MedicaidPrior AuthHigh impact
Hospital Monthly Important Message
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Apr 1, 2017
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY Health) updated multiple billing policies including changes to genetic testing prior authorization (effective April 1, 2017), updates to Medically Unlikely Edit (MUE) unit limits for several procedure codes, and system fixes for inpatient rehab claims and outpatient surgical procedures that will now be manually priced.
Action Required
By April 1, 2017: Update prior authorization processes for genetic testing services to use McKesson's InterQual Molecular Diagnostics Criteria instead of CHNCT policies. Immediately: Re-submit claims for procedure codes 90376 (up to 20 units), 86665 (up to 2 units), J7185 (up to 4000 units), 85397 (up to 3 units), and 76825 (up to 3 units) that were denied for MUE units exceeded. Monitor hospital Medicaid re-enrollment due dates and complete re-enrollment 6 months prior to avoid claim processing disruptions. Submit outpatient claims for previously inpatient-only procedures for manual pricing with EOB code 6000.