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- 2021 PI (formerly EHR) Important Messages Archived

Message Effective Date	Title
08/25/2021-12/31/2021	Announcement: The Deadline to Submit PY 2021 Attestations is August 31, 2021! (Posted 8/25/21)
06/02/2021-12/31/2021	Important Dates for Program Year 2021 (Posted 6/2/21)
01/26/2021-12/31/2021	Deadlines for Program Year 2020 and 2021 (posted 1/26/21)

+ 2020 PI (formerly EHR) Important Messages Archived

+ 2019 PI (formerly EHR) Important Messages Archived

+ 2018 PI (formerly EHR) Important Messages Archived

+ 2017 PI (formerly EHR) Important Messages Archived

+ 2016 PI (formerly EHR) Important Messages Archived

+ 2015 PI (formerly EHR) Important Messages Archived

+ 2014 PI (formerly EHR) Important Messages Archived

+ 2013 PI (formerly EHR) Important Messages Archived

Telehealth Important Messages Search Results

No matching Telehealth Important Messages were found.

- 2024 Important Messages Archived

Message Effective Date	Title
07/19/2024-07/26/2024	Attention All Providers: CALL CENTER SERVICE INTERRUPTION RESOLVED (Posted 7/19/24)
07/09/2024-07/12/2024	Attention All Providers: Provider Electronic Funds (EFT) Delay (Posted 7/9/24)
06/17/2024-07/14/2024	Hospital Monthly Important Message (Posted 6/17/24)
05/24/2024-07/15/2024	Attention Home Health Providers: Explanation of Benefit (EOB) 3332 Claim Denials for Electronic Visit Verification (EVV) Mandated Home Health Services (Posted 5/24/24)
05/20/2024-06/16/2024	Hospital Monthly Important Message (Posted 5/20/24)
05/16/2024-07/01/2024	Attention Home Health Providers: Electronic Visit Verification (EVV) Updates - as of May 16, 2024
05/10/2024-07/01/2024	Attention SUD Residential Providers: ACTION REQUIRED SUD Residential Certification Letter Upload Instructions (Posted 5/10/24)
04/26/2024-07/01/2024	Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers: Important Updates (Posted 4/26/24)
04/23/2024-07/23/2024	Attention Outpatient Hospitals: CMAP Addendum B Updated (April 1, 2024) (Posted 4/23/24)
04/23/2024-07/23/2024	Attention Inpatient Hospital Providers: DRG Grouper Update (Posted 4/23/24)
04/16/2024-06/15/2024	Attention All Providers: Data Loss: Faxed Medical Prior Authorizations (Posted 4/16/24)
04/15/2024-07/01/2024	Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Service Providers and Home Health Providers: Important Electronic Visit Verification (EVV) Update - Transition from Sandata Mobile to Sandata Mobile Connect (SMC) effective September 3, 2024 (Posted 4/15/24)
04/15/2024-05/19/2024	Hospital Monthly Important Message (Posted 4/15/24)
04/10/2024-06/01/2024	Attention Home Health Providers: Post and Pay Status for Explanation of Benefit (EOB) Code 3328 (Posted 4/10/24)
04/05/2024-06/01/2024	Attention Home Health Providers: Claim Denials for Electronic Visit Verification (EVV) Mandated Home Health Services (Posted 4/5/24)
03/28/2024-05/15/2024	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)
03/22/2024-05/01/2024	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)
03/22/2024-05/01/2024	Attention Home Health Providers: Important Electronic Visit Verification (EVV) Reminders - as of March 22, 2024
03/18/2024-04/14/2024	Hospital Monthly Important Message (Posted 3/18/24)
03/07/2024-06/30/2024	Electronic Data InterChange (EDI) Transaction and Trading Partner Updates (Posted 3/7/24)
02/29/2024-04/01/2024	Attention Dental Providers: UPDATED Service Interruption (Posted 2/29/24)
02/23/2024-04/01/2024	Attention Pharmacy Providers: Options for Pharmacies Affected by Optum Change Healthcare (CHC) Network Service Interruption (Posted 2/23/24)
02/22/2024-07/23/2024	Attention Providers and Trading Partners: Optum Change Healthcare (CHC) network service interruption (Posted 2/22/24)
02/21/2024-02/21/2024	Attention Providers and Trading Partners: Telephony Network Service Interruption (Posted 2/22/24)
02/16/2024-03/17/2024	Hospital Monthly Important Message (Posted 2/16/24)
02/09/2024-07/23/2024	Attention Home Health Providers: Electronic Visit Verification (EVV) Updates as of February 9, 2024
01/23/2024-04/22/2024	Attention Outpatient Hospitals: CMAP Addendum B Updated (January 1, 2024) (Posted 1/23/24)
01/19/2024-05/01/2024	Attention All Providers: 2023 1099s Available on CMAP Web Site (Posted 1/19/24)
01/18/2024-03/01/2024	Attention Home Health Providers: Electronic Visit Verification (EVV) Updates - as of January 18, 2024 (Posted 1/18/24)
01/12/2024-02/15/2024	Hospital Monthly Important Message (Posted 1/12/24)
01/11/2024-04/01/2024	Attention Home Health Providers: Home Health Authorizations: Upcoming Change (Posted 1/11/24)
01/09/2024-02/28/2024	Attention Home Health Providers: Electronic Visit Verification (EVV) Updates - as of January 9, 2024 (Posted 1/9/24)
01/05/2024-01/31/2024	Attention All Providers: Medicare Part A Crossover Claims (Posted 1/5/24)

+ 2023 Important Messages Archived

+ 2022 Important Messages Archived

+ 2021 Important Messages Archived

+ 2020 Important Messages Archived

+ 2019 Important Messages Archived

+ 2018 Important Messages Archived

+ 2017 Important Messages Archived

+ 2016 Important Messages Archived

+ 2015 Important Messages Archived

+ 2014 Important Messages Archived

+ 2013 Important Messages Archived

- 2024 RA Banner Announcements Archived

Banner Effective Date	Providers	Banner Page Announcement
07/19/2024-07/26/2024	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.
07/19/2024-07/26/2024	Attention Select Providers	Attention Select Providers. PCMH REPROCESS: Providers enrolled in the Person-Centered Medical Home Initiative (PCMH) were enrolled with retroactive effective dates or were approved for changes in PCMH level or site address with retroactive effective dates. Claims which processed prior to the completion of the provider's PCMH enrollment or level/site address change were not paid with the PCMH differential payment rate and have now been reprocessed to include that amount. For any providers with retroactive site terminations, claims which processed with the PCMH differential payment rate have now been reprocessed without that amount. The impacted claims have been identified and reprocessed and will appear on your July 24, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 55.
07/19/2024-07/26/2024	Attention Behavioral Health and Enhanced Care Clinic Providers	Attention Behavioral Health and Enhanced Care Clinic Providers. Claims denials effective June 1: Effective for dates of service June 1, 2024, and forward, the Department of Social Services (DSS) has implemented new system changes requiring all performing providers employed by or contracting with a Behavioral Health and Enhanced Care Clinic rendering services to HUSKY Health members (HUSKY A, B, C and D) to be enrolled in the Connecticut Medical Assistance Program (CMAP) and to be associated to that clinic for the claim date of service. If the performing provider is not already actively enrolled in CMAP, providers may use Gainwell Technologies Provider Enrollment Wizard located at www.ctdssmap.com to enroll. Please refer to bulletin 24-11 for more enrollment details. For organization members that are already enrolled, behavioral health and enhanced clinics will be required to review the members of their organization and associate them with the Clinic's organization. Please refer to bulletin 24-11 for more information on attaching clinicians to your organization. Claim Submission Requirements: Effective with dates of service June 1, 2024 and forward, claims will no longer post and pay; instead, they will deny if a valid enrolled performing provider's NPI is not included on the claim. Clinic claims that do not include a valid performing provider's NPI number, or the performing provider NPI is not associated to the billing provider number, will receive claim denials with the following Explanation of Benefit (EOB) codes: * 0231 - Performing Provider is Missing EOB code * 1007 - The Performing Provider is Not on File * 1008 - Performing Provider Must Have an Individual Number * 1010 - Performing Provider is Not a Member of the Billing Provider Group * 1011 - Performing Provider Number Not a Valid Format Performing provider. * 1051 - Performing Provider Not On File. For further information please read bulletin PB24-11
07/19/2024-07/26/2024	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 4, 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 4, 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 4, 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 following link to the Sandata Zendesk: https://sandata.zendesk.com/hc/en-us/articles/26853349240851-Sandata-Mobile-App-Going-Away-September-4-2024.
07/19/2024-07/26/2024	Attention Behavioral Health Clinician Groups And Clinicians	Attention Behavioral Health Clinician Groups And Clinicians. REMINDER OF BEHAVIORAL HEALTH ATTESTATION REQUIREMENT: DSS requires all Behavioral Health groups and clinicians 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 originally 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.
07/19/2024-07/26/2024	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 were implemented on May 8, 2024. Additional information, including vendor specifications, presentations and recordings for all three Town Hall sessions Frequently Asked Questions (FAQ) Document and Alternate EVV Provider Registration Form can be found on the www.ctdssmap.com Web site Home Page under Important Messages by selecting the Electronic Visit Verification (EVV) Updates - as of May 31, 2024 link.
07/05/2024-07/12/2024	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 were implemented on May 8, 2024. Additional information, including vendor specifications, presentations and recordings for all three Town Hall sessions Frequently Asked Questions (FAQ) Document and Alternate EVV Provider Registration Form can be found on the www.ctdssmap.com Web site Home Page under Important Messages by selecting the Electronic Visit Verification (EVV) Updates - as of May 31, 2024 link.
07/05/2024-07/12/2024	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.
07/05/2024-07/12/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially processed and paid under a temporary client ID as described in Provider Bulletin 2014-29. The impacted claims were reprocessed to reflect the client's true (permanent) 9-digit Connecticut Medical Assistance Program (CMAP) ID. The claims which processed under a temporary client ID will be recouped and appear on the July 10, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52 and Explanation of Benefits (EOB) code 8239 "ACA CLIENT TEMP ID REPLACED WITH CMAP ID. NEW CLAIM WILL BE SYSTEMATICALLY GENERATED". New claims will also appear on the July 10, 2024 RA with an ICN beginning with region code 27.
07/05/2024-07/12/2024	Attention Behavioral Health Clinician Groups and Clinicians	Attention Behavioral Health Clinician Groups and Clinicians. REMINDER OF BEHAVIORAL HEALTH ATTESTATION REQUIREMENT: DSS requires all Behavioral Health groups and clinicians 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 originally 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.
07/05/2024-07/12/2024	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 4, 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 4, 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 4, 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 following link to the Sandata Zendesk: https://sandata.zendesk.com/hc/en-us/articles/26853349240851-Sandata-Mobile-App-Going-Away-September-4-2024.
06/20/2024-06/27/2024	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 4, 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 4, 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 4, 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 following link to the Sandata Zendesk: https://sandata.zendesk.com/hc/en-us/articles/26853349240851-Sandata-Mobile-App-Going-Away-September-4-2024.
06/20/2024-06/27/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Primary Care Providers enrolled in the Person-Centered Medical Home Initiative (PCMH) were enrolled with retroactive effective dates or end dated from the PCMH program. Claims which processed prior to the completion of the provider's PCMH enrollment were not paid with the PCMH differential payment rate and have now been reprocessed to include that amount. For those providers retroactively end dated, claims were paid with the PCMH differential payment rate that have now been reprocessed without that amount. The impacted claims have been identified and reprocessed and will appear on your June 26, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 55.
06/20/2024-06/27/2024	Attention Home Health Agencies and Occupational Therapists	Attention Home Health Agencies and Occupational Therapists. New evidenced - based service models are being added to Medicaid-funded home and community-based services (HCBS) Acquired Brain Injury (ABI) l & ll, Autism, Connecticut Home care Program for Elders (CHCPE) and Personal Care Assistant (PCA) Waiver programs. Service opportunities to support these models include: 1) Training and Counseling Services for Unpaid Caregivers Supporting Participants, a.k.a. Care of Older People in their Environment (COPE) and 2) Confident Caregiver. Participant Training and Engagement to Support Goal Attainment and Independence, a.k.a. Community Aging in Place-Advancing Better Living for Elders (CAPABLE). The billing provider for both models will be Home Health Agencies, enrolled in the Connecticut Medical Assistance Program, with an opportunity to employ Occupational Therapists or contract with Occupational Therapist Groups or Individual Occupational Therapists. A provider bulletin will be forthcoming detailing more information. Please continue to monitor the Connecticut Medical Assistance Program (CMAP) Web site at www.ctdssmap.com for more information. Questions concerning COPE/Confident Caregiver and/or CAPABLE can be directed to the following email address: DSSCOPECAPABLEAttestation@ct.gov.
06/20/2024-06/27/2024	Attention Primary Care Providers	Attention Primary Care Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims for providers who were retroactively approved for the HUSKY Health Primary Care Increased Payments policy. The reprocessed claims will appear on your June 26, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 27 or 52.
06/20/2024-06/27/2024	Attention All Providers	Attention All Providers. HOLIDAY CLOSURE: Please be advised, the Department of Social Services (DSS) and Gainwell Technologies will be closed on Thursday, July 4, 2024 in observance of the Independence Day holiday. Both the DSS and Gainwell Technologies offices will re-open on Friday, July 5, 2024.
06/20/2024-06/27/2024	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.comWeb 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.comby 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.
06/20/2024-06/27/2024	Attention Behavioral Health Clinician Groups and Clinicians	Attention Behavioral Health Clinician Groups and Clinicians. REMINDER OF BEHAVIORAL HEALTH ATTESTATION REQUIREMENT: DSS requires all Behavioral Health Groups and Clinicians 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 originally 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.
06/20/2024-06/27/2024	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 were implemented on May 8, 2024. Additional information, including vendor specifications, presentations and recordings for all three Town Hall sessions Frequently Asked Questions (FAQ) Document and Alternate EVV Provider Registration Form can be found on the www.ctdssmap.com Web site Home Page under Important Messages by selecting the Electronic Visit Verification (EVV) Updates as of May 31, 2024 link.
06/20/2024-06/27/2024	Attention Behavioral Health and Enhanced Care Clinic Providers	Attention Behavioral Health and Enhanced Care Clinic Providers. Claims denials effective June 1: Effective for dates of service June 1st, 2024, and forward, the Department of Social Services (DSS) is implementing new system changes requiring all performing providers employed by or contracting with a Behavioral Health and Enhanced Care Clinic rendering services to HUSKY Health members (HUSKY A, B, C and D) to be enrolled in the Connecticut Medical Assistance Program (CMAP) and to be associated to that clinic for the claim date of service. If the performing provider is not already actively enrolled in CMAP, providers may use Gainwell Technologies Provider Enrollment Wizard located at www.ctdssmap.com to enroll. Please refer to provider bulletin 24-11 for more enrollment details. For organization members that are already enrolled, Behavioral Health and Enhanced Care Clinics will be required to review the members of their organization and associate them with the Clinic's organization. Please refer to provider bulletin 24-11 for more information on attaching clinicians to your organization. Claim Submission Requirements: Effective with dates of service June 1st, 2024 and forward, claims will no longer post and pay; instead, they will deny if a valid enrolled performing provider's NPI is not included on the claim. Clinic claims that do not include a valid performing provider's NPI number, or the performing provider NPI is not associated to the billing provider number, will receive claim denials with the following Explanation of Benefit (EOB) codes: 0231 Performing Provider is Missing EOB code 1007 The Performing Provider is Not on File 1008 Performing Provider Must Have an Individual Number 1010 Performing Provider is Not a Member of the Billing Provider Group 1011 Performing Provider Number Not a Valid Format Performing provider. For further information please read provider bulletin PB24-11
06/07/2024-06/14/2024	Attention Behavioral Health and Enhanced Care Clinic Providers	Attention Behavioral Health and Enhanced Care Clinic Providers. Claims denials effective June 1: Effective for dates of service June 1st, 2024, and forward, the Department of Social Services (DSS) is implementing new system changes requiring all performing providers employed by or contracting with a Behavioral Health and Enhanced Care Clinic rendering services to HUSKY Health members (HUSKY A, B, C and D) to be enrolled in the Connecticut Medical Assistance Program (CMAP) and to be associated to that clinic for the claim date of service. If the performing provider is not already actively enrolled in CMAP, providers may use Gainwell Technologies Provider Enrollment Wizard located at www.ctdssmap.com to enroll. Please refer to bulletin 24-11 for more enrollment details. For organization members that are already enrolled, behavioral health and enhanced clinics will be required to review the members of their organization and associate them with the Clinic's organization. Please refer to bulletin 24-11 for more information on attaching clinicians to your organization. Claim Submission Requirements: Effective with dates of service June 1st, 2024 and forward, claims will no longer post and pay; instead, they will deny if a valid enrolled performing provider's NPI is not included on the claim. Clinic claims that do not include a valid performing provider's NPI number, or the performing provider NPI is not associated to the billing provider number, will receive claim denials with the following Explanation of Benefit (EOB) codes: * 0231 - Performing Provider is Missing EOB code * 1007 - The Performing Provider is Not on File * 1008 - Performing Provider Must Have an Individual Number * 1010 - Performing Provider is Not a Member of the Billing Provider Group * 1011 - Performing Provider Number Not a Valid Format Performing provider. For further information please read bulletin PB24-11.
06/07/2024-06/14/2024	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 were implemented on May 8, 2024. Additional information, including vendor specifications, presentations and recordings for all three Town Hall sessions Frequently Asked Questions (FAQ) Document and Alternate EVV Provider Registration Form can be found on the www.ctdssmap.com Web site Home Page under Important Messages by selecting the Electronic Visit Verification (EVV) Updates - as of May 31, 2024 link.
06/07/2024-06/14/2024	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 4, 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 4, 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 4, 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 following link to the Sandata Zendesk: https://sandata.zendesk.com/hc/en-us/articles/26853349240851-Sandata-Mobile-App-Going-Away-September-4-2024.
06/07/2024-06/14/2024	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.comWeb 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.comby 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.
06/07/2024-06/14/2024	Attention Pharmacy Providers	Attention Pharmacy Providers. REPROCESSED: Gainwell Technologies has identified and reprocessed claims which initially paid and posted one of the following informational Ordering, Prescribing, Referring (OPR) Explanation of Benefit (EOB) codes, but for which the provider in question has since successfully enrolled in the Connecticut Medical Assistance Program (CMAP): * EOB Code 0237-PRESCRIBING PROVIDER IS A STUDENT OR RESIDENT AND MUST BE ENROLLED TO PRESCRIBE * EOB Code 0027-CLAIM BYPASSED EDIT 0207 DUE TO PPE AUTO-PA * EOB Code 0207-PRESCRIBER NOT ENROLLED * EOB Code 0028-PRESCRIBING PROVIDER IN PROCESS OF ENROLLING * EOB Code 1040-ORDERING/REFERRING/ATTENDING PROVIDER IS NOT ENROLLED ON DATE OF SERVICE These claims will appear on the June 12, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52.
06/07/2024-06/14/2024	Attention Home Health Providers	Attention Home Health Providers. Claim Denials for EOB 3332: An issue with the unit calculation has been identified where certain complex care skilled nursing procedure codes, when billed with the TG modifier ("Complex Visit:), are incorrectly being cut back to a unit of one (1). Gainwell Technologies has applied a fix to resolve the impacted claim denials with dates of service May 24, 2024 and forward. Gainwell will be a systematically reprocessing claims for dates of service May 24, 2024 and forward in the June 6, 2024 claims cycle and will appear on your June 12, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52. Now that the issue has been fixed, the EOBs will continue to "post and pay" up to the number of units available for the visit. Please note: Although the above mentioned EOB is currently set to "post and pay", if a provider is submitting claims with multiple units on the same day for the same client and there is not a confirmed visit to support all of the submitted units, the claim will cut back to the available visit units and post EOB 0047 ("Confirmed Visit Units are Exceeded") or EOB 3332. Such a result is based on the order of claims validation interChange Provider Important Message processing within the Medicaid Management Information System (MMIS), i.e., claims system.
06/07/2024-06/14/2024	Attention SUD Residential Providers	Attention SUD Residential Providers. ASAM CERTIFICATION: Please take action if you plan to continue to provide American Society of Addiction Medicine (ASAM) services noted below to prevent claim denials! Letters were sent indicating your new certification dates from Advanced Behavioral Health (ABH) the week of May 13, 2024. Most providers current certifications end 5/31/2024 or 6/1/2024 with three providers having later dates. Upon receiving your written notice of certification, providers must enter the appropriate certification(s) to the provider's secure Web Portal Demographic Maintenance panel and upload your letter. This must be completed on or before your current certification end date in order to prevent claim payment denials. An important message was recently published with the steps on how to complete this requirement. ASAM 3.1 = H2034 Treatment Component/H0047 HF Room and Board ASAM 3.3 = H2036 HI Treatment Component/H0047 HI Room and Board ASAM 3.5 = H2036 Treatment Component/H0047 Room and Board ASAM 3.5 PPW = H2036 HD Treatment Component/H0047 HD Room and Board ASAM 3.7 R= H2036 HV Treatment Component/H0047 HV Room and Board ASAM 3.7 RE= H2036 HE Treatment Component/H0047 HE Room and Board ASAM 3.2 WM= H0010 Treatment Component/H0047 HG Room and Board ASAM 3.7 WM= H0011 Treatment Component/H0047 HW Room and Board
06/07/2024-06/14/2024	Attention Behavioral Health Clinician Groups And Clinicians	Attention Behavioral Health Clinician Groups And Clinicians. REMINDER OF BEHAVIORAL HEALTH ATTESTATION REQUIREMENT: DSS requires all Behavioral Health groups and clinicians 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 originally 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.
06/07/2024-06/14/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially processed and paid under a temporary client ID as described in Provider Bulletin 2014-29. The impacted claims were reprocessed to reflect the client's true (permanent) 9-digit Connecticut Medical Assistance Program (CMAP) ID. The claims which processed under a temporary client ID will be recouped and appear on the June 12, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52 and Explanation of Benefits (EOB) code 8239 "ACA CLIENT TEMP ID REPLACED WITH CMAP ID. NEW CLAIM WILL BE SYSTEMATICALLY GENERATED". New claims will also appear on the June 12, 2024 RA with an ICN beginning with region code 27.
05/24/2024-05/31/2024	Attention Behavioral Health and Enhanced Care Clinic Providers	Attention Behavioral Health and Enhanced Care Clinic Providers. Claims denials effective June 1: Effective for dates of service June 1st, 2024, and forward, the Department of Social Services (DSS) is implementing new system changes requiring all performing providers employed by or contracting with a Behavioral Health and Enhanced Care Clinic rendering services to HUSKY Health members (HUSKY A, B, C and D) to be enrolled in the Connecticut Medical Assistance Program (CMAP) and to be associated to that clinic for the claim date of service. If the performing provider is not already actively enrolled in CMAP, providers may use Gainwell Technologies Provider Enrollment Wizard located at www.ctdssmap.com to enroll. Please refer to bulletin 24-11 for more enrollment details. For organization members that are already enrolled, behavioral health and enhanced clinics will be required to review the members of their organization and associate them with the Clinic's organization. Please refer to bulletin 24-11 for more information on attaching clinicians to your organization. Claim Submission Requirements: Effective with dates of service June 1st, 2024 and forward, claims will no longer post and pay; instead, they will deny if a valid enrolled performing provider's NPI is not included on the claim. Clinic claims that do not include a valid performing provider's NPI number, or the performing provider NPI is not associated to the billing provider number, will receive claim denials with the following Explanation of Benefit (EOB) codes: 0231 - Performing Provider is Missing EOB code 1007 - The Performing Provider is Not on File 1008 - Performing Provider Must Have an Individual Number 1010 - Performing Provider is Not a Member of the Billing Provider Group *1011 - Performing Provider Number Not a Valid Format Performing provider. For further information please read bulletin PB24-11
05/24/2024-05/31/2024	Attention Select Providers	Attention Select Providers. Recoupment of Interim Payment: DSS has been monitoring claim levels for all providers that received an interim payment due to the Change Healthcare Cyber Attack and have determined that you are back to normal payment levels based on your claim cycle payments in April and May. Your interim payment recoupment will appear under the account receivable section on your May 29, 2024 Remittance Advice (RA) with reason code 8409 "Provider Interim Payment".
05/24/2024-05/31/2024	Attention Behavioral Health Groups and Clinicians	Attention Behavioral Health Groups and Clinicians. REMINDER: BEHAVIORAL HEALTH ATTESTATION REQUIREMENT FOR BEHAVIORAL HEALTH GROUPS AND CLINICIANS. REMINDER OF BEHAVIORAL HEALTH ATTESTATION REQUIREMENT: DSS requires all Behavioral Health groups and clinicians 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 originally 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.
05/24/2024-05/30/2024	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.
05/24/2024-05/31/2024	Attention Select Providers	Attention Select Providers. REPROCESSED: Primary Care Providers enrolled in the Person-Centered Medical Home Initiative (PCMH) were enrolled with retroactive effective dates or end dated from the PCMH program. Claims which processed prior to the completion of the provider's PCMH enrollment were not paid with the PCMH differential payment rate and have now been reprocessed to include that amount. For those providers retroactively end dated, claims were paid with the PCMH differential payment rate that have now been reprocessed without that amount. The impacted claims have been identified and reprocessed and will appear on your May 29, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 55.
05/24/2024-05/30/2024	Attention All 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 4, 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 4, 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 4, 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 following link to the Sandata Zendesk: https://sandata.zendesk.com/hc/en-us/articles/26853349240851-Sandata-Mobile-App-Going-Away-September-4-2024.
05/24/2024-05/31/2024	Attention Home Health Providers	Attention Home Health Providers. Claim Denials for EOB 3332: An issue with the unit calculation has been identified where certain complex care skilled nursing procedure codes, when billed with the TG modifier ("Complex Visit"), are incorrectly being cut back to a unit of one (1). Gainwell Technologies has applied a fix to resolve the impacted claim denials with dates of service prior to May 25, 2024. Gainwell will be a systematically reprocessing claims for dates of service prior to May 25, 2024 in the May 24, 2024 claims cycle and will appear on your May 29, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52. Now that the issue has been fixed, the EOBs will continue to "post and pay" up to the number of units available for the visit. Please note: Although the above mentioned EOB is currently set to "post and pay", if a provider is submitting claims with multiple units on the same day for the same client and there is not a confirmed visit to support all of the submitted units, the claim will cut back to the available visit units and post EOB 0047 ("Confirmed Visit Units are Exceeded") or EOB 3332. Such a result is based on the order of claims validation interChange Provider Important Message processing within the Medicaid Management Information System (MMIS), i.e., claims system.
05/24/2024-05/31/2024	Attention Home Health	Attention Home Health. Important updates on the new COPE/Confident Caregiver and CAPABLE services. Providers should review the Important Message "Update on the New Services COPE and CAPABLE!" posted May 20, 2024 on the www.ctdssmap.com Web site Home Page to Home Health Agencies,: 1. Increases in the COPE/Confident Caregiver and CAPABLE OT and RN rates. 2. American Rescue Plan (ARP) 9817-funded training (time-limited opportunity) through June 2025. 3. Upcoming Provider Forums. To learn more on these evidence-based services and the provider enrollment process, register to attend one of the COPE/Confident Caregiver and/or CAPABLE forums offered from May 29, 2024 to June 10, 2024.
05/24/2024-05/31/2024	Attention SUD Residential Providers	Attention SUD Residential Providers. ASAM CERTIFICATION: Please take action if you plan to continue to provide American Society of Addiction Medicine (ASAM) services noted below to prevent claim denials! Please watch for a letter indicating your new certification dates from Advanced Behavioral Health (ABH) the week of May 13, 2024. Most providers current certifications end 5/31/2024 or 6/1/2024 with three providers having later dates. Upon receiving your written notice of certification, provider so must enter the appropriate certification(s) to the provider's secure Web Portal Demographic Maintenance panel and upload your letter. This must be completed on or before your current certification end date in order to prevent claim payment denials. An important message was recently published with the steps on how to complete this requirement. ASAM 3.1 = H2034 Treatment Component/H0047 HF Room and Board ASAM 3.3 = H2036 HI Treatment Component/H0047 HI Room and Board ASAM 3.5 = H2036 Treatment Component/H0047 Room and Board ASAM 3.5 PPW = H2036 HD Treatment Component/H0047 HD Room and Board ASAM 3.7 R= H2036 HV Treatment Component/H0047 HV Room and Board ASAM 3.7 RE= H2036 HE Treatment Component/H0047 HE Room and Board ASAM 3.2 WM= H0010 Treatment Component/H0047 HG Room and Board ASAM 3.7 WM= H0011 Treatment Component/H0047 HW Room and Board
05/24/2024-05/31/2024	Attention Department of Developmental Services (DDS) Billing Providers	Attention Department of Developmental Services (DDS) Billing Providers. REPROCESSED THIS CYCLE: The Department of Social Services has asked Gainwell Technologies to identify and reprocess claims this cycle which failed to set a duplicate audit against previously paid claims, resulting in select claims paying twice. These claims will reprocess in the May 24, 2024 claims cycle and will appear on your May 29, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52.
05/24/2024-05/30/2024	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.
05/10/2024-05/17/2024	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.
05/10/2024-05/17/2024	Attention Select Behavioral Health and Enhanced Care Clinic Providers	Attention Select Behavioral Health and Enhanced Care Clinic Providers. EOB 1007 Performing Provider not on file: A small sample of your production claims were recently reviewed. Two Scenarios were identified: Scenario 1 Some of your organization's claims need to be submitted with a performing provider NPI that is enrolled with the Connecticut Medical Assistance Program (CMAP) and that is associated to the billing provider group for the date of service on the claim. These claims will post Explanation of Benefits (EOB) code 1007 "DETAIL RENDERING (PERFORMING) PROVIDER NUMBER IS NOT ON FILE". For claim details with dates of service 6/1/2024 forward, claim details will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates. Scenario 2 Some of your organization's claims are being submitted with the billing provider NPI in the performing provider field and your claims are posting Explanation of Benefits (EOB) code 1008 "PERFORMING PROVIDER MUST HAVE AN INDIVIDUAL NUMBER". This EOB can be identified by downloading a copy of your PDF remittance advice. For claim details with dates of service 6/1/2024 forward, claims posting EOB 1008 will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates.
05/10/2024-05/17/2024	Attention Select Behavioral Health and Enhanced Care Clinic Providers	Attention Select Behavioral Health and Enhanced Care Clinic Providers. EOB 1008 PERFORMING PROVIDER MUST HAVE AN INDIVIDUAL NUMBER: In a recent sampling of production claims that were reviewed for your organization, the following findings were discovered. Your organization is currently submitting the billing provider NPI in the performing provider field and your claims are posting Explanation of Benefits (EOB) code 1008: "PERFORMING PROVIDER MUST HAVE AN INDIVDUAL NUMBER" Claims posting this EOB can be identified by downloading a copy of your PDF remittance advice. Please update claim details by submitting the enrolled performing provider's National Provider Identifier (NPI) in the performing provider field on the claim. Beginning 6/1/2024, claim details without a performing provider will deny and post EOB 1008. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health and Enhanced Care Clinic Providers and make the necessary updates.
05/10/2024-05/17/2024	Attention SELECT Behavioral Health Providers	Attention SELECT Behavioral Health Providers. BEHAVIORAL HEALTH ATTESTATION REQUIREMENT FOR BEHAVIORAL HEALTH CLINICIAN GROUPS AND CLINICIANS: As previously communicated, the Department of Social Services (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 6, 2023. Providers have been given a full year in order to provide sufficient time for your organization to comply. Non-compliance letters will be sent starting August 1, 2024 in a phased approach to notify providers that their claims will be begin to deny. 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.
05/10/2024-05/17/2024	Attention All Providers	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 updated 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 CO-INSURANCE OR COPAY BILLED, COPAY ONLY IF OUTPT XOVR SUBMITTED AT DETAIL
05/10/2024-05/17/2024		ATTENTION SELECT PROVIDERS. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially processed and paid under a temporary client ID as described in Provider Bulletin 2014-29. The claims were reprocessed to reflect the client's true (permanent) 9-digit Connecticut Medical Assistance Program (CMAP) ID. The claims which processed under a temporary client ID will be recouped and appear on the May 14, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52 and Explanation of Benefits (EOB) code 8239 "ACA CLIENT TEMP ID REPLACED WITH CMAP ID. NEW CLAIM WILL BE SYSTEMATICALLY GENERATED". New claims will also appear on the May 14, 2024 RA with an ICN beginning with region code 27.
05/10/2024-05/17/2024	Attention SELECT Behavioral Health and Enhanced Care Clinic PROVIDERS	Attention SELECT Behavioral Health and Enhanced Care Clinic PROVIDERS. EOB 1010 Performer not associated to Billing Provider Group: In reviewing a small sample of your production claims, claim details are being submitted with a performing provider NPI. However, the performing provider NPI on the claim is not associated to the billing provider group for the date of service on the claim. Claims posting Explanation of Benefits (EOB) code 1010 "PERFORMING PROVIDER IS NOT A MEMBER OF THE BILLING PROVIDER GROUP" will deny for dates of service 6/1/2024 and forward. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health and Enhanced Clinic Providers and make the necessary updates.
05/10/2024-05/17/2024		ATTENTION SUD RESIDENTIAL PROVIDERS, ASAM CERTIFICATION: Please take action if you plan to continue to provide American Society of Addiction Medicine (ASAM) services noted below to prevent claim denials! Please watch for a letter indicating your new certification dates from Advanced Behavioral Health (ABH) the week of May 13, 2024. Most providers current certifications end 5/31/2024 or 6/1/2024 with three providers having later dates. Upon receiving your written notice of certification, providers must enter the appropriate certification(s) to the provider's secure Web Portal Demographic Maintenance panel and upload your letter. This must be completed on or before your current certification end date in order to prevent claim payment denials. An important message was recently published with the steps on how to complete this requirement. ASAM 3.1 = H2034 Treatment Component/H0047 HF Room and Board ASAM 3.3 = H2036 HI Treatment Component/H0047 HI Room and Board ASAM 3.5 = H2036 Treatment Component/H0047 Room and Board ASAM 3.5 PPW = H2036 HD Treatment Component/H0047 HD Room and Board ASAM 3.7 R= H2036 HV Treatment Component/H0047 HV Room and Board ASAM 3.7 RE= H2036 HE Treatment Component/H0047 HE Room and Board ASAM 3.2 WM= H0010 Treatment Component/H0047 HG Room and Board ASAM 3.7 WM= H0011 Treatment Component/H0047 HW Room and Board
05/10/2024-05/17/2024	Attention Select Behavioral Health and Enhanced Care Clinic Providers	Attention Select Behavioral Health and Enhanced Care Clinic Providers. EOB 1010 Performing not in Group and EOB 1008 Billing in performing: A small sample of your production claims were reviewed. Two Scenarios were identified: Scenario 1 Some of your organization's claims are being submitted with a performing provider NPI. However, the performing provider on the claim is not associated to the billing provider group for the date of service on the claim. With dates of service 6/1/2024, these claim details will post Explanation of Benefits (EOB) code 1010 "PERFORMING PROVIDER IS NOT A MEMBER OF THE BILLING PROVIDER GROUP" and will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health and Enhanced Care Clinic Providers and make the necessary updates. Scenario 2 Some of your organization's claims are being submitted with the billing provider NPI in the performing provider field and your claims are posting Explanation of Benefits (EOB) code 1008 "PERFORMING PROVIDER MUST HAVE AN INDIVIDUAL NUMBER". This EOB can be identified by downloading a copy of your PDF remittance advice. For claim details with dates of service 6/1/2024 forward, claims posting EOB 1008 will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health and Enhanced Care Clinic Providers and make the necessary updates.
05/10/2024-05/17/2024	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 4, 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 4, 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 4, 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 following link to the Sandata Zendesk: https://sandata.zendesk.com/hc/en-us/articles/26853349240851-Sandata-Mobile-App-Going-Away-September-4-2024.
05/10/2024-05/17/2024	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: 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 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 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 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).
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: 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.
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. EOB 1008 BILLING IN PERFORMING BANNER. A very small sample of your production claims were reviewed. Your organization is currently submitting the billing provider in the performing provider field and your claims are posting EOB 1008. Performing Provider Must Have an Individual Number. Please update claim details by submitting the performing provider who saw the client. Beginning 6/1/2024, claim details without a performing provider will deny and post EOB 1008 will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates.
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. EOB 231 Mix No performing submitted and EOB 1008 Billing in performing banner. A very small sample of your production claims were reviewed. Two Scenarios were identified: Scenario 1 Some of your organization's claims need to be submitted with the performing provider on each detail of your claim. This is required to prevent upcoming claim denials. Beginning 6/1/2024, claim details without a performing provider will deny and post EOB 231 Performing Provider is Missing. Scenario 2 Some of your organization's claims are being submitted with the billing provider in the performing provider field and your claims are posting EOB 1008 Performing Provider Must Have an Individual Number. This can be seen by downloading a copy of your PDF remittance advice. For claim details with dates of service 6/1/2024 forward, claims posting EOB 1008 will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates.
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. EOB 231 NOT SUBMITTING PERFORMING BANNER. A very small sample of your production claims were reviewed. Your organization needs to submit the performing provider on each detail of your claim. This is required to prevent upcoming claim denials. Beginning 6/1/2024, claim details without a performing provider will deny and post EOB 231 Performing Provider is Missing. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary claim submission updates.
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. Mix EOB 1007 Performing Provider not on file and EOB 1008 Billing in performing banner. A very small sample of your production claims were reviewed. Two Scenarios were identified: Scenario 1 When a performing provider is required on the claim, the performing provider must be enrolled with the Connecticut Medical Assistance Program (CMAP), AND be associated with the billing provider group, for dates of service on the claim. Some of your organization's claims are being submitted with a performing provider that is not enrolled in CMAP. These claims will post EOB 1007 Detail rendering (performing) provider identification number is not on file. For claim details with dates of service 6/1/2024 forward, claim details will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates. Scenario 2 Some of your organization's claims are being submitted with the billing provider in the performing provider field and your claims are posting EOB 1008 Performing Provider Must Have an Individual Number. This can be seen by downloading a copy of your PDF remittance advice. For claim details with dates of service 6/1/2024 forward, claims posting EOB 1008 will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates.
04/05/2024-04/12/2024	Attention Home Health Providers	Attention Home Health Providers. All home health providers are reminded that they should now be utilizing Electronic Visit Verification (EVV) to capture Home Health Care Services (HHCS) visit data in accordance with the federal mandate in the 21st Century Cures Act. Effective for dates of service March 22, 2024, through March 31, 2024, providers will see an explanation of benefit (EOB) code post to claims but still pay when a confirmed visit cannot be found or when units are exceeded. Effective for dates of service April 1, 2024, and forward, providers will receive claim denials when a confirmed visit cannot be found or when units are exceeded. Please note that as of April 1, 2024, the following medication administration procedure codes will not be subject to EVV claim editing: T1502, T1503, and H0033. Providers must continue to use EVV to capture visit data for these services. Providers utilizing Sandata Agency Management will be issued step-by-step instructions on how to enter visits for medication administration services that are less than 8 minutes. Claim edit enforcement dates for medication administration procedure codes will be communicated in a future Important Message.
04/05/2024-04/12/2024	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.
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. 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.
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. PERFORMING PROVIDERS REQUIRED FOR BEHAVIORAL HEALTH CLINIC CLAIMS: Effective with dates of service 6/1/2024, DSS will require all claims to be submitted with an enrolled performing provider's National Provider Identifier (NPI). Currently, claims are not denied for the omission of the performing provider's NPI on Behavioral Health Clinic claims. Please refer to Provider Bulletin 2023-44 issued on June 5, 2023 for full policy. DSS has extended the time to allow providers to enroll performing providers for a full year providing sufficient time for your organization to comply. Claims will begin to deny for claims with dates of service 6/1/2024 forward. You are receiving this banner message as your organization still needs to enroll performing providers. To avoid any service interruption please complete requirement.
04/05/2024-04/12/2024	Attention Home Health, Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers	Attention Home Health, Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers. Providers are reminded that Sandata released a new SMC mobile application with enhanced features. All providers must be using the "NEW SMC 2.0" version by June 15, 2024, as the previous application will no longer be supported after June 30, 2024. Please use the following Sandata on Demand (SoD) link to download the SMC 2.0 application as well as review articles (e.g., Introduction, Language Support, Offline Mode) and screenshots of the different application screens (e.g., Visits Screen, Clients Screen, Settings Screen): https://sandata.zendesk.com/hc/en-us/sections/18037326015635- Sandata-Mobile-Connect-SMC-Version-2. Providers are also encouraged to review the SMC 2.0 application video library at the following SoD link: https://sandata.zendesk.com/hc/en-us/articles/21560498569491-- Sandata-Mobile-Connect-2-0-Video-Library.
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. Mix EOB 1010 Performing not in Group and EOB 1008 Billing in performing banner. A very small sample of your production claims were reviewed. Two Scenarios were identified: Scenario 1 Some of your organization's claims are being submitted with a performing provider. However, the performing provider on the claim is not associated to the billing provider group for the date of service on the claim. With dates of service 6/1/2024, these claim details will post EOB 1010 Performing Provider is Not a Member of the Billing Provider Group and will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates. Scenario 2 Some of your organization's claims are being submitted with the billing provider in the performing provider field and your claims are posting EOB 1008 Performing Provider Must Have an Individual Number. This can be seen by downloading a copy of your PDF remittance advice. For claim details with dates of service 6/1/2024 forward, claims posting EOB 1008 will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates.
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. EOB 1010 Banner Performer not associated to Billing Provider Group Banner. In reviewing a very small sample of claims, your claim details are being submitted with a performing provider. However, the performing provider on the claim is not associated to the billing provider group for the date of service on the claim. These claims will post EOB 1010 Performing Provider is Not a Member of the Billing Provider Group for claim details with dates of service 6/1/2024 forward and the claim details will deny. Please review PB24-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers and make the necessary updates.
04/05/2024-04/12/2024	Attention Select Providers	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 before 4/1/2024. 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).
04/05/2024-04/12/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially processed and paid under a temporary client ID as described in Provider Bulletin 2014-29. The claims were reprocessed to reflect the client's true (permanent) 9-digit Connecticut Medical Assistance Program (CMAP) ID. The claims which processed under a temporary client ID will be recouped and appear on the April 10, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52 and Explanation of Benefits (EOB) code 8239 "ACA CLIENT TEMP ID REPLACED WITH CMAP ID. NEW CLAIM WILL BE SYSTEMATICALLY GENERATED". New claims will also appear on the April 10, 2024 RA with an ICN beginning with region code 27.
03/22/2024-03/29/2024	Attention Home Health Providers	Attention Home Health Providers. All home health providers are reminded that they should now be utilizing Electronic Visit Verification (EVV) to capture Home Health Care Services (HHCS) visit data in accordance with the federal mandate in the 21st Century Cures Act. Effective for dates of service March 22, 2024, through March 31, 2024, providers will see an explanation of benefit (EOB) code post to claims but still pay when a confirmed visit cannot be found or when units are exceeded. Effective for dates of service April 1, 2024, and forward, providers will receive claim denials when a confirmed visit cannot be found or when units are exceeded. Please note that as of April 1, 2024, the following medication administration procedure codes will not be subject to EVV claim editing: T1502, T1503, and H0033. Providers must continue to use EVV to capture visit data for these services. Providers utilizing Sandata Agency Management will be issued step-by-step instructions on how to enter visits for medication administration services that are less than 8 minutes. Claim edit enforcement dates for medication administration procedure codes will be communicated in a future Important Message.
03/22/2024-03/29/2024	Attention Performing Providers Required for Behavioral Health Clinic Claims	Attention Performing Providers Required for Behavioral Health Clinic Claims. DSS will require all claims to be submitted with an enrolled performing provider's National Provider Identifier (NPI). Currently, claims are not denied for the omission of the performing provider's NPI on Behavioral Health Clinic claims. Please refer to Provider Bulletin 2023-44 issued on June 5, 2023 for full policy. DSS has extended the time to allow providers to enroll performing providers for a full year providing sufficient time for your organization to comply. Claims will begin to deny for claims with dates of service 6/1/2024 forward. You are receiving this banner message as your organization still needs to enroll performing providers. Your ID indicates claim activity in 2024. To avoid any service interruption please complete requirement.
03/22/2024-03/29/2024	Attention All Providers	Attention All Providers. HOLIDAY CLOSURE: Please be advised, the Department of Social Services (DSS) and Gainwell Technologies will be closed on Friday, March 29, 2024 in observance of the Good Friday holiday. Both the DSS and Gainwell Technologies offices will re-open on Monday, April 1, 2024.
03/22/2024-03/29/2024	Attention Select Providers	Attention Select Providers. Place Of Service 55 Requirement: Based on reviewing your most current remittance advice, your organization still needs to make a claims billing changes to utilize place of service (POS) 55 before 4/1/2024. 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).
03/22/2024-03/29/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed Professional and Professional Crossover claims that incorrectly paid at the Default (DEF) rate instead of the Facility (FTD) rate for procedure code 99152, when billed with a facility place of service of 19,21,22,23,24,25,31 or 32. The reprocessed claims will appear on the March 27, 2024 Remittance Advice (RA) with an ICN beginning with region code 52.
03/22/2024-03/29/2024	Attention Home Health, Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers	Attention Home Health, Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers. Providers are reminded that Sandata released a new SMC mobile application with enhanced features. All providers must be using the "NEW SMC 2.0" version by June 15, 2024, as the previous application will no longer be supported after June 30, 2024. Please use the following Sandata on Demand (SoD) link to download the SMC 2.0 application as well as review articles (e.g., Introduction, Language Support, Offline Mode) and screenshots of the different application screens (e.g., Visits Screen, Clients Screen, Settings Screen): https://sandata.zendesk.com/hc/en-us/sections/18037326015635- Sandata-Mobile-Connect-SMC-Version-2. Providers are also encouraged to review the SMC 2.0 application video library at the following SoD link: https://sandata.zendesk.com/hc/en-us/articles/21560498569491-- Sandata-Mobile-Connect-2-0-Video-Library.
03/22/2024-03/29/2024	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.comWeb 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.comby 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.
03/22/2024-03/29/2024	Attention Select Providers	Attention Select Providers. PCMH REPROCESS: Providers enrolled in the Person-Centered Medical Home Initiative (PCMH) were enrolled with retroactive effective dates or were approved for changes in PCMH level or site address with retroactive effective dates. Claims which processed prior to the completion of the provider's PCMH enrollment or level/site address change were not paid with the PCMH differential payment rate and have now been reprocessed to include that amount. For any providers with retroactive site terminations, claims which processed with the PCMH differential payment rate have now been reprocessed without that amount. The impacted claims have been identified and reprocessed and will appear on your March 27, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 55.
03/22/2024-03/29/2024	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.
03/22/2024-03/29/2024	Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism Waiver Service and Support and Planning Coach Providers	Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism Waiver Service and Support and Planning Coach Providers. Credentialing Update - New Fiscal Intermediary (FI) GT Independence. Providers working on credentialing through Allied Community Resources should continue to do so until March 24, 2024. Autism Waiver Service providers previously credentialed by the Department of Social Services (DSS) Community Options unit, will transition to GT Independence when renewing their credentials prior to their next reenrollment period. More information on credentialing, including an updated credentialing process will be coming soon. The current credentialing process will continue, until more information is made available.
03/22/2024-03/29/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Primary Care Providers enrolled in the Person-Centered Medical Home Initiative (PCMH) were enrolled with retroactive effective dates or end dated from the PCMH program. Claims which processed prior to the completion of the provider's PCMH enrollment were not paid with the PCMH differential payment rate and have now been reprocessed to include that amount. For those providers retroactively end dated, claims were paid with the PCMH differential payment rate that have now been reprocessed without that amount. The impacted claims have been identified and reprocessed and will appear on your March 27, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 55.
03/22/2024-03/29/2024	Attention Primary Care Providers	Attention Primary Care Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims for providers who were retroactively approved for the HUSKY Health Primary Care Increased Payments policy. The reprocessed claims will appear on your March 27, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 27 or 52.
03/08/2024-03/15/2024	Attention Pharmacy Providers	Attention Pharmacy Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially paid and posted one of the following informational Ordering, Prescribing, Referring (OPR) Explanation of Benefit (EOB) codes, but for which the provider in question has since successfully enrolled in the Connecticut Medical Assistance Program (CMAP): EOB Code 0237-PRESCRIBING PROVIDER IS A STUDENT OR RESIDENT AND MUST BE ENROLLED TO PRESCRIBE EOB Code 0027-CLAIM BYPASSED EDIT 0207 DUE TO PPE AUTO-PA EOB Code 0207-PRESCRIBER NOT ENROLLED EOB Code 0028-PRESCRIBING PROVIDER IN PROCESS OF ENROLLING EOB Code 1040-ORDERING/REFERRING/ATTENDING PROVIDER IS NOT ENROLLED ON DATE OF SERVICE These claims will appear on the March 13, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52.
03/08/2024-03/15/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially processed under the COVID benefit plan as described in Provider Bulletin 2020-42. The claims were reprocessed to reflect the client's retroactive benefit plan change to one of the HUSKY benefit plans. The reprocessed claims will appear on the March 13, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52.
03/08/2024-03/15/2024	Attention Select Providers	Attention Select Providers. PERFORMING PROVIDERS REQUIRED FOR BEHAVIORAL HEALTH CLINIC CLAIMS: DSS will require all claims to be submitted with an enrolled performing provider's National Provider Identifier (NPI). Currently, claims are not denied for the omission of the performing provider's NPI on Behavioral Health Clinic claims. Please refer to Provider Bulletin 2023-44 issued on June 5, 2023 for full policy. DSS has extended the time to allow providers to enroll performing providers for a full year providing sufficient time for your organization to comply. Claims will begin to deny for claims with dates of service 6/1/2024 forward. You are receiving this banner message as your organization still needs to enroll performing providers. Your ID indicates claim activity in 2024. To avoid any service interruption please complete requirement.
03/08/2024-03/15/2024	Attention Select Providers	Attention Select Providers. PERFORMING PROVIDERS REQUIRED FOR BEHAVIORAL HEALTH CLINIC CLAIMS: DSS will require all claims to be submitted with an enrolled performing provider's National Provider Identifier (NPI). Currently, claims are not denied for the omission of the performing provider's NPI on Behavioral Health Clinic claims. Please refer to Provider Bulletin 2023-44 issued on June 5, 2023 for full policy. DSS has extended the time to allow providers to enroll performing providers for a full year providing sufficient time for your organization to comply. Claims will begin to deny for claims with dates of service 6/1/2024 forward. You are receiving this banner message as your organization still needs to enroll performing providers.
03/08/2024-03/15/2024	Attention Select Providers	Attention Select Providers. Place Of Service 55 Requirement: Based on reviewing your most current remittance advice, your organization still needs to make a claims billing changes to utilize place of service (POS) 55 before 4/1/2024. 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).
03/08/2024-03/15/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially processed and paid under a temporary client ID as described in Provider Bulletin 2014-29. The claims were reprocessed to reflect the client's true (permanent) 9-digit Connecticut Medical Assistance Program (CMAP) ID. The claims which processed under a temporary client ID will be recouped and appear on the March 13, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52 and Explanation of Benefits (EOB) code 8239 "ACA CLIENT TEMP ID REPLACED WITH CMAP ID. NEW CLAIM WILL BE SYSTEMATICALLY GENERATED". New claims will also appear on the March 13, 2024 RA with an ICN beginning with region code 27.
03/08/2024-03/15/2024	Attention Home Health Providers	Attention Home Health Providers. Home health providers must prioritize onboarding and submission of Electronic Visit Verification (EVV) production data for all Home Health Care Services (HHCS) either via the State's EVV system (i.e., Sandata Agency Management) or an Alternate EVV solution. Moreover, home health claims without a confirmed visit will result in a payment denial for dates of service effective April 1, 2024, and forward. Furthermore, the following trainings have been conducted regarding utilization of Sandata Agency Management to capture home health visit data: a DELTA training geared towards home health providers currently using Sandata Agency Management; and a series of training sessions for new Sandata Agency Management users. The recordings are available for review on the Sandata on Demand (SoD) Web site for those who were unable to attend the trainings. To access the recordings and other helpful information on the SoD Web site, please log into your account on Sandata Technologies (sandata.zendesk.com), click Payer Programs, followed by Connecticut (CT DSS, DDS, MHW), and then Connecticut Instructional Videos. The DELTA training recording is available under the Connecticut Home Health Non-Waiver Delta Training Sessions tab. The training recordings for new Sandata Agency Management users are accessible under the Connecticut Home Health Non-Waiver Training Sessions 2023 tab. For providers using the Sandata Agency Management system, training is required to receive the EVV Welcome Kit. As for providers utilizing an Alternate EVV solution, Sandata self-paced online aggregator training must be completed once providers have received their EVV production credentials.
02/23/2024-03/01/2024	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.
02/23/2024-03/01/2024	Attention Select Providers	Attention Select Providers. PERFORMING PROVIDERS REQUIRED FOR BEHAVIORAL HEALTH CLINIC CLAIMS: DSS will require all claims to be submitted with an enrolled performing provider's National Provider Identifier (NPI). Currently, claims are not denied for the omission of the performing provider's NPI on Behavioral Health Clinic claims. Please refer to Provider Bulletin 2023-44 issued on June 5, 2023 for full policy. DSS has extended the time to allow providers to enroll performing providers for a full year providing sufficient time for your organization to comply. Claims will begin to deny for claims with dates of service 6/1/2024 forward. You are receiving this banner message as your organization still needs to enroll performing providers.
02/23/2024-03/01/2024	Attention Home Health Providers	Attention Home Health Providers. Home health providers must prioritize onboarding and submission of Electronic Visit Verification (EVV) production data for all Home Health Care Services (HHCS) either via the State's EVV system (i.e., Sandata Agency Management) or an Alternate EVV solution. Moreover, home health claims without a confirmed visit will result in a payment denial for dates of service effective April 1, 2024, and forward. Furthermore, the following trainings have been conducted regarding utilization of Sandata Agency Management to capture home health visit data: a DELTA training geared towards home health providers currently using Sandata Agency Management; and a series of training sessions for new Sandata Agency Management users. The recordings are available for review on the Sandata on Demand (SoD) Web site for those who were unable to attend the trainings. To access the recordings and other helpful information on the SoD Web site, please log into your account on Sandata Technologies (sandata.zendesk.com), click Payer Programs, followed by Connecticut (CT DSS, DDS, MHW), and then Connecticut Instructional Videos. The DELTA training recording is available under the Connecticut Home Health Non-Waiver Delta Training Sessions tab. The training recordings for new Sandata Agency Management users are accessible under the Connecticut Home Health Non-Waiver Training Sessions 2023 tab. For providers using the Sandata Agency Management system, training is required to receive the EVV Welcome Kit. As for providers utilizing an Alternate EVV solution, Sandata self-paced online aggregator training must be completed once providers have received their EVV production credentials.
02/23/2024-03/01/2024	Attention Select Dental Providers	Attention Select Dental Providers. REPROCESSED THIS CYCLE: DSS and Gainwell Technologies have identified and reprocessed Dental claims with procedure code D2991 that processed between 1/1/2024 and 2/13/2024. These claims have been reprocessed and will appear on the February 27, 2024 Remittance Advice (RA) with an internal control Number (ICN) beginning with region code 50.
02/23/2024-03/01/2024	Attention Outpatient Hospital Providers	Attention Outpatient Hospital Providers. REPROCESSED THIS CYCLE: DSS and Gainwell Technologies have identified and reprocessed Outpatient Hospital claims where the claim set edit 334 because the grouper did not assign a status indicator. The grouper did not assign the status indicator because changes that were required to support assigning the status indicator were not in place at the start of the quarter. These claims have been reprocessed and will appear on the February 27, 2024 Remittance Advice (RA) with an internal control Number (ICN) beginning with region code 52.
02/09/2024-02/16/2024	Attention Home Health Providers	Attention Home Health Providers. Home health providers must prioritize onboarding and submission of Electronic Visit Verification (EVV) production data for all Home Health Care Services (HHCS) either via the State's EVV system (i.e., Sandata Agency Management) or an Alternate EVV solution. Moreover, home health claims without a confirmed visit will result in a payment denial for dates of service effective April 1, 2024, and forward. Furthermore, the following trainings have been conducted regarding utilization of Sandata Agency Management to capture home health visit data: a DELTA training geared towards home health providers currently using Sandata Agency Management; and a series of training sessions for new Sandata Agency Management users. The recordings are available for review on the Sandata on Demand (SoD) Web site for those who were unable to attend the trainings. To access the recordings and other helpful information on the SoD Web site, please log into your account on Sandata Technologies (sandata.zendesk.com), click Payer Programs, followed by Connecticut (CT DSS, DDS, MHW), and then Connecticut Instructional Videos. The DELTA training recording is available under the Connecticut Home Health Non-Waiver Delta Training Sessions tab. The training recordings for new Sandata Agency Management users are accessible under the Connecticut Home Health Non-Waiver Training Sessions 2023 tab. For providers using the Sandata Agency Management system, training is required to receive the EVV Welcome Kit. As for providers utilizing an Alternate EVV solution, Sandata self-paced online aggregator training must be completed once providers have received their EVV production credentials.
02/09/2024-02/16/2024	Attention Outpatient Hospital Providers	Attention Outpatient Hospital Providers. REPROCESSED THIS CYCLE: DSS and Gainwell Technologies have identified and reprocessed Outpatient and Outpatient Crossover claims where the claim header DOS is on or after January 1, 2024, claim contains a new procedure code and the claims processed on or before January 24, 2024, when the updated grouper was implemented. These claims have been reprocessed and will appear on the February 14, 2024, Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 61 or 27.
02/09/2024-02/16/2024	Attention Select Providers	Attention Select Providers. PERFORMING PROVIDERS REQUIRED FOR BEHAVIORAL HEALTH CLINIC CLAIMS: DSS will require all claims to be submitted with an enrolled performing provider's National Provider Identifier (NPI). Currently, claims are not denied for the omission of the performing provider's NPI on Behavioral Health Clinic claims. Please refer to Provider Bulletin 2023-44 issued on June 5, 2023 for full policy. DSS has extended the time to allow providers to enroll performing providers for a full year providing sufficient time for your organization to comply. Claims will begin to deny for claims with dates of service 6/1/2024 forward. You are receiving this banner message as your organization still needs to enroll performing providers.
02/09/2024-02/16/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially processed and paid under a temporary client ID as described in Provider Bulletin 2014-29. The claims were reprocessed to reflect the client's true (permanent) 9-digit Connecticut Medical Assistance Program (CMAP) ID. The claims which processed under a temporary client ID will be recouped and appear on the February 14, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52 and Explanation of Benefits (EOB) code 8239 "ACA CLIENT TEMP ID REPLACED WITH CMAP ID. NEW CLAIM WILL BE SYSTEMATICALLY GENERATED". New claims will also appear on the February 14, 2024 RA with an ICN beginning with region code 27.
02/09/2024-02/16/2024	Attention Select Hospital Providers	Attention Select Hospital Providers. REPROCESSED THIS CYCLE: DSS and Gainwell Technologies have identified and reprocessed Outpatient and Outpatient Crossover APC claims that denied for edit 309 between 10/25/2023 and 1/30/2024. These claims have been reprocessed and will appear on the February 14, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 27.
02/09/2024-02/16/2024	Attention All Providers	Attention All Providers. Provider Satisfaction Survey Reminder: Providers are reminded to participate in the Provider Satisfaction Survey. Providers may access this survey by going to Provider Bulletin PB24-03 and clicking on the link to the survey. The survey will be open through February 16, 2024.
01/19/2024-01/26/2024	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.
01/19/2024-01/26/2024	Attention Select Providers	Attention Select Providers. PERFORMING PROVIDERS REQUIRED FOR BEHAVIORAL HEALTH CLINIC CLAIMS: DSS will require all claims to be submitted with an enrolled performing provider's National Provider Identifier (NPI). Currently, claims are not denied for the omission of the performing provider's NPI on Behavioral Health Clinic claims. Please refer to Provider Bulletin 2023-44 issued on June 5, 2023 for full policy. DSS has extended the time to allow providers to enroll performing providers for a full year to provide sufficient time for your organization to comply. Claims will begin to deny for claims with dates of service 6/1/2024 forward. You are receiving this banner message as your organization still needs to enroll performing providers.
01/19/2024-01/26/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified an issue where select professional and professional crossover claims submitted before December 20, 2023 incorrectly overpaid on procedure code 61650. These claims have been reprocessed and will appear on your January 23, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with a region code 52.
01/19/2024-01/26/2024	Attention Home Health Providers	Attention Home Health Providers. Home health providers must prioritize onboarding and submission of Electronic Visit Verification (EVV) production data for all Home Health Care Services (HHCS) either via the State's EVV system (i.e., Sandata Agency Management) or an Alternate EVV solution. Moreover, home health claims without a confirmed visit will result in a payment denial for dates of service effective February 15, 2024, and forward. Furthermore, the following trainings have been conducted regarding utilization of Sandata Agency Management to capture home health visit data: a DELTA training geared towards home health providers currently using Sandata Agency Management; and a series of training sessions for new Sandata Agency Management users. The recordings are available for review on the Sandata on Demand (SoD) Web site for those who were unable to attend the trainings. To access the recordings and other helpful information on the SoD Web site, please log into your account on Sandata Technologies (sandata.zendesk.com), click Payer Programs, followed by Connecticut (CT DSS, DDS, MHW), and then Connecticut Instructional Videos. The DELTA training recording is available under the Connecticut Home Health Non-Waiver Delta Training Sessions tab. The training recordings for new Sandata Agency Management users are accessible under the Connecticut Home Health Non-Waiver Training Sessions 2023 tab. For providers using the Sandata Agency Management system, training is required to receive the EVV Welcome Kit. As for providers utilizing an Alternate EVV solution, Sandata self-paced online aggregator training must be completed once providers have received their EVV production credentials.
01/19/2024-01/26/2024	Attention All Providers	Attention All Providers. HOLIDAY CLOSURE: Please be advised, the Department of Social Services (DSS') office will be closed on Monday, February 12, 2024, in observance of the Lincoln's Birthday Holiday. The Department of Social Services (DSS) will re-open on Tuesday, February 13, 2024. Both the Department of Social Services (DSS) and Gainwell Technologies' offices will be closed on Monday, February 19, 2024, in observance of President's Day Holiday. The Department of Social Services (DSS) and Gainwell Technologies will re-open on Tuesday, February 20, 2024.
01/05/2024-01/12/2024	Attention Select Providers	Attention Select Providers. REPROCESSED THIS CYCLE: Gainwell Technologies has identified and reprocessed claims which initially processed and paid under a temporary client ID as described in Provider Bulletin 2014-29. The claims were reprocessed to reflect the client's true (permanent) 9-digit Connecticut Medical Assistance Program (CMAP) ID. The claims which processed under a temporary client ID will be recouped and appear on the January 10, 2024 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52 and Explanation of Benefits (EOB) code 8239 "ACA CLIENT TEMP ID REPLACED WITH CMAP ID. NEW CLAIM WILL BE SYSTEMATICALLY GENERATED". New claims will also appear on the January 10, 2024 RA with an ICN beginning with region code 27.
01/05/2024-01/12/2024	Attention Home Health Providers	Attention Home Health Providers. Home health providers must prioritize onboarding and submission of Electronic Visit Verification (EVV) production data for all Home Health Care Services (HHCS) either via the State's EVV system (i.e., Sandata Agency Management) or an Alternate EVV solution. Moreover, home health claims without a confirmed visit will result in a payment denial for dates of service effective February 1, 2024, and forward. Furthermore, the following trainings have been conducted regarding utilization of Sandata Agency Management to capture home health visit data: a DELTA training geared towards home health providers currently using Sandata Agency Management; and a series of training sessions for new Sandata Agency Management users. The recordings are available for review on the Sandata on Demand (SoD) Web site for those who were unable to attend the trainings. To access the recordings and other helpful information on the SoD Web site, please log into your account on Sandata Technologies (sandata.zendesk.com), click Payer Programs, followed by Connecticut (CT DSS, DDS, MHW), and then Connecticut Instructional Videos. The DELTA training recording is available under the Connecticut Home Health Non-Waiver Delta Training Sessions tab. The training recordings for new Sandata Agency Management users are accessible under the Connecticut Home Health Non-Waiver Training Sessions 2023 tab. For providers using the Sandata Agency Management system, training is required to receive the EVV Welcome Kit. As for providers utilizing an Alternate EVV solution, Sandata self-paced online aggregator training must be completed once providers have received their EVV production credentials.

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