MedicaidAdministrativeHigh impact
Hospital interChange Provider Issues Updated
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Jul 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut DSS is implementing a new Ambulatory Payment Classification (APC) system for hospital outpatient services effective July 1, 2016, moving from revenue center code-based payments to a prospective payment system based on service complexity. Hospitals must enroll practitioner groups in CMAP to bill for outpatient professional services separately from the OPPS system.
Action Required
By July 1, 2016: Hospital billing teams must create and enroll practitioner groups in Connecticut Medical Assistance Program (CMAP) to bill for outpatient professional services. Update billing systems to use new APC methodology instead of revenue center codes. For partial behavioral health program days, submit appropriate Revenue Center Code with HCPC and modifier 52. Ensure performing providers are enrolled in CMAP under individual provider participation or as employed/contracted by organization.