MedicaidAdministrativeMedium impact
Pharmacy Claim Rejections pdf
Connecticut Medicaid (HUSKY Health)·CT·Pharmacy
Effective date
Aug 1, 2018
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY Health) has updated guidance for handling pharmacy claim rejections, including quantity limits, diagnosis code requirements, and prior authorization overrides. Pharmacists can now resubmit claims immediately with specific override codes to ensure patients receive medications without delays.
Action Required
Immediately: Pharmacy staff must implement claim resubmission procedures for Connecticut Medicaid rejections. For quantity limit rejections, resubmit with 30-day supply amounts. For diagnosis code requirements, contact prescribers to obtain appropriate ICD-10 codes before resubmission. For prior authorization needs, use override codes (all 9's in PA field, value '1' in PA type field) for one-time 14-day supplies (7-day for opioids). Call 1-866-409-8386 for emergency 5-day supplies when needed.