Below are new and updated payment policies that will go into effect Aug. 1, 2020:
- New multiple procedure reduction policy and updated multiple diagnostic imaging payment reduction policy: ConnectiCare will be aligning with the Centers for Medicare & Medicaid Services (CMS) Multiple Procedure Payment Reduction (MPPR) Policy for commercial members. ConnectiCare has adopted CMS guidelines when multiple diagnostic cardiovascular procedures or diagnostic ophthalmology procedures are performed on the same day by providers who report under the same federal tax identification number (TIN). See the Payment Policy: Multiple Procedure Payment Reduction Cardiology/Ophthalmology (Commercial and Medicare) for details.
- Multiple diagnostic imaging payment reduction policy has also been updated to indicate that the professional component of the diagnostic imaging may also be subject to reductions in alignment with CMS. Here’s the Payment Policy: Multiple Diagnostic Imaging Payment Reduction (Commercial).
- Updated laboratory policy for commercial and Medicare Advantage plans: ConnectiCare will be aligning with CMS and the Federal Clinical Laboratory Improvement Amendments (CLIA) regulations. If you are a physician, practitioner or medical group, you may only bill for services that you or your staff perform. Pass-through billing is not permitted and may not be billed to our members.
We only reimburse for laboratory services that you are certified to perform through the federal CLIA. You must not bill our members for any laboratory services for which you lack the applicable CLIA certification. A valid federal CLIA Certificate Identification number is required for reimbursement of clinical laboratory services reported on a CMS 1500 Health Insurance Claim Form or its electronic equivalent.
See the Payment Policy: Laboratory/Venipuncture (Commercial and Medicare) for more details.