MedicaidAdministrativeMedium impact
CMAP COVID-19 Response – Temp Changes to Claims for Coagulation Factor RX pdf
Connecticut Medicaid (HUSKY Health)·CT · Hematology·Pharmacy
Effective date
Apr 4, 2020
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has temporarily suspended paper claim submissions for coagulation factor drugs (Factor VII, VIII, IX, X, and XIII) due to COVID-19, requiring all claims to be submitted electronically via Point of Sale using NCPDP version D.0 format. Reimbursement will use a custom rate based on the provider's actual acquisition costs from Q1 2020 plus 8% markup.
Action Required
Immediately: Pharmacy providers in Connecticut must stop submitting paper claims for Factor VII, VIII, IX, X, and XIII drugs. Submit all coagulation factor drug claims electronically via Point of Sale using NCPDP version D.0 format. Update billing systems to handle custom reimbursement rates based on Q1 2020 actual acquisition costs. Note special billing units: anti-hemophilic factors (except Hemlibra) bill each unit as EACH, while Hemlibra bills each milliliter as EACH.