Medicaid Connecticut

Connecticut Medicaid Home Health (HH), UB-04 Hardcopy

Connecticut Home Health is a fee-for-service claim. Each type of service provided by a specific discipline is listed individually on the claim. Providers must submit paper claims using the original red UB-04 claim forms with black ink only.

For service dates on or after 04.01.2010, Connecticut Medicaid requires the HHABN date and the HIPAA adjustment reason code to be reported for dually eligible patients in those cases when Medicare will not pay for the service. Due to the limitations of the UB-04 form only allowing a single date, if agencies need to bill the HHABN on the UB-04, please enter these claims online. The Home Health electronic template accommodates the HHABN reporting requirements.

The insurance code should be defined in Administration>Financial>Insurance Codes>General as the type K (Medicaid), billing mode R (Regular), and state CT (Connecticut). The form should be defined as UB-04.

In Administration>Financial>Insurance Codes>Print Variations, under Specialized Formats section, select CT Medicaid Home Health and Hospice (FFS) Format. In FL 4, Bill Type 331 prints for all claims except for 337 replacements and 338 voids.

Detail Charge Line Section: For FL 42-49, use the Tiered Rates function under Billing Rates to enter new rates for nursing visits (a service that requires multiple charge lines to be reported for visits in excess of 1 hour). Choose an effective date, such as the first day of the month, to start using these new rates (for more information, see Recalculating Claims).

1.	Access billing rates in the Administration>Financial>Billing Rates>Rates tab.

2.	Enter a new rate for an RN Nursing Visit with a Revenue Code of 580.

3.	Select the check box in the T.R. column at the right side of the window to indicate that the tiered rates detail information should be used for this insurance code service.

The Tiered Rates grid appears.

4.	In the first row of the grid, enter information for the first hour of service.

•	Leave the From column blank.

•	In the Thru column, enter 1 hour.

•	Enter the appropriate dollar amounts in the Gross Rate and Net Rate fields.

•	Enter Revenue Code 580 and HCPCS S9123.

•	The Gross Basis and Net Basis fields should be set to use the V rate.

5.	Add a second row for the portion of service time that exceeds 1 hour.

•	In the From column, enter 1 hour 1 minute.

•	Enter the appropriate dollar amounts in the Gross Rate and Net Rate fields.

•	Enter Revenue Code 580 with a HCPCS code of T1002.

•	The Gross Basis and Net Basis for this row will be J which will calculate the units in 15 minute increments, no unit minimum, and units are rounded down (full 15 minutes of service are required in order to charge 1 unit).

•	If the authorization only allows a second hour to be billed, then enter 2h in the Thru column. This will prevent additional service time of over 2 hours from being billed. If there is no limit to the number of 15-minute units that can be billed, then leave the Thru column blank.

6.

Click OK.

The application returns you to the Billing Rates window. If you wish to edit tiered rates, click the T button in the last column of the grid.

On the claim form, this service is reported as two separate charge lines. If more than one nursing visit with HCPCS S9123/T1002 occurs in one day, the application groups the services accordingly and prints only two charge lines for the given date of service. In other words, on the same day, the same types of services are grouped together. The application prints these two charge lines on the same claim page.

Recalculating Claims

Most likely, you will need to recalculate claims for services already entered in the current claim cycle. For example, assume the current date is February 10, 2005 and you have already entered all services for February 1- 9. If the effective date for the new rates is set at February 1, 2005, you will need to recalculate the claims for the already entered February services.

1.	Go to Administration>Maintenance>Recalculate Claims.

2.	Select the appropriate payer and patients, but do not select the Generate Void/Replacements for Closed Claims check box (doing so will generate many void and replacement claims).

3.	Select the start date that is the same as the effective date for the new bill rates that you have entered.

4.

Click OK.

This function will recalculate your current working claims for the selected payer and patients.

The following fields or areas in the application may be required.


Field	Description
Carrier Code	For Payer (Locator 50), enter the three digit carrier code for other insurance carriers in the Carrier Code field in Administration>Financial>Insurance Codes>Carrier Codes.
HIPAA EDI Revenue Code	For Locator 42, enter the required revenue center codes in the HIPAA EDI Revenue Code field in Administration>Financial>Billing Rates>Other.
Rates	For Locator 44, HCPCS codes are required for nursing services. Enter the HCPCS code and any required modifiers in Administration>Financial>Billing Rates>Rates. If different combinations of HCPCS/Modifiers are needed, create a new billing rate for each combination. Also, see section above regarding Tiered Rate Billing for nursing visits that require multiple charge lines for visits greater than 1 hour in length.)
NPI	Select to report NPI numbers in Administration>Financial>Insurance Codes>NPI.

Connecticut Medicaid Home Health (HH), 837I 4010A1 Electronic

Refer to the Connecticut Medicaid Home Health (HH), UB-04 Hardcopy instructions for additional information.

Beginning with Dates of Service 04.01.2010, Connecticut Medicaid requires the Home Health Advanced Beneficiary Notice (HHABN) date and its corresponding HIPAA Adjustment reason code to be reported on electronic claims when patients are dually eligible with Medicare. The following steps need to be followed to get the correct output on the claim.

1.	Medicare needs to be added as a payer in Patient>General>Payers if not present.

2.	Agencies are required to enter denial information in Patient>General>Payer Denial Information. Permissions are required to access this window.

The following data needs to be entered:

•	Select the corresponding Pay Source pointer to Medicare in the Other Payer field.

•	Enter the HHABN date in the Denial Date field. This date is reported on the first claim of the effective date and all subsequent claims until the end date has been entered.

•	Enter 0 in the Denial Amount field. The template calculates the correct claim or service amount to report.

•	Enter the HIPAA Adjustment reason code in the Denial Code field.

•	Enter the effective date to be the same as the denial date.

More than one date can be reported on the same claim. If so, enter the end date to the effective date of the first line and add a second line. If denial dates fall in the same claim period, the corresponding denial date is reported for each appropriate service. If a denial date covers the entire claim period, that date is reported once for the claim.


Field	Description
Submitter ID	Enter the submitter ID assigned to you by CT Medicaid in Administration>Financial>Insurance Codes>EMC.
Receiver ID (File Recipient)	Enter the CT Medicaid receiver ID of 061274678 in Administration>Financial>Insurance Codes>EMC.
Test Submission Indicator	Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Provider Taxonomy Code	Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes.
Carrier Code	Enter the Connecticut Medicaid assigned ID codes (Recipient Other Insurance Codes) for each insurance carrier in Administration>Financial>Insurance Codes>Carrier Codes.
Federal Tax ID -OR- Social Security # -AND- State License # NPI	For the patient's attending/ordering physician, enter either the doctors' Federal Tax ID or Social Security number. Enter the physician's Medicaid-assigned Provider ID in the State License Number field. Enter the Physician's NPI in the NPI field. These fields are located in Resource>General>Roles.
HIPAA EDI Revenue Code	For charges with service dates 07.01.03 or greater, local codes are not accepted. For Locator 42, enter the required Revenue Center Codes in the HIPAA EDI Revenue Code field.

If submitting a void or replacement claim, enter the ICN of the original claim through Claims>Process>Annotate Claims unless your agency uses the Connecticut ERA.

Connecticut Medicaid Home Health (HH), 837I 5010A2 Electronic

Refer to the Connecticut Medicaid Home Health (HH), UB-04 Hardcopy instructions for additional information.

Beginning with Dates of Service 04.01.2010, Connecticut Medicaid requires the Home Health Advanced Beneficiary Notice (HHABN) date and its corresponding HIPAA adjustment reason code to be reported on the electronic claims when patients are dually eligible with Medicare. Complete the following steps to get the correct output on the claim:

1.	Add the Medicare insurance as a payer in Patient>General>Payers, if not present.

2.	Enter the denial information in Patient>General>Payer Denial Information. To access this window, you must have the appropriate privileges granted by the Allscripts Homecare administrator. You must perform the following actions:

•	In the Other Payer field, select the corresponding Pay Source pointer to Medicare.

•	In the Denial Date field, enter the HHABN date. This date is reported on the first claim of the effective date and all subsequent claims until the end date has been entered.

•	In the Denial Amount field, enter 0. The template calculates the correct claim or service amount to report.

•	In the Denial Code field, enter the HIPAA adjustment reason code.

•	Enter the effective date equal to the denial date.

More than one date can be reported on the same claim. If so, enter the end date to the effective date of the first line and add a second line. If denial dates fall in the same claim period, the corresponding denial date is reported for each appropriate service. If a denial date covers the entire claim period, that date is reported once for the claim.


Field	Description
Submitter ID	Enter the submitter ID assigned to you by Connecticut Medicaid in Administration>Financial>Insurance Codes>EMC.
Receiver ID (File Recipient)	Enter the Connecticut Medicaid receiver ID of 061274678 in Administration>Financial>Insurance Codes>EMC.
Test Submission Indicator	Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Provider Taxonomy Code	Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes.
Carrier Code	Enter the Connecticut Medicaid assigned ID codes (Recipient Other Insurance Codes) for each insurance carrier in Administration>Financial>Insurance Codes>Carrier Codes.
Federal Tax ID -OR- Social Security # -AND- State License # NPI	For the patient's attending/ordering physician, enter either the doctors' Federal Tax ID or Social Security number. Enter the physician's Medicaid-assigned Provider ID in the State License Number field. Enter the Physician's NPI in the NPI field. These fields are located in Resource>General>Roles.
HIPAA EDI Revenue Code	For charges with service dates 07.01.03 or greater, local codes are not accepted. For Locator 42, enter the required Revenue Center Codes in the HIPAA EDI Revenue Code field.

If submitting a void or replacement claim, enter the ICN of the original claim through Claims>Process>Annotate Claims unless your agency uses the Connecticut ERA.

Connecticut Medicaid Homecare Services Waiver (CHC), CMS-1500 (02/12) Hardcopy

The Connecticut Medicaid Homecare Services Waiver requires the use of the CMS-1500 (02/12) paper form. Use an original red-and-white claim form when submitting paper claims. Photocopies or laser-printed copies of the claim form are not accepted.

Set up the following items in Administration>Financial>Insurance Codes:

1.	On the General tab, define a new insurance code with the type K (Medicaid), billing mode R (Regular), and state CT (Connecticut). The form should be defined as CMS-1500 (02/12) or CMS-1500 (02/12)R.

2.	In Administration>Financial>Billing Rates>Rates, enter the rates for the CT Medicaid Homecare Services Waiver program.

3.	In the Medicaid CCN field, enter the AVRS# or Medicaid Provider Number.

4.	On the NPI tab, enter the NPI number and select Legacy IDs and National Provider IDs (NPI) in the IDs to include in EMC files and IDs to include in Paper Claimssections.

Group Practice Billing is reserved for independently enrolled fee-for-service healthcare practitioners (physicians, podiatrists, psychologists, and so on) that share the same Federal Employer Identification Number. Facility-based organizations (NPI Type 2), sole practitioners, and providers assigned an Atypical Provider Identifier (API) may not use group billing functionality.

In Administration>Financial>Insurance Codes>Print Variations, define the following items for this payer.


Locator	Locator Name	Setup Instructions
Box 9	Other Insured's Name	Select the Print only if primary insurance is commercial print variation.
Box 9d	Insurance Plan Name or Program Name	Select the Print the payer assigned Carrier Code print variation. If the client has other insurance coverage and a payment is received, enter the 3-digit code of other insurance carrier, paid amount, and payment date in Patient>General>Claim Constants. If a denial was received from the other insurer, enter the 3-digit code(s) of other insurance carrier(s) followed by Not Applicable or N/A, and then by the denial date. A response from each other insurance policy must be indicated in this field. If the client has Medicare and a payment is received, then enter either Medicare or MPB in this field through Patient>General>Claim Constants. If a Medicare Health Maintenance Organization (HMO) is the primary insurer and a payment is received, the words Medicare HMO must be indicated in this Box. Do not enter the amount that Medicare paid in this Box (9d) or Box 29. Note: You do not need to indicate the date of the EOMB in this field.
Box 10a	Is Patient's Condition Related To Employment	If the patient's condition is related to employment, enter the code Y in Patient>General>Claim Constants.
Box 10b	Is Patient's Condition Related To Auto Accident	If the patient's condition is related to an auto accident, enter the code Y in Patient>General>Claim Constants.
Box 10c	Is Patient's Condition Related To Other Accident	If the patient's condition is related to other accident, enter the code Y in Patient>General>Claim Constants.
Box 17	Name of Referring Provider or Other Source	Select the Print the Referral Source print variation. Enter the qualifier of DN for the referring provider in Patient>General>Claim Constants.
Box 21	Diagnosis or Nature of Illness or Injury	Select the Print the ICD-9 diagnoses codes with the decimal point print variation.
Box 24	Date of Service	Enter the from and thru dates in a 2-digit format for the month, day, and year (for example, 07/01/14). Important: The dates must be within the same month.
Box 24A Shaded	TPL Qualifier	Select the Print Prorated TPL amount with qualifier TPL print variation.
Box 24J Shaded	Rendering Provider ID	Select the Print rendering provider's NPI print variation.
Box 26	Patient's Account Number	Select the Print Patient Code print variation.
Box 31	Signature of Physician or Supplier	Select the Print 'SIGNATURE ON FILE' and Date print variation.
Box 33	Billing Provider Info & Phone	Select the Print the agency name, address and phone number print variation.
Box 33b	Shaded	Select the Print Taxonomy Code and ZZ Qualifier of the provider print variation.

Connecticut Medicaid Homecare Services Waiver (CHC), 837P 5010A1 Electronic

Refer to the Connecticut Medicaid Homecare Services Waiver (CHC), CMS-1500 (02/12) Hardcopy instructions for additional information.

Beginning with dates of service on or after 04.01.2010, Connecticut Medicaid requires the Home Health Advanced Beneficiary Notice (HHABN) date and its corresponding HIPAA adjustment reason code to be reported on the electronic claims when patients are dually eligible with Medicare.

Complete the following steps to get the correct output on the claim:

1.	Add the Medicare insurance as a payer in Patient>General>Payers, if not present.

2.	Enter the denial information in Patient>General>Payer Denial Information. To access this window, you must have the appropriate privileges granted by the administrator. You must perform the following actions:

a.	In the Other Payer field, select the corresponding Pay Source pointer to Medicare.

b.	In the Denial Date field, enter the HHABN date. This date is reported on the first claim of the effective date and all subsequent claims until the end date has been entered.

c.	In the Denial Amount field, enter 0. The template calculates the correct claim or service amount to report.

d.	Enter the effective date that is equal to the denial date.

More than one date can be reported on the same claim. If so, enter the end date to the effective date of the first line and add a second line. If denial dates fall in the same claim period, the corresponding denial date is reported for each appropriate service. If a denial date covers the entire claim period, that date is reported once for the claim.


Field	Description
Submitter ID	Enter the submitter ID assigned to you by CT Medicaid in Administration>Financial>Insurance Codes>EMC.
Receiver ID (File Recipient)	Enter the CT Medicaid receiver ID of 061274678 in Administration>Financial>Insurance Codes>EMC.
Test Submission Indicator	Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Provider Taxonomy Code	Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes.
Carrier Code	Enter the Connecticut Medicaid assigned ID codes (Recipient Other Insurance Codes) for each insurance carrier in Administration>Financial>Insurance Codes>Carrier Codes.
Federal Tax ID -OR- Social Security # -AND- State License # NPI	For the patient's attending/ordering physician, enter either the Federal Tax ID or Social Security number. Enter the physician's Medicaid-assigned Provider ID in the State License Number field. Enter the Physician's NPI in the NPI field. These fields are located in Resource>General>Roles.
HIPAA EDI Revenue Code	For charges with service dates 07.01.03 or later, local codes are not accepted. For Box 42, enter the required Revenue Center Codes in the HIPAA EDI Revenue Code field.

If submitting a void or replacement claim, enter the ICN of the original claim through Claims>Process>Annotate Claims unless your agency uses the Connecticut ERA.

Connecticut Medicaid Hospice (HO), UB-04 Hardcopy

In 2009, Connecticut Medicaid launched the Hospice program for Medicaid patients as a distinct program separate from Home Health. Hospice services bill per diem for routine, respite, and general inpatient care and must meet the 8-hour daily minimum for continuous care billing.

This requires a new insurance code to be set up as a benefit payer to produce the correct output on UB-04. Room and Board charges can be submitted on the same claim as hospice services (separate insurance code is not needed). Also, billing rates need to be added or updated for this insurance code.

Hospice services can be billed for the following four revenue center codes:

>	651 - Routine

>	652 - Continuous Care (a minimum of 8 hours of care (50% nursing) must have been provided on the same day)

>	655 - Respite

>	656 - General Inpatient

In addition, billing rates should be added if your agency provides these services:

>	658 - Can be billed when patient received routine or continuous care while residing in a nursing facility.

>	657 - Physician services can be billed with hospice codes. HCPCS codes must be set up for appropriate service rendered. Radiology services with HCPCS in the 7xxxx range must be billed with modifier 26.

>	659 - Add-on escort services can be billed with hospice codes. HCPCS code S9381 must be entered in the HCPCS Code field.

General Setup Rules

To establish a new insurance code for Connecticut Medicaid, the insurance code should be defined in Administration>Financial>Insurance Codes>General as the type K (Medicaid), billing mode B (Benefit), and state CT (Connecticut). Enter Medicaid in the Payer Name field. If applicable, enter the carrier codes on the Carrier Code tab. In Administration>Financial>Insurance Codes>NPI, enter the NPI for paper claims.

Use the following print variations or claim constants to complete the paper format:

>	Specialized Formats: Make no selection.

>	Printer: Select the appropriate printer.

>	Benefit and Hybrid Claims: Select the Line Item Billing option.


Field Locator	Field Locator Name	Setup
FL5	Federal Tax ID	Suppress Printing Federal Tax ID
FL6	Statement Cover Period From/Through Dates	Use the first and last dates of service
FL8	Patient Name	Print comma between first name and middle
FL9	Patient Address	Suppress Printing Patient Address
FL11	Sex	Suppress Printing Patient Sex
FL12	Admission Date	Suppress Printing Admission Date
FL 17	Status	Suppress Printing Patient Status Code
FL18-28	Condition Codes	Suppress Printing Condition codes
FL31ab-34ab	Occurrence Codes	If your agency reports occurrence codes, you must enter these codes in Patient>General>Claim Constants. The code 24 should be reported for a denial date with the associated date.
FL 42	Revenue Code	Enter the appropriate 3-digit revenue codes in the Billing Rates window for this insurance. Ensure that 0001 is entered in the Total Revenue section.
FL 43	Description	Suppress Printing Description
FL50	Payer	Print the payer's assigned carrier code. Connecticut Medicaid has very specific instructions depending on who the other payer is that must be entered in FL 50. See Chapter 8 in the Connecticut Medicaid Provider Manual for exact information. Enter this information in Patient>General>Claim Constants.
FL51a-c	Health Plan ID	Suppress Printing Health Plan ID
FL52a-c	Rel. Info. A - C	If applicable, enter the appropriate code for release of information through Patient>General>Claim Constants.
FL53a-c	Asg. Ben	If applicable, enter the appropriate code for release of information through Patient>General>Claim Constants.
FL55a-b	Est. Amount Due A-B	Suppress printing estimated amount due
FL 59	A - P. Rel	Print NUBC Relationship Codes effective 10.16.03
FL 64 a-c	Document Control Number	To report adjustment claims, you need to set up it Claims>Process>Annotate Claims by entering an A followed by the 13-character internal control number for void and replacement claims.
FL80	Remarks	If your agency needs to report remarks or other insurance paid date, enter any remarks in Patient>General>Claim Constants.
FL81CCa		Print agency's Taxonomy code and B3 qualifier

Connecticut Medicaid Hospice (HO), 837I 4010A1 Electronic

Refer to the Connecticut Medicaid Hospice (HO), UB-04 Hardcopy instructions for additional information.


Field	Description
Submitter ID	Enter the submitter ID assigned to you by CT Medicaid in Administration>Financial>Insurance Codes>EMC.
Receiver ID (File Recipient)	Enter the CT Medicaid receiver ID of 061274678 in Administration>Financial>Insurance Codes>EMC.
Test Submission Indicator	Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Provider Taxonomy Code	Enter the taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>EMC.
Carrier Code	Enter the Connecticut Medicaid assigned ID codes (Recipient Other Insurance Codes) for each insurance carrier in Administration>Financial>Insurance Codes>Carrier Codes.
Federal Tax ID -OR- Social Security # -AND- State License # NPI	For the patient's attending/ordering physician, enter either the doctors' Federal Tax ID or Social Security number. Enter the physician's Medicaid-assigned Provider ID in the State License Number field. Enter the Physician's NPI in the NPI field. These fields are located in Resource>General>Roles.
HIPAA EDI Revenue Code	For charges with service dates 07.01.03 or greater, local codes are not accepted. For Locator 42, enter the required Revenue Center Codes in the HIPAA EDI Revenue Code field.

If submitting a void or replacement claim, enter the ICN of the original claim through Claims>Process>Annotate Claims unless your agency uses the Connecticut ERA.

Connecticut Medicaid Hospice (HO), 837I 5010A2 Electronic

Refer to the Connecticut Medicaid Hospice (HO), UB-04 Hardcopy instructions for additional information.


Field	Description
Submitter ID	Enter the submitter ID assigned to you by Connecticut Medicaid in Administration>Financial>Insurance Codes>EMC.
Receiver ID (File Recipient)	Enter the Connecticut Medicaid receiver ID of 061274678 in Administration>Financial>Insurance Codes>EMC.
Test Submission Indicator	Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
Provider Taxonomy Code	Enter the taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>EMC.
Carrier Code	Enter the Connecticut Medicaid assigned ID codes (Recipient Other Insurance Codes) for each insurance carrier in Administration>Financial>Insurance Codes>Carrier Codes.
Federal Tax ID -OR- Social Security # -AND- State License # NPI	For the patient's attending/ordering physician, enter either the doctors' Federal Tax ID or Social Security number. Enter the physician's Medicaid-assigned Provider ID in the State License Number field. Enter the Physician's NPI in the NPI field. These fields are located in Resource>General>Roles.
HIPAA EDI Revenue Code	For charges with service dates 07.01.03 or greater, local codes are not accepted. For Locator 42, enter the required Revenue Center Codes in the HIPAA EDI Revenue Code field.

If submitting a void or replacement claim, enter the ICN of the original claim through Claims>Process>Annotate Claims unless your agency uses the Connecticut ERA.

Connecticut Medicaid Remittance, 835 4010A1 Electronic

Allscripts Homecare currently supports the ANSI 835 format and the New York State Department of Health Medicaid Management Information System (MMIS) proprietary format. Connecticut Medical Assistance Program has a proprietary format for Home Health.

CT Medicaid reimburses both for the claim in total and by line item. Allscripts Homecare does not at this time apply payments or adjustments to claim detail lines so the process ignores the detail records and applies the payment amount to the claim. The claim to post to is determined by field 8, Provider Recipient ID Number, positions 36-47 on the header record. This is the CLAIM_ID field generated by Allscripts Homecare.

Note: The provider ID in position 17-22 of the first record must match the provider IDs for insurance codes defined as insurance type K and state CT. In addition, the vendor ID in position 67-69 must match the EMC submitter ID, and the billing mode for the insurance code must be R.