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:
As a routine business practice, claims are subject to payment edits that are updated at regular intervals and generally based on CMS (including the National Correct Coding Initiative [NCCI] edits), specialty society guidelines and drug manufacturers’ package label inserts.
CarePartners of Connecticut continues to look for ways to improve the provider experience. In response to valuable feedback from providers, CarePartners of Connecticut will implement the following improvements, effective January 1, 2020:
An Annual Wellness Visit (AWV) can foster provider-patient engagement and promote preventive health. Many components of an AWV, if done by the health care provider, meet the criteria for the Health Outcome Survey for CMS Star measures. AWVs are also associated with closing quality gaps.
Components to focus on during an AWV:
CMS recently restructured the Beneficiary and Family Centered Care Quality Improvement Organizations’ (BFCC-QIO) coverage area. Effective June 8, 2019, KEPRO is the BFCC-QIO for all Connecticut health plans.