When does this change take effect?

This change is effective Jul 1, 2019.

MedicaidAdministrativeHigh impact

Performing Providers Required for Select Federally Qualified Health Centers pdf

Q: Who is affected by this change?

This affects Connecticut Medicaid (HUSKY Health) Family Medicine, Internal Medicine, Pediatrics, Physical Therapy, Occupational Therapy providers in CT on Medicaid plans.

Connecticut Medicaid (HUSKY Health)·CT · Family Medicine, Internal Medicine, Pediatrics +2 more·Provider Bulletin

Effective date

Jul 1, 2019

We identified it

Jun 20, 2026

Days to comply

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Summary

Starting July 1, 2019, Connecticut Medicaid requires all performing providers at FQHCs to be enrolled in CMAP and associated with the FQHC. Claims must include the performing provider's NPI or they will be denied.

Action Required

Action needed

By July 1, 2019: All performing providers (physicians, APRNs, PAs, therapists, etc.) must be enrolled in Connecticut Medical Assistance Program via www.ctdssmap.com and associated with the FQHC. Billing team must ensure all claims include performing provider NPI in 837P NM109 segment. Claims without valid performing provider NPI will be denied with EOB codes 0231, 1007, 1008, 1010, or 1011.

Related policy hubs

Connecticut Medicaid (HUSKY Health) policies CT policy changes Family Medicine Internal Medicine Pediatrics Physical Therapy Occupational Therapy