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.
The Pharmacy Tip Sheets focus on pharmacy-related measures that affect Medicare Star Rating performance. They include practical information such as ICD-10 codes, medication lists, exclusions, and targeted approaches you can use to improve patients’ outcomes.
CAHPS is an industry-standard survey tool to evaluate patient satisfaction. Improving patient satisfaction has many benefits, such as:
Additional resources are available for office staff and patients:
Providers can access the Availity Essentials portal to:
Please encourage your patients who have received the CAHPS Survey to participate. Listed below are several questions asked in the survey regarding patient care:
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:
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:
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:
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.