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Inpatient Delivery Stays and Prior Authorization Reminder pdf
Connecticut Medicaid (HUSKY Health)·CT · OB-GYN·Prior Authorization
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has clarified which diagnosis codes bypass prior authorization requirements for inpatient delivery stays. Claims with non-approved primary diagnosis codes will be denied with EOB code 3004, requiring hospitals to use specific delivery-related diagnosis codes or obtain prior authorization.
Action Required
Immediately: Billing team must verify all inpatient delivery claims use approved primary diagnosis codes from the DSS list to bypass prior authorization. Update billing system edits to flag claims with denied diagnosis codes (D58.2, D64.9, N36.1, Z34.03, etc.) for prior auth or code review. Train coders to use childbirth-specific codes instead of trimester codes when delivery occurs. Claims with non-approved codes will deny with EOB 3004.