As a routine business practice, claims are subject to payment edits that are updated at regular intervals and generally based on CMS (including NCCI edits), specialty society guidelines and drug manufacturers’ package label inserts.
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:
CarePartners of Connecticut is working to improve provider directory information for its members. CarePartners of Connecticut currently uses CAQH for credentialing purposes through ProView®. Beginning in 2020, providers will be able to review and maintain up-to-date provider directory information through CAQH’s DirectAssure® directory solution.
CarePartners of Connecticut members are eligible to receive a Healthy Behavior Reward in the form of a $75 gift card if they complete the required diabetes screenings by November 30, 2020. In order to earn the incentive, members need to have a blood pressure check, a retinal eye exam, two hemoglobin A1C tests and a urine protein test.
Effective January 1, 2020, all new CarePartners of Connecticut members will be assigned a Health Navigator (Outreach Specialist) or a Care Manager, who will reach out and conduct a Health Risk Assessment. Members with certain health conditions will be eligible to remain in care management.