MedicaidReimbursementHigh impact
Hospital Monthly Important Message (Updated 9/14/16)
Connecticut Medicaid (HUSKY Health)·CT · Dentistry, Psychiatry·Provider Bulletin
Effective date
Sep 1, 2016
We identified it
Jun 20, 2026
Summary
This comprehensive hospital policy bulletin includes multiple updates: a 2% reduction in children's dental fee schedule rates effective September 1, 2016, new Autism Spectrum Disorder services requiring prior authorization from Beacon Health Options for members under 21, and various system fixes for claim processing issues including inpatient admissions and Medicare HMO crossover claims.
Action Required
Immediately: Hospital billing teams must implement 2% rate reduction for children's dental services (excluding services from PB 2016-45). For ASD services effective July 1, 2016: obtain prior authorization from Beacon Health Options for all Autism Spectrum Disorder services for members under 21, bill with applicable HCPC/CPT and RCC 919 combination, and use rate type 'OMH' for reimbursement calculation. Review CMAP Addendum B for inpatient-only procedures marked with status indicator 'C' and submit justifications for outpatient eligibility to ctxixhosppay@hpe.com. Re-submit previously denied claims for inpatient admissions following outpatient/ED services as system fixes are now implemented.