Office Visit

Earlier this year, we shared exciting news about the acquisition of ConnectiCare by Molina Healthcare. Now, we want to make sure our network providers have the information needed to facilitate a smooth transition as we become fully integrated into the Molina family.

Beginning Jan. 1, 2026, network providers will see some operational changes in how to work with ConnectiCare to care for our Marketplace and Medicare members. You can find more details about these important changes and other valuable resources on our dedicated provider hub.

Remember, these changes do not go into effect until Jan. 1, 2026. Until then, network providers should continue to follow ConnectiCare’s existing policies and processes as posted on our website.

IMPORTANT NOTE: These changes will not apply to commercial members with an ID number that begins with a “K”. For these members, providers will continue to follow ConnectiCare’s existing policies and processes after Dec. 31, 2025.

Social interactions are important in maintaining overall health and well-being. Encourage your patients to actively seek out opportunities to engage with others.

Below is an upcoming community event for your patients to join:

• Yoga In Our City (YOIC) has free classes all summer long in local city parks. Classes are open to everyone, regardless of age or skill level. Check out the full schedule.
• YIOC will also host a free community workshop on Saturday, Oct. 25, from 10 a.m. to noon at the Hartford Public Library, Park Street Library @ the Lyric. Breath as a Bridge: Using Breath as a Bridge for Collective Care and Nervous System Support. Registration is required.

Our ConnectiCare Centers 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 events.

Let your patients know about these upcoming events at the ConnectiCare Center in Manchester:

• More Fire Fitness will offer 4-week exercise classes at 5:30 p.m. on Wednesday, Oct. 1 (More Fire FLEX), and Oct. 29 (More Fire FITE). Classes are open to ConnectiCare members only. Registration is required.
• Community Café Conversation Series: Families & Prevention class for parents and families will be held on Thursday, Oct. 2, from 5 to 7 p.m. Not My Kid? The Truth About Opioids and Prescription Medications is the second in a 3-part series that will analyze the realities of opioid and prescription medication misuse and discuss strategies for prevention at home and in the community. Registration is required.
• No-Cost Vaccine Clinic will be held on Wednesday, Oct. 8, from 8 a.m. to noon. Walgreens will administer vaccines for influenza, COVID-19, RSV, pneumococcal, shingles, and tetanus. Registration is required, and walk-ins are welcomed .
• Force Fitness will offer a nutrition program on Thursday, Oct. 15, from 6 to 8 p.m. Registration is required.
• More Fire Fitness will offer a children’s event on Saturday, Oct. 25 from 10 a.m. to noon featuring an animal-themed exercise class, face painting, balloon animals, and more.

Each year in the United States, about 270,000 women get breast cancer* and 42,000 women die from the disease. Most breast cancers are found in women who are 50 years of age or older, but breast cancer also affects younger women. About one out of every 100 breast cancers diagnosed in the United States is found in a man.

We encourage you to talk to your patients between the ages of 40 and 49 about when to start annual screening and how often they should get a mammogram. The U.S. Preventive Services Task Force recommends women get their annual mammogram starting at age 40.

Here are some tips to help increase breast cancer screening compliance:

• Women age 50 to 54 years should be screened with a mammography annually.
• For women age 55 years and older, screening with a mammography is recommended once every two years for those with normal risk or once a year for those with increased risk.
• Have your staff chart-prep and flag patients who need an annual screening order placed during their visit.
• Help boost compliance by offering your patients a “standing order” for their annual screening mammogram, allowing them to complete the screening mammogram before their annual visit with you.

Be sure your documentation meets CMS standards and that your provider credentials are attached to the correct ICD-10 codes when ordering to ensure accurate data capture. Next month, we’ll share more information on proper documentation of breast cancer screening for HEDIS measure.

Here are six ways to help raise breast cancer awareness at your office:

• Wear pink ribbons. In celebration of breast cancer awareness month, give out pink ribbons to everyone at the office.
• Volunteer together.
• Shop pink items and show support.
• Have a pink car wash as a fundraiser.
• Add pink to your office.
• Have a pink potluck lunch.

Additional resources for providers and members can be found at cdc.gov and at komen.org. Also see recommendations for breast cancer: screening.

*Centers for Disease Control and Prevention.

If Medicare-Medicaid dual-eligible individuals have their Part A and Part B cost share fully covered by their Medicaid plan or are Qualified Medicare Beneficiaries (QMBs), they are not responsible for their Medicare Advantage cost share for covered services. Please do not balance bill these members for any other costs. Any Medicare and Medicaid payments for services given to these members must be accepted as payment in full.

For ConnectiCare members, visit the Connecticut Department of Social Services or call 800-842-8440. For more details, see ConnectiCare Medicare Advantage plans

The following reimbursement policies have been updated. If the policy name does not have a company name shown, the policy applies to both ConnectiCare and EmblemHealth. Refer to the website applicable to the member’s plan (ConnectiCare | EmblemHealth) and see the revision histories for effective dates and applicable changes.

• Coding Edits Reimbursement Policies (9 of the edits originally scheduled to start July 4, 2025, will begin to be applied Sept. 26, 2025.) 

• EmblemHealth: Radiology Cardiology Ultrasound Bundling Rules (Administered by EviCore) Reimbursement Policy 

• EmblemHealth: Radiology Cardiology Ultrasound Correct Coding Rules (Administered by EviCore) Reimbursement Policy 

• EmblemHealth: Radiology Cardiology Ultrasound Frequency Rules (Administered by EviCore) Reimbursement Policy 

The following Medical Policies were updated. See revision history for applicable updates/effective dates.

• ConnectiCare: Experimental, Investigational or Unproved Services Policy
• EmblemHealth: Medical Necessity Guidelines: Experimental, Investigational or Unproven Services
• EmblemHealth revised the medical guideline, Continuous Passive Motion Devices, to add an indication for high-risk procedures associated with arthrofibrosis intra-articular major joint reconstruction, and fracture repair

If you need help navigating our provider portals, please see our videos, quick guides, and Frequently Asked Questions pages:

• ConnectiCare Videos and Guides.
• ConnectiCare Frequently Asked Questions.
• EmblemHealth Videos and Guides.

  Updated: Search For Preauthorization

• EmblemHealth Frequently Asked Questions.

If you still have questions or need additional support, contact Provider Customer Service using the provider portal’s Message Center or live agent chat.

It’s important to maintain your profile with the Council for Affordable Quality Healthcare (CAQH). Failure to do so will result in your voluntary termination from our provider networks.

CAQH conducts our quarterly provider directory validation audits to ensure the accuracy of our provider directories:

• Make your staff aware that CAQH may call and empower them to validate your directory information and network participation.
• Maintain your CAQH profile and keep your information updated.

See more about keeping your directory information current:

ConnectiCare |  EmblemHealth