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Preauthorization policies updated, effective Aug 1, 2019

07/03/2019

Our preauthorization policies will include site-of-service reviews for dates of services on or after Aug. 1, 2019. The changes are:

  • Preauthorization requests for certain non-emergent surgical services and/or procedures will be reviewed to determine if the proposed site of service is medically appropriate for the service or procedure. This will apply to all commercial plans, including group and individual plans.
  • Certain medical-injectable drugs (J-codes) will need prior approval for all commercial and Medicare Advantage plans.

Medical services preauthorization updates
Under the new policy, providers will need to submit preauthorization requests to us if:

  1. Office-based procedures are provided in an outpatient hospital or ambulatory surgery center, or
  2. Certain outpatient surgical procedures are provided in an outpatient hospital, including hospital-owned, off-campus facilities.

Affected services include, but are not limited to: dermatology, gastrointestinal, gynecological, orthopedic, ophthalmologic and urologic procedures. The medical services preauthorization program seeks to ensure the members receive care in the most appropriate setting.

Here’s the policy and affected medical codes.

Providers who have ordered or scheduled affected services for dates on or after Aug. 1, 2019 should make sure they obtain authorizations before services are performed on patients with ConnectiCare commercial plans. If providers do not get the site-of-service approvals for affected medical services, claims may be denied and members cannot be billed for the services.

You can fax preauthorization requests for medical services to 1-800-923-2882 or call 1-800-562-6833.

Pharmacy services preauthorization updates
The medicines on this drug list will need to be preapproved before prescriptions can be written for ConnectiCare commercial and Medicare Advantage patients on or after Aug. 1, 2019.

Please use one of the following options to get preauthorization. You may submit more than one preauthorization request at a time.

  • For chemotherapy treatments, please submit requests to New Century Health (NCH), which manages ConnectiCare’s oncology management program, by:
    • Going to the NCH secure website at my.newcenturyhealth.com (log-in required), or
    • Calling NCH’s Utilization Management Intake department at 1-888-999-7713, option 1, between 8 a.m. and 8 p.m. (ET) Monday through Friday.
  • For all other drugs, complete the preauthorization request form, available on connecticare.com/providers, and submit requests in writing in one of these ways:

    For commercial plans For Medicare Advantage plans
    Fax: 1-800-249-1367 Fax: 1-877-300-9695
    Mail: ConnectiCare
    Attn: Pharmacy Services
    175 Scott Swamp Road
    Farmington, CT 06032
    Mail: ConnectiCare
    Attn: Pharmacy Services
    55 Water St.
    New York, NY 10041