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Drugs and Biologicals Claim Edits

Friday, January 31, 2020

Effective for dates of service on or after April 1, 2020, 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:

  • AMA’s CPT Manual
  • CMS and CMS HCPCS Level II Manual
  • National Comprehensive Cancer Network Drugs & Biologics Compendium™
  • National Government Services Inc. website
  • Micromedex® and DRUGDEX®

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.

This information is documented in the Drugs and Biologicals Payment Policy.