to a participating pharmacy before the new year.

  • 2021 updates to our Medicare Advantage plans: Here’s how changes to our 2021 ConnectiCare Medicare Advantage plans will affect you and your patients:

    • New expanded Medicare Advantage provider network: VIP Bold in New York will replace the EmblemHealth VIP Prime Network and be accessible to ConnectiCare members with Choice or Flex plans. These members will present ConnectiCare ID cards that also have an EmblemHealth logo. This means your patients can visit New York health care professional and medical facilities in the new VIP Bold network for certain services after Jan. 1, 2021. Please note, the VIP Bold network does not apply to members with ConnectiCare Choice Dual (HMO D-SNP) and ConnectiCare Choice Dual Basic (HMO D-SNP) plans.

    • 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 or her eligibility on the EmblemHealth website.

    • New dual special needs plan: After Jan. 1, 2021, ConnectiCare will have two special needs plans — ConnectiCare Choice Dual (HMO D-SNP) and the new ConnectiCare Choice Dual Basic (HMO D-SNP). These plans do not have access to the VIP Bold network in New York.

    • Telehealth benefits added to all plans so our Medicare Advantage members with individual plans can visit their primary care doctors, specialists, or mental health clinicians from home. Medicare Advantage members with group plans can also visit primary care doctors and specialists using telehealth. Please note, this benefit will go into effect after the national public health emergency related to the coronavirus (COVID-19) ends. Our temporary telehealth policy in response to COVID-19 remains in effect during the emergency.