Office Visit
Your source for important provider news and updates
December 2025
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Starting Jan. 1, 2026, network providers will experience some operational changes in how they work with ConnectiCare. Below are some key changes providers should note to ensure a smooth transition into the new year.
Lines of business
ConnectiCare will have three lines of business: commercial (employer groups), marketplace (exchange), and Medicare.
Provider portals
ConnectiCare providers will use two provider portals to perform various online functions, including preauthorization requests, verifying member eligibility, accessing benefit and claims information, and facilitating dispute resolution.
Vendor preauthorization requests
ConnectiCare has established relationships with vendors for some utilization management programs. To contact these vendors directly for preauthorization requests, visit Vendor-Managed Utilization Management Programs.
Resources
Be sure to visit the provider hub for more details about the 2026 operational changes and a list of helpful resources, including:
Attend these provider orientation and training webinars to understand how ConnectiCare operational changes will impact your practice starting Jan. 1, 2026.
Beginning Jan. 1, 2026, vision benefits for ConnectiCare Marketplace members will be administered by Vision Service Plan (VSP). For members to receive in-network benefits for pediatric vision care (routine eye exams and eyewear) and adult routine eye exams, services must be provided by a participating VSP provider.
Providers interested in joining the VSP network can email credentialing@vsp.com or call
800-742-6907, Option 3. VSP providers must send claims to VSP, Attention: Claims Services, P.O. Box 495937, Cincinnati, OH 45249-5937. Any claims sent to ConnectiCare will be rejected with a request to submit to VSP.
More than 13,000 women in the United States are diagnosed with invasive cervical cancer each year. However, vaccination and appropriate screening can help prevent this disease and increase the rate of early detection. There is no single solution to ending cervical cancer, but together, we can help close gaps in care for our members.
Steps for closing care gaps:
See Clinical Practice Guidelines and the latest guidance from the American Cancer Society that was just released Dec. 4, 2025.
Actions needed for compliance:
Cervical cancer screening for women 21 to 64 years of age, following the required timeframe:
Documentation and coding requirements:
Documentation of date (month, year) cervical cytology was performed and results or findings. Use correct billing codes and ensure timely submission of claims: Cervical cytology CPT: 88141 – 88143, 88147, 88148, 88150, 88152 – 88164 – 88167, 88174, 88175. HCPCS: G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091. HPV test CPT: 87624, 87625. HCPCS: G0476.
In case you missed it in last month’s edition of Office Visit, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey season is here. We all play an important role in shaping the member experience that is captured each year through CAHPS.
High CAHPS survey scores reflect positive relationships between providers and our members, and their ability to access timely, well-coordinated care. The survey questions are also a great way to make sure your patients take care of their health, including reminding them to get their flu vaccine this holiday season.
As a provider, you are on the front lines of the patient experience, and your interaction has a direct impact on their responses to the CAHPS survey.
Here are some tips to help you provide exceptional patient care for our members:
Visit our Quality Improvement web page for more details and to find out how to improve your CAHPS scores.
See Commercial Networks and Benefit Plans for the Commercial benefit plans we will be offering in 2026.
See Marketplace Networks and Benefit Plans for the Marketplace benefit plans we will be offering in 2026.
See Medicare Networks and Benefit Plans for the Medicare benefit plans we will be offering in 2026.
The Centers for Medicare & Medicaid Services (CMS) requires all hospitals and critical access hospitals to provide Medicare beneficiaries, including Medicare Advantage enrollees, with the Office of Management and Budget approved Medicare Outpatient Observation Notice (MOON). Visit CMS for details on MOON and instructions for completing notices.
ConnectiCare and EmblemHealth have made updates to two reimbursement policies. See the revision histories for changes and their effective dates for the following policies:
Reimbursement policy reminders
For full details, please review the reimbursement policies and refer to the revision history for effective dates.
Observation Stay – Commercial
Observation Stay – Medicare and Medicaid
The following Medical Guidelines have been updated for ConnectiCare and EmblemHealth:
The following Medical Policies were also updated: See revision history for applicable updates/effective dates.
The EmblemHealth medical guideline, Hyperbaric Oxygen Therapy was revised to add as covered indications:
If you need help navigating our provider portals, please see our videos, quick guides, and Frequently Asked Questions pages:
If you still have questions or need additional support, contact Provider Customer Service using the provider portal’s Message Center or live agent chat.
We recommend that you take advantage of the training opportunities offered by CMS’ Medicare Learning Network.
Our ConnectiCare Centers and EmblemHealth Neighborhood Care locations provide one-on-one customer support to help members understand their health plan, provide connection to community resources, and offer free health and wellness events to help the entire community learn healthy behaviors. Our virtual and on-demand events are available to you and all your patients. View locations and upcoming events for ConnectiCare Centers and EmblemHealth Neighborhood Care.
If a provider in your practice is leaving, please inform us as soon as possible. See how to submit data changes as required by our participation agreements for ConnectiCare and EmblemHealth.
If you participate with us under a delegated credentialing agreement, please have your administrator submit these changes.
Remember to review your CAQH application every 120 days and ensure you have authorized EmblemHealth as an eligible plan to access your CAQH information.
Consult ConnectiCare’s Provider Manuals for Important Information
The ConnectiCare Provider Manuals are valuable resources and extensions of your Provider Agreement. They include details about your administrative responsibilities and contractual and regulatory obligations. You can also find information about best practices for interacting with our plans and how to help our members navigate their health care. A key resource is the Access & Availability Standards, which set up the expected time frames for appointment availability, appointment wait times, and after hours coverage. You can find the ConnectiCare Provider Manuals in the top navigation menu of our provider website.
