MedicaidAdministrativeHigh impact
Three (3) Day Rule: Outpatient Stay Prior to Inpatient Admission
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Nov 1, 2015
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is implementing a 3-day rule requiring hospitals to bill outpatient services provided within 3 days of inpatient admission on the inpatient claim instead of separately. The policy begins with a post-and-pay period on November 1, 2015, followed by actual denials starting March 1, 2016.
Action Required
By March 1, 2016: Billing team must update workflows to include all related outpatient services within 3 days prior to inpatient admission on the inpatient claim for Connecticut Medicaid patients. Exceptions: Continue billing maintenance renal dialysis (RCC 82X-85X), therapy services (RCC 42X, 43X, 44X, 47X), and behavioral health services (RCC 905-906, 913-916) separately. For unrelated outpatient services, use Condition Code 51. Monitor EOB codes 5077 and 5078 during post-and-pay period. Failure to comply will result in claim denials after March 1, 2016.