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.
Members use CarePartners of Connecticut’s online provider directory, i.e., Doctor Search, to locate physicians, specialists and Allied Health providers who fit their health care needs.
Providers logged in to the secure Provider website are able to use the MHK (formerly MedHOK – Medical House of Knowledge) system to complete requests for inpatient and outpatient services, attach documentation, check authorization requests, and in some cases receive an approval and reference number online at the time of e
The following claim edits are effective for dates of service on or after July 1, 2019. These policies are derived from CMS, the AMA’s Current Procedural Terminology Manual, the Healthcare Common Procedure Coding System, ICD-10, nationally accredited societies and CarePartners of Connecticut policy.
CarePartners of Connecticut will implement the following claim edits:
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.