Payment policy updates

CarePartners of Connecticut would like to inform our provider network of some recent updates to our payment policies.

We have retired our Outpatient Cardiac and Pulmonary Rehabilitation Facility Payment Policy, and the pertinent information from this policy can now be found on the Cardiac Services Payment Policy.

In addition, CarePartners of Connecticut has developed two new payment policies outlining essential billing and reimbursement guidelines, provider requirements and responsibilities, and other information pertaining to Fraud, Waste, and Abuse, as well as Clinical Trials. These policies document existing requirements for CarePartners of Connecticut providers and do not represent a change in processes or services.

Fraud, Waste, and Abuse
This policy provides detailed definitions for what CarePartners of Connecticut considers fraud, waste, and abuse to entail.

CarePartners of Connecticut is committed to detecting, investigating, and preventing wrongful acts, and will identify, investigate, recover funds, report, and when appropriate, take legal actions, if suspected fraud, waste, and/or abuse has occurred.

We reserve the right to conduct audits on any provider and/or facility to ensure compliance with the guidelines stated in this payment policy. If such an audit determines that a provider/facility did not comply, CarePartners of Connecticut will expect the provider/facility to refund all payments related to noncompliance.

Clinical Trials 
The Clinical Trials Payment Policy outlines CarePartners of Connecticut’s coverage of routine costs associated with in-network services rendered during qualified clinical trials for cancer and other life-threatening conditions, in accordance with state and federal mandates and when medically necessary and consistent with the member’s benefits.

For complete information, please refer to the Fraud, Waste, and Abuse and Clinical Trials Payment Policies.