Your ZIP Code spans multiple counties.

Available counties

Cancel

Change in Time Frames for Part B Drug Requests

Thursday, October 31, 2019

Prior Authorization Requests
Per CMS requirements and effective for dates of service on or after January 1, 2020, the following changes will be implemented to Medicare Part B drug time frames:

  • CarePartners of Connecticut must notify the member (and the prescribing provider or other prescriber involved, as appropriate) of its determination as soon as possible as the member’s health condition requires, but no later than 72 hours after receipt of the request. 
  • When a request for expedited determination is approved, CarePartners of Connecticut must make its determination and notify the member (and the provider or prescriber involved, as appropriate) of its decision as soon as possible as the member’s health condition requires, but no later than 24 hours after receiving the request.

Providers should fax all Part B drug requests to 857.304.6463. As a reminder, providers should fax all Part D drug requests to 617.673.0956. Note: Providers are reminded to respond to inquiries for clinical information from CarePartners of Connecticut in a timely manner.

Requests for Reconsideration
Per CMS requirements and effective for dates of service on or after January 1, 2020, Medicare Part B drug time frames for reconsiderations (appeals) will be as follows:

  • CarePartners of Connecticut must notify the member (and the prescribing provider or other prescriber involved, as appropriate) of its determination as soon as possible as the member’s health condition requires, but no later than seven calendar days after the receipt of the request.
  • When a request for an expedited determination is approved, CarePartners of Connecticut must make its determination and notify the member (and the prescribing provider or other prescriber involved, as appropriate) of its decision as soon as possible as the member’s health condition requires, but no later than 72 hours after receiving the request. 

For a listing of all Part B drugs that require prior authorization, visit the Resource Center on the public Provider website. The Request for Medicare Part B Prescription Drug Organization Determination form will be available in the Resource Center on the public Provider website effective January 1, 2020.