MedicaidPrior AuthHigh impact
Inpatient delivery stays denying due to lack of prior authorization when the delivery stays do not require prior authorization
Connecticut Medicaid (HUSKY Health)·CT · OB-GYN·Prior Authorization
Effective date
Apr 1, 2016
We identified it
Jun 20, 2026
Summary
Medicaid has updated their system to exempt additional ICD-10 diagnosis codes from prior authorization requirements for inpatient delivery stays. Multiple diagnosis codes were added on 3/30/2016 and 4/1/2016 that will automatically bypass prior authorization when used as the primary diagnosis for delivery-related inpatient stays.
Action Required
Immediately: Billing team must update system settings to recognize that the listed ICD-10 diagnosis codes automatically bypass prior authorization requirements when used as primary diagnosis for inpatient delivery stays. Stop requesting prior authorization for delivery stays with these primary diagnosis codes. Review any previously denied claims with these codes and resubmit without prior authorization.