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Attention Inpatient Hospital Providers: DRG Grouper Update (Posted 4/23/24)
Attention Outpatient Hospitals: CMAP Addendum B Updated (April 1, 2024) (Posted 4/23/24)
Attention All Providers: Data Loss: Faxed Medical Prior Authorizations (Posted 4/16/24)
Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Service Providers and Home Health Providers: Important Electronic Visit Verification (EVV) Update - Transition from Sandata Mobile to Sandata Mobile Connect (SMC) effective September 3, 2024 (Posted 4/15/24)
Hospital Monthly Important Message (Posted 4/15/24)
Attention Home Health Providers: Post and Pay Status for Explanation of Benefit (EOB) Code 3328 (Posted 4/10/24)
Attention Home Health Providers: Claim Denials for Electronic Visit Verification (EVV) Mandated Home Health Services (Posted 4/5/24)
Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers: Alternate Electronic Visit Verification (EVV) - Personal Care Services (PCS) Town Hall Session #2 and #3 Dates & Registration Links (Posted 3/28/2024)
Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism Waiver Service Providers and Support and Planning Coach (S&PC) Providers: New Fiscal Intermediary (FI) for Connecticut, GT Independence to support Waiver and S&PC Credentialing Process (Posted 3/22/24)
Attention Home Health Providers: Important Electronic Visit Verification (EVV) Reminders - as of March 22, 2024
Electronic Data InterChange (EDI) Transaction and Trading Partner Updates (Posted 3/7/24)
Attention Providers and Trading Partners: Optum Change Healthcare (CHC) network service interruption (Posted 2/22/24)
ATTENTION Obstetrics & Gynecology and Family Practice Physicians and APRNs, Women's Health APRNs and Certified Nurse Midwives: Register for the HUSKY Maternity Bundle Provider Forum (Posted 2/12/24)
Attention Home Health Providers: Electronic Visit Verification (EVV) Updates as of February 9, 2024
Attention All Board-Certified Behavioral Analysts (BCBAs) and Autism Specialty Groups: BCBA Licensure Requirement for Enrollment in Connecticut Medical Assistance Program (Posted 1/31/24)
Attention All Providers: 2023 1099s Available on CMAP Web Site (Posted 1/19/24)
Attention All Providers: Revised CT Medical Assistance Program (CMAP) Telehealth Table - Updated the end date to 2024 (Posted 12/27/23)
Attention All Providers: CMAP Telehealth Services (Posted 11/27/23)
Attention Acquired Brain Injury, Connecticut Home Care Program, and Personal Care Services/Assistant (PCA) Providers: Prior Authorization Issue (Posted 11/22/23)
Attention Behavorial Health Clinics: UPDATE Performing Providers Required for Behavioral Health Clinic Claim Submission (Posting 9/22/23)
Procedures for Updating Client Third Party Liability Information NEW HMS Phone Number: 1-866-252-0671 (Posted 6/7/23)
HUSKY Health Primary Care Payment Program Extension Notification
Click here for Archived Messages
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RA Banner Announcements |
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| Banner Effective Date | Providers | Banner Page Announcement |
| 04/19/2024-04/26/2024 | | ATTENTION: BEHAVIORAL HEALTH ATTESTATION REQUIREMENT FOR BEHAVIORAL HEALTH CLINICIAN GROUPS AND CLINICIANS. DSS requires all Behavioral Health Groups and Providers to complete the Behavioral Health Attestation through their Secure Web Portal. Currently, claims are not denied for not completing the attestation. DSS has extended the time to allow providers to complete this requirement. This requirement was presented in a phased approach beginning July 6th, 2023. Providers have been given a full year to provide sufficient time for your organization to comply. Non-compliance letters will be sent starting August 1st, 2024 in a phased approach to notify providers that their claims will be denied. Please reference PB 2023-56 for detailed instructions.
You are receiving this banner message as your organization and performing providers still need to comply with this requirement. |
| 04/19/2024-04/26/2024 | Attention All Providers | Claim Adjustment Reason Codes (CARC) Changes on the X12 835 Health Care Claim Payment/Advice This banner serves to inform all providers that on May 1, 2024 the Department of Social Services (DSS) and Gainwell Technologies will be updating the Claim Adjustment Reason Codes (CARCs) and Claim Adjustment Group Codes (CAGCs) combinations for specific EOB codes on the X12 835 Health Care Claim Payment/Advice. This change is in response to feedback from the provider community indicating the difficulty in separating Medicare crossover claim adjustments from Medicaid primary claim adjustments.
The Following Explanation of Benefit (EOB) codes are impacted: 0158 CLAIM/DETAIL PAID PARTIAL CO-INSURANCE AND DEDUCTIBLE BILLED. 0159 CLAIM/DETAIL PAID PARTIAL DEDUCTIBLE BILLED. 0161 CLAIM DETAIL DENIED OR SERVICE INCLUDED IN PAYMENT / ALLOWANCE ALREADY ADJUDICATED BY MEDICARE 0164 CLAIM/DETAIL PAID IN FULL BY MEDICARE. 0165 MEDICARE PAYMENT IS EQUAL TO OR EXCEEDS MEDICAID ALLOWED CHARGE. 0870 CLAIM/DETAIL PAID FULL CO-INSURANCE OR COPAY BILLED. COPAY ONLY IF OUTPT XOVR SUBMITTED AT DETAIL 0871 CLAIM/DETAIL PAID FULL CO-INSURANCE & DEDUCTIBLE OR COPAY BILLED, COPAY IF OUTPT XOVR 0872 CLAIM/DETAIL PAID FULL DEDUCTIBLE BILLED. 0885 CLAIM/DETAIL PAID PARTIAL COINSURANCE OR COPAY BILLED, COPAY ONLY IF OUTPT XOVR SUBMITTED AT DETAIL |
| 04/19/2024-04/26/2024 | Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers | Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers. REMINDER OF OPTIONAL TRANSITION TO OPEN VENDOR ELECTRONIC VISIT VERIFICATION (EVV) MODEL. In 2016, Section 12006 of the 21st Century Cures Act established a requirement for all states to use an Electronic Visit Verification (EVV) system for Medicaid-funded Personal Care Services (PCS). Currently, the Department of Social Services (DSS) and Department of Mental Health and Addiction Services (DMHAS) utilize a State Mandated External Vendor model for the collection of PCS visit data. All PCS providers are required to submit visit data to the system designed by the State's external EVV vendor (i.e., Sandata Technologies). DSS and DMHAS will be transitioning from a State Mandated External Vendor model to an Open Vendor EVV model with an aggregator solution for PCS. The Open Vendor EVV model will allow providers the opportunity to use either the State's existing external EVV vendor system (i.e., Sandata Agency Management) or their own third-party ("Alternate EVV") system to capture visit data. Changes to accept all PCS visit data from either the State's existing EVV system or an Alternate EVV system are targeted for implementation in May 2024. Additional information, including vendor specifications and upcoming Town Halls, can be found on the www.ctdssmap.com Web site by selecting Information > Publications and performing a search on PB24-22 Open Vendor Electronic Visit Verification (EVV) Model Implementation for Personal Care Services (PCS) - Technical Specification and Town Hall Registration. |
| 04/19/2024-04/26/2024 | Attention: Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Service Providers and Home Health Providers | Attention: Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Service Providers and Home Health Providers. Important Electronic Visit Verification (EVV) Update - Transition from Sandata Mobile to Sandata Mobile Connect (SMC) effective September 3, 2024. The purpose of this communication is to notify Personal Care Services (PCS) and Home Health Care Services (HHCS) providers that Sandata Technologies has released a new mobile application (i.e., SMC) with enhanced features for capturing visit data. All providers must be using the "NEW SMC 2.0" application by September 3, 2024, as the previous application (i.e., Sandata Mobile) will no longer be available for usage. The "NEW SMC 2.0" application is available to download through the Apple and Google app stores as of April 1, 2024. Also, Sandata Mobile is no longer being updated for technical improvements. Existing users may still utilize Sandata Mobile on their phones until 8:00 a.m. EST on September 3, 2024, at which time the application will be removed, and users will be prompted to download "NEW SMC 2.0" application. Please refer to the recommended steps to be taken for this transition provided in the Important Message posted 4/16/24. |
| 04/19/2024-04/26/2024 | Attention All Providers | Attention All Providers: PROVIDER FILE MAINTENANCE: In order to maintain the accuracy and completeness of the Connecticut Medical Assistance Program (CMAP) network, we are requesting all providers update their provider file on a regular basis. The information that you provide is presented in the on-line provider directory at www.ct.gov/husky. Thousands of members statewide rely on the accuracy of this source of information to find a suitable health care provider. Inaccurate addresses, phone numbers, and names may affect a member's ability to contact you. To update your provider profile, the main account administrator can log into their secure Web account from the www.ctdssmap.com Web site and click on the "Demographic Maintenance" tab. Once on the Demographic Maintenance page, the provider can select from options listed as links below the Demographic Maintenance header panel. For instance, you can update your address* if you happen to move to a new location; all you have to do is click on the "Location Name Address" link, select the address to be updated, click on the "Maintain Address" button to type in the new address and then save your changes. You can also add or remove performing providers to your group practice as applicable by clicking on "Maintain Organization Members". For detailed instructions, please refer to Section 10.18 "Provider Demographic Maintenance" in Chapter 10 of the Provider Manual. The chapter is available from the Web site www.ctdssmap.com by clicking on "Publications" under Information, scrolling down to Provider Manuals and then clicking on "Web Portal/AVRS". Providers may contact the Provider Assistance Center at 1-800-842-8440 between the hours of 8:00 AM to 5:00 PM Monday through Friday if further assistance is needed in updating the information from their secure Web portal account. *There are special instructions for PCMH providers and licensed facilities such as hospitals, pharmacies, and clinic providers for updating their service location or alternate service location addresses. Please refer to the warning messages on the Web pages, as well as Chapter 10 for additional information. |
| 04/19/2024-04/26/2024 | | ATTENTION HOME HEALTH PROVIDERS: Post and Pay Status for Explanation of Benefit (EOB) Code 3328. As a follow-up to the Important Message posted on 4/5/2024, the Department of Social Services (DSS) is notifying providers of an issue that has been reported concerning claim denials for Electronic Visit Verification (EVV) mandated home health services with dates of service (DOS) 4/1/2024 and forward. Effective 4/10/2024 EOB code 3328 "Confirmed Visit Units are Exceeded" has been set to post and pay for Waiver Home Health Claims. Gainwell Technologies advises ALL providers to rebill denied claims with EOB 3328. Please note, the guidance in the Important Message posted on 4/5/2024 regarding EOBs 3327, 3331, and 3332 remains unchanged at this time. Gainwell and DSS are actively researching the cause of this issue and apologize for any inconvenience. Impacted providers are asked to monitor the Connecticut Medical Assistance Program (CMAP) Web site for further communication on this issue and resolution as well as when to expect the above mentioned edits to be reactivated. |
| 04/19/2024-04/26/2024 | | ATTENTION SELECT PROVIDERS: Place Of Service 55 Requirement: Based on reviewing your most current remittance advice, your organization still needs to make claim billing changes to utilize place of service (POS) 55. Claims with date of service on or after April 1, 2024 that are billed without POS 55 will deny with Explanation of Benefit (EOB) code 4821 "Facility Type is Restricted for Procedure Under Provider Contract". Please see bulletin PB24-09 Place of Service (POS) Requirements for Substance Use Disorder (SUD) Treatment for further details. NOTE: POS can also be referred to as facility type code (FTC). |
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