MedicaidAdministrativeMedium impact
Diagnostic Related Group Review Process pdf
Connecticut Medicaid (HUSKY Health)·CT · General Surgery, Orthopedics, Cardiology +1 more·Provider Bulletin
Effective date
Sep 1, 2021
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has streamlined their DRG review process for inpatient hospital claims, replacing the recoupment and rebill process with direct repricing in MMIS. Hospitals must respond to HMS medical record requests within 30 days or face full claim recoupment.
Action Required
Immediately: Billing teams at Connecticut hospitals must register for HMS Provider Portal at HMSPortal.HMS.com and check monthly for medical record requests. Respond to all HMS record requests within 30 calendar days via portal, sFTP, mail, or fax to avoid full claim recoupment. Monitor findings letters and submit reconsideration requests within 30 days if disputing findings. Claims recouped before June 2021 must be rebilled with corrected DRG coding.