Claim Edits

Drugs and Biologicals

Effective for dates of service on or after December 1, 2021, CarePartners of Connecticut will implement additional claim edits for drugs and biologicals.

CarePartners of Connecticut’s policies regarding drugs and biologicals are derived from evaluation of drug manufacturers’ prescribing information and the following sources:

  • CMS and CMS HCPCS Level II Manual
  • National Comprehensive Cancer Network Drugs & Biologics Compendium™
  • National Government Services Inc. website
  • Micromedex® and DRUGDEX®
  • Pharmaceutical Compendium
  • FDA
  • Medical Journals
  • ICD Manual

These policies support appropriate diagnosis codes, indications, dosages and frequencies. In some instances, off-label indications will also be allowed where there is evidence of efficacy.

For more information, refer to the Drugs and Biologicals Payment Policy.