MedicaidAdministrativeMedium impact
Outpatient Crossover Claim Pricing Changes pdf
Connecticut Medicaid (HUSKY Health)·CT · Radiology, Physical Therapy·Coding
Effective date
Dec 1, 2021
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is changing how outpatient crossover claims are priced effective December 1, 2021. Claims will now be priced using Medicare information submitted at the detail level, and providers can submit copay information using claim adjustment reason code 3.
Action Required
Future requirement (timeline TBD): Billing team must update claim submission process to include Medicare information at the claim detail level using ASC X12N 837I format as outlined in Chapter 11 of the Provider Manual. Update systems to support copay submission using claim adjustment reason code 3 for outpatient crossover claims. Failure to submit Medicare detail information will result in claim denials once implemented.