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DDSS Important Message - ASD Provider Enrollment vs. Carelon Qualification - Roles and Requirements
Connecticut Medicaid (HUSKY Health)·CT · Psychiatry·Provider Bulletin
We identified it
Jul 11, 2026
Summary
This is a clarification bulletin for ASD providers enrolling in HUSKY Health (Connecticut Medicaid) that distinguishes roles: DSS/Gainwell handle enrollment and claims processing (4-8 weeks), while Carelon BH CT only qualifies providers on clinical credentials. Providers must submit specific qualification documents to Carelon before enrollment and understand that Carelon cannot expedite processing or resolve enrollment status issues. Out-of-state providers must reside within 45 minutes of the Connecticut border, and telehealth is limited to specific procedure codes with in-person parent training required.
Action Required
REQUIREMENTS:
- Immediately: Billing team must update internal workflows and provider communications to clarify that Carelon BH CT handles ONLY qualification (credential review), not enrollment status. Direct all enrollment, claims processing, and status inquiries to DSS/Gainwell, not Carelon.
- Before next ASD provider enrollment: Providers submitting new or re-enrollment applications must understand that Carelon qualification approval is a prerequisite; obtain Carelon approval BEFORE submitting enrollment application to Gainwell to avoid processing delays.
- Update provider intake packets to require submission of all qualification documents to Carelon first (DCF Release form with SSN/DOB, letter of intent, resume/CV with ASD experience years, university diploma, current license/BCBA certificate, two sample behavior support plans with functional assessments, and $500K professional liability insurance if applicable).
- For re-enrolling providers: Verify current active license, current BACB certification (if BCBA), and new DCF background check form are submitted before re-enrollment application.
- Billing team must verify provider's correct participation type selection (Individual Practitioner vs. Employed/Contracted Group/Clinic/Outpatient Hospital) during application planning, as applications cannot be saved mid-completion.
- For out-of-state ASD providers: Confirm home residence is within 45 minutes commutable distance of Connecticut state line (not office location) for border provider consideration; update credentialing files with residence verification.
- For telehealth-capable providers: Update billing system and clinical protocols to restrict ASD telehealth to only procedures listed in CMAP Telehealth Table; ensure parent training is billed/scheduled as in-person only. Non-compliance will result in claim denials.
- Providers must monitor enrollment status via www.ctdssmap.com using ATN and Last Name/Business Name after application submission; plan for 4-8 week processing timeline.