MedicaidAdministrativeMedium impact
Electronic Claim Submission with Paper Attachment Process pdf
Connecticut Medicaid (HUSKY Health)·CT · OB-GYN·Coding
Effective date
Jun 1, 2017
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid now allows electronic claim submission with paper attachments for claims requiring manual pricing and sterilization/hysterectomy procedures. Providers must use specific 837 transaction segments and submit attachments with a required ACN Electronic Claim Cover Sheet via fax or mail.
Action Required
Immediately: Connecticut providers billing Medicaid must update their 837 electronic claim submission process to include PWK segments (PWK01=OZ, PWK02=FX/BM, PWK05=AC, PWK06=11-digit ACN) for claims requiring manual pricing or sterilization/hysterectomy procedures. Download the ACN Electronic Claim Cover Sheet from ctdssmap.com and use it when faxing attachments to (860) 986-7995 or mailing to DXC Technology. Submit attachments within 30 days (90 days for sterilization/hysterectomy) to avoid claim denials.