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Attention SUD Residential Providers: ACTION REQUIRED SUD Residential Certification Letter Upload Instructions (Posted 5/10/24)
Attention Behavioral Health Clinics: Reminder: Provider Bulletin 2024-11 Revised Deadline: Performing Providers Required for Behavioral Health Clinic Providers (Posted 5/7/24)
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)
Attention Outpatient Hospitals: CMAP Addendum B Updated (April 1, 2024) (Posted 4/23/24)
Attention Inpatient Hospital Providers: DRG Grouper Update (Posted 4/23/24)
Attention All Providers: Data Loss: Faxed Medical Prior Authorizations (Posted 4/16/24)
Hospital Monthly Important Message (Posted 4/15/24)
Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Service Providers and Home Health Providers: Important Electronic Visit Verification (EVV) Update - Transition from Sandata Mobile to Sandata Mobile Connect (SMC) effective September 3, 2024 (Posted 4/15/24)
Attention Home Health Providers: Post and Pay Status for Explanation of Benefit (EOB) Code 3328 (Posted 4/10/24)
Attention Home Health Providers: Claim Denials for Electronic Visit Verification (EVV) Mandated Home Health Services (Posted 4/5/24)
Attention Connecticut Home Care (CHC), Personal Care Assistant (PCA), Acquired Brain Injury (ABI), Autism and Mental Health (MH) Waiver Service Providers: Alternate Electronic Visit Verification (EVV) - Personal Care Services (PCS) Town Hall Session #2 and #3 Dates & Registration Links (Posted 3/28/2024)
Electronic Data InterChange (EDI) Transaction and Trading Partner Updates (Posted 3/7/24)
Attention Providers and Trading Partners: Optum Change Healthcare (CHC) network service interruption (Posted 2/22/24)
ATTENTION Obstetrics & Gynecology and Family Practice Physicians and APRNs, Women's Health APRNs and Certified Nurse Midwives: Register for the HUSKY Maternity Bundle Provider Forum (Posted 2/12/24)
Attention Home Health Providers: Electronic Visit Verification (EVV) Updates as of February 9, 2024
Attention All Board-Certified Behavioral Analysts (BCBAs) and Autism Specialty Groups: BCBA Licensure Requirement for Enrollment in Connecticut Medical Assistance Program (Posted 1/31/24)
Attention All Providers: Revised CT Medical Assistance Program (CMAP) Telehealth Table - Updated the end date to 2024 (Posted 12/27/23)
Attention All Providers: CMAP Telehealth Services (Posted 11/27/23)
Attention Acquired Brain Injury, Connecticut Home Care Program, and Personal Care Services/Assistant (PCA) Providers: Prior Authorization Issue (Posted 11/22/23)
Attention Behavorial Health Clinics: UPDATE Performing Providers Required for Behavioral Health Clinic Claim Submission (Posting 9/22/23)
Procedures for Updating Client Third Party Liability Information NEW HMS Phone Number: 1-866-252-0671 (Posted 6/7/23)
HUSKY Health Primary Care Payment Program Extension Notification
Click here for Archived Messages
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RA Banner Announcements |
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| Banner Effective Date | Providers | Banner Page Announcement |
| 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 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 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 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: 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. |
| 05/10/2024-05/17/2024 | Attention All Providers | Attention All Providers. HOLIDAY CLOSURE: Please be advised, the Department of Social Services (DSS) and Gainwell Technologies will be closed on Monday, May 27, 2024 in observance of the Memorial Day holiday. Both the DSS and Gainwell Technologies offices will re-open on Tuesday, May 28, 2024. |
| 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 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 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. |
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