MedicaidPrior AuthHigh impact
Release of Claims Held in Suspense Due to no Care Plan or Service Authorization
Connecticut Medicaid (HUSKY Health)·CT · Physical Therapy, Occupational Therapy·Prior Authorization
Effective date
Nov 18, 2016
We identified it
Jun 20, 2026
Summary
Connecticut is ending the suspension of home care and waiver service claims that were previously held due to missing care plans or service authorizations. Starting November 18, 2016, these claims will be denied instead of suspended, requiring providers to ensure proper care plans and authorizations are in place before submitting claims.
Action Required
Before November 18, 2016: Home health agencies and waiver service providers must contact their ABI clients' Case Management Agency Care Managers to ensure all services (including those at or below standard benefit) are added to client care plans. Update internal processes to verify care plan authorization before claim submission. Claims without proper care plans or service authorizations will be denied with EOB codes 3015 or 3016.