Office Visit

ConnectiCare would like to remind our providers that the Health Outcomes Survey (HOS) and Pharmacy Tip Sheets are available on the Availity Essentials provider portal for easy digital access.

The HOS Tip Sheets are designed to help you understand the specific questions included in the HOS and the Medicare Star Rating measures influenced by your patients’ responses. These sheets outline both general strategies and actionable steps you can take to positively impact these measures in your practice.

CAHPS is an industry-standard survey tool to evaluate patient satisfaction. Improving patient satisfaction has many benefits, such as:

• Increasing patient retention
• Increasing compliance with physician clinical recommendations
• Improving patients’ overall wellness and health outcomes
• Ensuring preventive care needs are addressed more timely
• Reducing no-show rates

Additional resources are available for office staff and patients:

• For additional after-hours coverage, ConnectiCare members can call the 24-hour Nurse Advice Line at 833-957-0169.
• ConnectiCare members can access Interpreter Services at no cost by calling Member Services at 800-251-7722 for Marketplace plans and 800-224-2273 for Medicare plans.

Providers can access the Availity Essentials portal to:

• Search for patients and check member eligibility.
• Submit service request authorizations and/or claims and check status.
• Review patient care plans.
• Obtain CAHPS tip sheets.
• Participate in online cultural competency training.
  

Many older adults experience the “winter blues” as days get shorter and colder, but there are ways to feel better. Talk to your patients. Let them know they are not alone. Help them explore simple steps like light exercise, social activities, or other supports to boost their mood and energy. Mental health matters at every age. Even small changes can make a big difference in how your patients feel.

Below are some tips for managing your patients’ mental health:

• Encourage patients to seek treatment (if needed)
• Limit media consumption
• Engage in healthy activities, such as:
  • Getting enough sleep
  • Eating well
  • Exercising your body and mind
  • Abstaining from the use of tobacco, vaping, etc.
  • Limiting consumption of alcohol
• Take your medications on time, every day
• Stick to regular routines
• Stay socially connected
• Try to focus on the positive and find joy in the simple things in life

Engage your patients today—a brighter season starts with a conversation.

In alignment with requirements from the Centers for Medicare & Medicaid Services (CMS), ConnectiCare requires PCPs and key high-volume specialists, including cardiology, orthopedics, and oncology to receive training about ConnectiCare’s Special Needs Plan (SNP) Model of Care (MOC).

The SNP MOC is the plan for delivering coordinated care and care management to special needs members. Per CMS requirements, managed care organizations (MCOs) are responsible for conducting their own MOC training, which means multiple insurers may ask you to complete separate training.

MOC training materials and attestation forms are available at Special Needs Plan Model of Care Provider Training. The completion date for the training is upon joining the network, or no later than Dec. 31, 2028.

Providers must ensure ConnectiCare has accurate practice and business information. Accurate information allows us to better support and serve our members and provider network.

Maintaining an accurate and current Provider Directory is a state and federal regulatory

requirement and a National Committee for Quality Assurance (NCQA) requirement. Invalid information can negatively impact members’ access to care, member/primary care provider (PCP) assignments and referrals. Additionally, current information is critical for timely and accurate claims processing. Providers must validate their information on file with ConnectiCare at least once every ninety (90) days for correctness and completeness.

Failure to do so may result in your REMOVAL from the ConnectiCare Provider Directory.

Provider information that must be validated includes, but is not limited to:

• Provider or practice name
• Location(s)/address(es)
• Specialty(ies)
• Telephone and fax numbers and email
• Digital contact information
• Whether your practice is open to new patients (PCPs only)
• Tax ID and/or National Provider Identifier (NPI)

The information above must be provided as follows:

Delegated and other providers that typically submit rosters must submit a complete roster with the above information by email to CCI-ProviderFileOperations@MolinaHealthcare.com.

All other providers must log into their Council for Affordable Quality Healthcare (CAQH) account to attest to the accuracy of the above information for each health care provider and/or facility in your practice contracted with ConnectiCare. If the information is correct, please select the option to attest. If it is incorrect, providers can make updates through the CAQH portal. Providers unable to make updates through the CAQH portal should contact Provider Services for assistance.

Additionally, in accordance with the terms specified in your Provider Agreement, providers must notify ConnectiCare of any changes, as soon as possible, but at least thirty (30) calendar days in advance, of any changes in any provider information on file with ConnectiCare. Changes include, but are not limited to:

• Change in office location(s)/address, office hours, phone, fax or email
• Addition or closure of office location(s)
• Addition of a provider (within an existing clinic/practice)
• Change in provider or practice name, Tax ID and/or NPI
• Opening or closing your practice to new patients (PCPs only)
• Change in specialty
• Any other information that may impact member access to care

ConnectiCare Provider Manuals are customarily updated annually but may be updated more frequently as needed. To access the most current Provider Manuals, providers can review the 2026 Marketplace Provider Manual and 2026 Medicare Provider Manual.

ConnectiCare has adopted Molina Clinical Policies (MCPs). The policies are used by providers, medical directors, and internal reviewers to make medical necessity determinations. MCPs are reviewed annually and approved bimonthly by the Molina Clinical Policy Committee (MCPC).

Annually, ConnectiCare evaluates health plan quality performance using two important data sets. These data sets allow ConnectiCare to assess health plan performance for critical indicators of quality and member satisfaction.

First area of focus

ConnectiCare collects and reports on Healthcare Effectiveness Data and Information Set (HEDIS®) measures to evaluate quality performance. Collected by health plans across the country, HEDIS measures are related to key health care issues, such as well care and immunizations, preventive screenings, tests and exams, management of chronic conditions, access to care, medication management, and utilization of services. ConnectiCare sets performance goals for each measure evaluated to identify areas of success, opportunities for improvement, and priority areas of focus for the following year.

Second area of focus

ConnectiCare also works with external survey vendors to collect and report Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey results annually. ConnectiCare uses CAHPS Survey results to evaluate how satisfied our members are with the health care and services they receive from the health plan and providers. ConnectiCare also sets performance goals for CAHPS to identify areas of success, opportunities for improvement, and priority areas of focus for the following year.

If you have any questions or want additional information or printed copies with HEDIS or CAHPS results, please contact Provider Services at 800-828-3407.