Credentialing in Connecticut

What is specific to Connecticut

Connecticut moved HUSKY Health off risk-bearing managed care in 2012 and now self-insures the programme, paying claims fee-for-service through administrative services organizations rather than through contracted managed care plans.

Connecticut’s Medicaid programme is HUSKY Health. Practices with a meaningful HUSKY Health mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.

What a credentialing seat does in Connecticut

Applications, revalidations and payer follow-up, with every enrollment's status visible.

HUSKY Health is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.

• Initial applications prepared and submitted
• Revalidations tracked ahead of the deadline
• CAQH kept current
• Payer follow-up until an effective date is issued
• Status of every enrollment visible to you
• Worked during Connecticut business hours, not queued overnight

For the statute behind all of this — Connecticut’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Connecticut billing page.

HUSKY Health, in practice

HUSKY Health (Medicaid and CHIP) is run by the Department of Social Services through a single medical Administrative Services Organization rather than competing risk-bearing MCOs, so providers deal with one medical administrator statewide. Quotes: "HUSKY Health includes Medicaid and the Children's Health Insurance Program, and is administered by the Connecticut Department of Social Services (DSS)."; "the State of Connecticut's Medical Administrative Services Organization (ASO) for the HUSKY Health program". Source

HUSKY dental is carved out to a separate administrator, so dental claims do not route through the medical ASO. Quote: "The Connecticut Dental Health Partnership (CTDHP) is part of the HUSKY Health program. Specifically, the CTDHP provides management and customer service for the dental benefits portion of HUSKY Health." Source

For enrolment that is not a detail, it is a second application. A carved-out benefit is administered by a different organisation, which credentials separately, on its own timetable, and a provider who is live everywhere else can still be out of network for that one service without anybody noticing until the first claim is denied.

Working Connecticut hours

Connecticut runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.

That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Connecticut hours and nobody else’s.

What it costs in Connecticut

$2,400

Per seat, per month, in US dollars — $28,800 a year for one full-time person, forty hours a week, on Connecticut hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Connecticut run $1,600 to $2,700; the full list is published.

That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.

Getting started in Connecticut

About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.

Questions