MedicaidAdministrativeMedium impact
2023.16 Provider Bulletin - Expiration of Temporary Effective Period & Claim Submission Requirements for Coagulation Factors pdf
Connecticut Medicaid (HUSKY Health)·CT · Hematology·Coding
Effective date
May 11, 2023
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has permanently adopted electronic submission requirements for coagulation factors (Factor VII, VIII, IX, X, and XIII) that were temporarily implemented during COVID-19. All claims for anti-hemophilic factor drugs must be submitted electronically via Point of Sale using NCPDP D.0 format, with specific billing unit requirements for different factor drugs.
Action Required
By May 11, 2023: Pharmacy billing teams must ensure all coagulation factor claims (Factor VII, VIII, IX, X, XIII) are submitted electronically via Point of Sale using NCPDP D.0 format. Update billing systems to bill units correctly: most anti-hemophilic factors as EACH per unit, Sevenfact as MCG, and Hemlibra as ML billed as EACH. Paper claim submissions will no longer be accepted for these drugs.