State · CT
Medical billing services in Connecticut
Short answer
Medical billing services in Connecticut have one Medicaid payer: HUSKY Health pays every claim fee-for-service through the Department of Social Services and its fiscal agent, while Community Health Network of Connecticut and Carelon Behavioral Health Connecticut authorize care as administrative services organizations without paying claims.
A claim has to reach the fiscal agent within twelve months of the date of service under section 17b-262-529, commercial claims owe interest after 45 days under the prompt pay statute, waiver home care runs through Sandata EVV, and MTM brokers Medicaid rides. A Remitwright dedicated biller works those rules, serving Connecticut practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Connecticut: what's different
The rules below change how a claim is filed and paid in Connecticut. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Connecticut | Source |
|---|---|---|
| Medicaid program | HUSKY Health (Connecticut Medicaid and CHIP)Connecticut Department of Social Services (DSS) | 1 |
| Fee-for-service portal | Connecticut Medical Assistance Program (CMAP) web portal | 1 |
| How Medicaid is delivered | No Medicaid managed care plans | 4 |
| Managed care plans | 2 plansCommunity Health Network of Connecticut (medical ASO, does not pay claims), Carelon Behavioral Health Connecticut (behavioral health ASO, does not pay claims) | 2 |
| Medicaid timely filing (fee-for-service) | 12 months after the date of service | 5 |
| Prompt-pay law | Conn. Gen. Stat. § 38a-816(15), prompt payment of accident and health claims | 6 |
HUSKY Health (Connecticut Medicaid and CHIP)
HUSKY Health (Connecticut Medicaid and CHIP) is run by the Connecticut Department of Social Services (DSS). Fee-for-service claims and provider enrollment go through the Connecticut Medical Assistance Program (CMAP) web portal1, at www.ctdssmap.com. No Medicaid managed care plans: CMS's 2024 managed care enrollment report shows none of Connecticut's 1,085,951 Medicaid enrollees in a managed care plan, because HUSKY Health pays providers fee-for-service through DSS4. Care coordination and prior authorization sit with administrative services organizations under contract to the state, which do not pay claims.
Fee-for-service filing limit: 12 months after the date of service for a claim to reach the DSS fiscal agent, under section 17b-262-529(a) of the Regulations of Connecticut State Agencies5. When eligibility is granted retroactively, the provider has one year from the eligibility determination or award, whichever is later. A claim tied up in the grievance process gets twelve months from a resolution in favor of payment, and when a third party insurer has not answered in a reasonable time the twelve months run from receipt of its explanation of benefits. An out-of-state provider's first contact with the fiscal agent, to enroll or to bill, must also fall within twelve months of the service.
Managed care plans2
- Community Health Network of Connecticut (medical ASO, does not pay claims)CHNCT is the state's medical administrative services organization for HUSKY Health; it reviews prior authorizations and runs the provider site, and claims go to DSS through the CMAP portal
- Carelon Behavioral Health Connecticut (behavioral health ASO, does not pay claims)Behavioral health administrative services organization for the Connecticut Behavioral Health Partnership, a DSS, DCF and DMHAS program; payment stays with DSS
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Connecticut Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Connecticut7: Anthem Health Plans (Anthem Blue Cross and Blue Shield of Connecticut), ConnectiCare Benefits, Inc., ConnectiCare, Inc., ConnectiCare Insurance Company, Inc. No two of them share a provider manual: filing windows, corrected-claim processes and appeal levels are set payer by payer, and the timely filing limits table lists verified deadlines, each with its source.
Clean-claim payment window under Conn. Gen. Stat. § 38a-816(15), prompt payment of accident and health claims: 45 days from receipt of a claim that contains all the information necessary for payment, after which interest is owed6. Insurance Department Bulletin HC-56 reads the section this way: an insurer that needs more information has 30 days to ask for it and 30 days after receiving it to pay without interest, and a submission counts as a claim only when the listed HCFA 1500 or UB-92 fields, such as the insured's ID number, patient name, diagnosis and dates of service, are complete. The bulletin dates from 2000, so the current statute text is checked before a day count is quoted to a payer. The practical use of the statute is in A/R follow-up: a clean claim past the statutory window is escalated with the statute cited, and interest is requested where the law provides it.
NEMT and home care in Connecticut
Non-emergency medical transportation. Medical Transportation Management (MTM) is the current statewide broker arranging non-emergency medical transportation for Medicaid members and Covered Connecticut enrollees8. DSS publishes the eligibility rules, the covered modes of transportation and the program FAQs, and members book through MTM rather than through a health plan. The NEMT billing in Connecticut page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Mandatory for agencies serving Connecticut Home Care Program, Personal Care Assistance and Acquired Brain Injury waiver clients, using the Sandata Technologies system that DSS implemented in partnership with Hewlett Packard Enterprise and Sandata Technologies, with home health services on a separate timeline9. DSS describes EVV as a telephonic and computer-based in-home scheduling, tracking and billing system that documents the time and type of care at the point of care. DSS first set November 1, 2016 for non-medical services and January 1, 2017 for home health; its October 19, 2016 update pushed those to no earlier than December 1, 2016 and February 1, 2017. See home care billing in Connecticut for waiver programs, EVV exceptions and authorizations.
Rules that change how Connecticut claims are billed
Behavioral health runs through its own ASO under a three-agency partnership10
The Connecticut Behavioral Health Partnership is a partnership of the Department of Social Services, the Department of Children and Families and the Department of Mental Health and Addiction Services. Carelon Behavioral Health Connecticut has been its administrative services organization since the partnership began, selected through competitive bids in 2006 for children and 2010 for adults, with the two programs integrated in 2011 and the contract most recently renewed in 2022. In 2024 it managed behavioral health care for more than 1.1 million HUSKY Health members, assessing network adequacy and authorizing care at the appropriate level, while payment stays with DSS.
The CMAP regulation lets DSS make EVV a condition of billing5
Section 17b-262-529 of the state regulations says that, if directed by DSS in a provider bulletin, providers shall submit all claims using the electronic visit verification system defined in section 17b-342-1, and that claims must carry every data element DSS requires in its provider billing manuals, with the date of service being the actual date care was provided. The same regulation defines the twelve-month filing clock, the retroactive eligibility, grievance and third-party exceptions, and the rule that an out-of-state provider's first contact with the fiscal agent must fall within twelve months of the service.
A claim starts the prompt pay clock only when the minimum fields are complete6
Bulletin HC-56, issued August 9, 2000 to interpret section 38a-816(15) as amended by Public Act 99-284, lists the HCFA 1500 and UB-92 items that must be filled in before a submission counts as a claim: the insured's ID number, patient name, diagnosis and dates of service among them. Interest applies when a claim containing all the information necessary for payment is not paid within 45 days of receipt; an insurer that needs more information has 30 days to request it and 30 days after receiving it to pay without interest. A biller who wants the interest clock to run checks those fields before the claim leaves.
HUSKY Health covers children, parents, elders and adults without dependents under one program11
HUSKY Health is Connecticut's Medicaid and CHIP program, offering coverage to eligible children, parents, relative caregivers, elders, individuals with disabilities, adults without dependent children and pregnant women. Applications for HUSKY A, B and D run through Access Health CT, the state exchange, and the provider information site that DSS links to is run by Community Health Network of Connecticut. Because the coverage groups share one fee-for-service payer, a practice credentials once with DSS rather than once per plan.
The CMAP site is where DSS publishes the rules a biller works from1
DSS points providers to the Connecticut Medical Assistance Program site at ctdssmap.com for enrollment information, billing manuals, provider bulletins, program regulations and the details of electronic data interchange and the Automated Eligibility Verification System. Because HUSKY Health has no health plans in between, claims, remittances and bulletins all come from that one program site rather than from a set of plan portals.
Services for Connecticut practices
Remitwright serves Connecticut practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Connecticut practices
What is the Connecticut Medicaid timely filing limit?
Which Medicaid plans do we contract with in Connecticut?
How quickly must insurers in Connecticut pay a clean claim?
Does Connecticut require EVV for home care visits?
Who arranges NEMT rides for our HUSKY patients?
Where do HUSKY Health fee-for-service claims go?
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