Reminder: Core Administrative System Implementation Updates
As previously communicated, CarePartners of Connecticut has actively been working to migrate to a new core administrative system to support claims processing and will go live on May 1, 2021.
Providers contracting with CarePartners of Connecticut can expect the following changes on the new core administrative system:
- All products will appear on one EOP and one 835: Current state, providers receive separate EOPs and 835s for the CarePartners of Connecticut HMO and PPO products. This will continue for claims that have dates of service (DOS) prior to the implementation date. For claims with DOS after the implementation date, the EOPs and 835s will be combined for the HMO and PPO products.
- Pending claims: For claims submitted with DOS after the system implementation date, claim details represented on paper EOP statements will include only claims that are finalized (in process and held claims will be excluded). Currently, CarePartners of Connecticut’s providers view all claims regardless of status. Providers can log in to the secure Provider portal and use the Claims Status Inquiry tool to see if a claim is pending. Providers can register for the secure Provider portal here.
- Claim adjustment reason pay code: Currently on accounting adjustment lines (reversal and void), the Pay Code column on the EOP displays the CarePartners of Connecticut Pay Code (e.g., FEESC). For claims with DOS on or after the implementation date, the Adjustment Reason in the Pay Code column will always be populated with “ADJST.”
- Multiple checks: Providers may receive up to three check payments during a weekly check run (two for claims paid on the existing system [one for HMO and one for PPO], and one for claims paid from the new system).
- Credit balance applied and refunds/recoupments: For claims with DOS on or after the implementation date, there will be changes to EOPs and 835s.
For more information and details regarding the above changes, refer to the Core Administrative System Implementation Updates Frequently Asked Questions (FAQs) and CarePartners of Connecticut’s Explanation of Payment (EOP) Guide.
At this time, CarePartners of Connecticut does not anticipate any changes that providers will need to make or action to be taken because of, or in preparation for, this system update. CarePartners of Connecticut has managed this update through a structured program, which has included extensive testing efforts. CarePartners of Connecticut will continue to provide further updates on the system migration and possible changes that may impact providers, if any.
For questions regarding the system implementation, call Provider Services at 888.341.1508.