Important authorization and utilization management reminders
We’re offering a reminder of some significant changes now in place at CarePartners of Connecticut, including prior authorization requirements for a number of services such as skilled nursing facility (SNF) care and non-emergent medical transportation (ambulance), as well as utilization and care management delegation for select members.
Prior authorization: SNF care and non-emergent medical transportation, among others
As part of a broader implementation of new prior authorization requirements effective as of Jan. 1, 2025 — which we outlined in the November issue of Provider Update — you’ll need to obtain prior authorization in order to be covered and appropriately reimbursed for SNF care rendered to CarePartners of Connecticut members. We will leverage Medicare Benefit Policy Manual Chapter 8 for prior authorization coverage criteria, as identified in our Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines.
Additionally, CarePartners of Connecticut now requires prior authorization for HCPCS codes A0426, A0428, A0430, and A0435 for non-emergent medical transportation (ambulance), as detailed in our Non-Emergent Ambulance Transportation Medical Necessity Guidelines, and we’ll follow Medicare Benefit Policy Manual Chapter 10 for criteria.
When submitting prior authorization requests, please keep in mind that care management and utilization management of medical services and Medicare Part B drugs for CarePartners of Connecticut members with an Advantage Plus Network – Connecticut (APN-CT) primary care provider have been delegated to APN-CT, a partnership of Optum® and Hartford Healthcare.
If you are aware that one of your CarePartners of Connecticut patients has an APN-CT primary care provider (PCP), which includes providers under Hartford Healthcare Medical Group and ProHealth Physicians, you can request authorization for medical services and Part B drugs directly with APN-CT in one of the following ways:
- Online: via the Optum Pro portal at optumproportal.com
- Phone: 1-888-556-7048, 8 a.m.– 6 p.m. ET, Monday–Friday (only if online unavailable)
You can identify whether the member has an APN-CT PCP using the Optum Pro portal. For your patients who do not have an APN-CT identifier, you can continue to request authorizations as you typically do: using CarePartners of Connecticut’s secure online provider portal — which is the preferred method for efficiency and ease of use — or alternatively by submitting the Standard Prior Authorization Request Form to our Precertification Operations Department by fax (857-304-6463 for outpatient or 857-304-6410 for inpatient). If you’re unsure whether the patient has an APN-CT PCP, continue to use our provider portal; in the event the patient has an APN-CT PCP, the request will be redirected to Optum for review.
Resources for your facility
We’ve developed this handy electronic flyer outlining the aforementioned updates, among other notable changes impacting CarePartners of Connecticut providers in 2025. We encourage you to review the information conveyed in the flyer and the related documentation it links to, and please feel free to share the flyer with others in your facility.