HUSKY Health
Medicaid and CHIP, fee-for-service Check the member's program before the visit. See CMAP enrollment. Your authorizations go to CHNCT.
Connecticut cardiology billing
Medical billing services for cardiology in Connecticut.
Cardialogy Billing performs the billing for cardiology practices in Connecticut. HUSKY Health claims. Enrolling in CMAP. ConnectiCare & Anthem Authorizations. Medicare Part B, and the accompanying rejections.
HUSKY Health
Determine program eligibility
CMAP enrollment
Gainwell portal and reenrollment
ConnectiCare and Anthem
Evolent and Availity’s checks
RCM Cardiology
Eligibility determined by final payment
CT billing assistance
Billing on echo labs, cath labs and device clinics.
At independent cardiologist, multi-physician group and hospital-affiliated offices around Connecticut.
4 HUSKY programs
A, B, C and D all billed via CMAP
0 Medicaid MCOs
HUSKY is fee for service
3 ConnectiCare Lines
Marketplace Medicare Commercial
Jurisdiction K
NGS procedures Part B for 7 states
Connecticut payers
Who covers heart care in Connecticut?
Connecticut cardiology claims land with four payors. Each has a gateway, an authorization route, and claim rules. Usually if you make a claim for one it will bounce off another.
ConnectiCare
Molina owned. Commercial, Marketplace and Medicare products. Evolent examines elective cardiovascular operations for Medicare and Marketplace participants.
Anthem Blue Cross and Blue Shield
Authorization rules vary per plan. We validate each member in Availity and determine if the request is Anthem-managed or review vendor-managed.
Medicare Jurisdiction K
National Government Services processes Part B for Connecticut and 6 other states. Each claim is subject to its local coverage rules.
Eligibility requirements vary amongst HUSKY programs
Coverage might be from scheduling to the visit. So we look at the member’s program on the date of service, not only at admission.
HUSKY A
Children, parents, pregnant members
HUSKY B
CHIP for children under age 19
HUSKY C
Adults age 65 and above and disabled adults
HUSKY D
Adults 19-64 without dependent children
Connecticut Medicaid
Impact of CMAP on HUSKY claims
Gainwell Technologies manages the gateway to the Department of Social Services’ Connecticut Medical Assistance Program. That's where enrollment, eligibility checks and claims all start. Prior authorization is another gateway. Connecticut Community Health Network.
- Confirm HUSKY program for date of service.
- Group NPI maintenance, Individual NPI and taxonomy code matching.
- Submit medical and radiographic authorizations to CHNCT.
- Skip HUSKY authorization unless Medicare does not cover service.
- Look for re-enrollment notifications. They come six months before the date.
Connecticut billing issues
Why Connecticut cardiology claims get bogged down
Connecticut-specific criteria determine whether a cardiology claim pays. Who is authorized? Who does. Claim ID Which ID is on the claim.
Four HUSKY programs
Active coverage is not enough. The service has defined eligibility restrictions for the member’s program, whether A, B, C or D.
CMAP Re-enrollment Notices
are received six months before the provider’s due date. Leave the application incomplete and you will be disenrolled. The provider cannot bill HUSKY anymore.
Separate Authorization and Gainwell
Gainwell receives the claims. CHNCT evaluates the authorizations. A denied claim is a separate phone call than a lost permission.
Dual Eligibles
For members with dual coverages, Medicare pays first; HUSKY authorization is normally waived. The crossover claim still requires good data from Medicare.
ConnectiCare by Molina
Different processes and payer IDs for Commercial, Marketplace, and Medicare participants. Evolent operates marketplace and Medicare cardiology.
Anthem plan differences
Some requests go to a review vendor, and requirements vary per plan. The inappropriate source of authorization may not be honored.
Part B coding and necessity
Echo and stress claims are divided into technical and professional components, TC and 26 NGS coverage policies determine which diagnoses are supported by each test.
Denials and aged A/R
Unpaid claims need a reason, a solution and a date. Payers have different appeal windows. Skip one, and the claim is typically done.
What we do
Cardiology Practice Billing Services in Connecticut
Every stage from initial benefits check through to the final aged balance. It’s all based on Connecticut payer rules.
Final payment eligibility.
One team does verification, coding, claims, posting, rejections, enrollment.
No vendor handovers.
Benefits & Eligibility Verification
Find coverage, benefits, network status and authorization needs for HUSKY, Medicare, Medicare Advantage and commercial insurance.
Cardiology medical coding
Review CPT, HCPCS, ICD-10-CM, modifiers, units, POS and documentation for compliance with appropriate billing requirements.
Charge Capture and Coding
Convert Documented Cardiovascular Services to Proper Billing Codes
Claim scrubbing
Before submitting, check demographics, provider data, coding links, payer routing and authorization.
Electronic claims submission
Manage electronic routing and submission stages for commercial and government claims by payer
Payment posting
Post ERA/EOB transactions, contractual adjustments, patient responsibility. Mark payment discrepancies.
Denial management
Review authorizations, eligibility, coding, duplication and other reasons for denial and coordinate resolution.
A/R follow-up
Investigate unpaid claims, call payer reps and process the corrections and appeals that work.
Credentialing and Provider Enrollment
assistance with Medicare, Medicaid and commercial enrollment. Keep individual and group information correct.
Things we bill for
Cardiology Tests and Procedures We Bill
Billing guidelines for an office visit are different from an echo or a cath. We organize each service line the way payers want to view it.
Consultations and follow-up visits
12-lead ECG
Transthoracic echocardiography
Transesophageal echo
Exercise and pharmacologic stress testing
Nuclear stress tests
MRI and Cardiac CT
Event & Holter monitors
Implantation and testing of pacemakers
ICD implants & check ups
L and R heart caths
Interventions in the coronary
EP studies and ablation
Structural interventions and TAVR
Rehabilitation of the heart
Remote monitoring of patients
Lipid and preventive visit
NOTE:
Authorization, coding, and documentation standards vary by payer, plan, method,
and location of care. We verify the rule for each combination, before the claim is constructed.
Specialties
Cardiology specialties billed in Connecticut
Every specialization has its own peculiarities of coding and authorization patterns. Billing a stress lab is a different animal from billing an EP lab.
General Cardiology
High volume E/M, non-invasive diagnostics, preventive cardiovascular care.
Interventional cardiology
Coding procedures for complicated cardiovascular intervention. Procedural and packaged.
Electrophysiology
Reimbursement support for ablation, mapping, device implant and related operations.
Cardiac Imaging
advancing advanced cardiovascular imaging and its billing rules
Nuclear cardiology
Simplified billing for nuclear testing, imaging, modifiers and payor needs.
Heart Failure and Preventive Cardiology
Demonstrating Specialized Care Models and Chronic-Care Billing Workflows.
How we work
The path of a Connecticut claim via our staff
Each stage feeds into the next, from the registration desk to the final report.
Collect accurate patient and insurance information.
Verify HUSKY category, Medicare or commercial coverage.
Confirm benefits that are important to plan and network membership.
Review of applicable ConnectiCare, Anthem or other payer criteria.
Verify charges and coding conform to documentation and coverage criteria.
Review codes, demographics, provider information, payor information.
Correct submission of claims to the relevant payer and clearinghouse.
Updates and patient balances correctly. Payment posting and reconciliation.
Explore causes of denial and plan corrective action.
Aging of Work Claims, Corrected Claims, Appeals & Open Balances.
Manage billing operations and modifications to the revenue cycle.
Why farm out
How Connecticut cardiology practices shift billing responsibilities to experts
A practice that bills HUSKY, Medicare, ConnectiCare and Anthem might end up functioning across five distinct portals. Outsourcing shifts that task away from the clinical team.
Reduce administrative burden
Lower the internal burden related to claims, payer portals, follow-up and billing administration.
Stay updated on changing payer requirements
Track changes to Medicaid, Medicare, and commercial payer processes.
Support coding accuracy
Maintain CPT, HCPCS, ICD-10-CM, modifiers and documentation review.
Manage complicated Medicaid and commercial claims
Manage payer specific work flows and follow up on pending claims.
Address aging A/R
Review past due accounts and follow up and appeal with appropriate payers.
Enhance revenue-cycle visibility
Keep a clearer picture of claims, payments, rejections and receivables outstanding.
State-wide support
Services for Connecticut Cardiology Practices
Billing support is centralized. So a team in Stamford and a team in Norwich have the same team and the same method.
Hartford
New Haven
Stamford
Bridgeport
Waterbury
Norwalk
Danbury
East Connecticut
What to know before deciding
Questions for a Connecticut billing firm
A billing business that is operating in many states may not know how CMAP, CHNCT or Evolent operates. Ask these things directly.
Daily work in CMAP portal
Processing CMAP re-enrollment notices
Current ConnectiCare Evolent regulations
Plan level inspections from Availity by Anthem
Knowledge of NGS Jurisdiction K policies
Follow-up on cath lab and imaging claim denials
FAQs
Billing Questions for Cardiology in Connecticut
CMAP, ConnectiCare, HUSKY Health, Anthem, Medicare, authorization. & Other Common Questions
Q1. What does a cardiology medical billing company do for Connecticut practices?
It may manage benefits verification, prior authorization review, cardiac coding, claim filing, payment posting, denial management and A/R follow-up.
Q2. How do the 4 HUSKY programs affect cardiology billing?
HUSKY A, B, C and D serve various demographics hence the qualifying standards are varied for each program. We examine the member program at each service date. Dual eligible members have both Medicare and Medicaid, with Medicare as the primary payer.
Q3. What is CMAP and what does Gainwell do?
The Connecticut Medical Assistance Program is the state’s Medicaid program. Gainwell Technologies manages its provider standards and claims processing.
Q4. What does Connecticut Medicaid provider enrollment mean?
You must have the right provider type, specialization, taxonomy, NPI and group affiliation on file to enroll.
Q5. Who needs pre-authorization for HUSKY?
The Community Health Network of Connecticut processes medical and radiological referrals for HUSKY Health. The ordering provider and the billing provider must be enrolled in CMAP. Approval does not mean payment. If you are dually eligible, you do not need HUSKY authorization, unless the treatment isn’t covered by Medicare.
Q6. Do I need prior authorization for cardiac treatments in Connecticut?
It varies by payer, plan, procedure, and location of care. It is usually some advanced cardiac imaging and interventional treatments.
Q7. How does Molina’s ownership of ConnectiCare influence cardiology billing?
ConnectiCare now has different protocols for commercial, Marketplace and Medicare lines. Evolent will approve elective diagnostic and interventional cardiovascular services for Medicare and Marketplace participants and the payer ID for these claims will be MLNCT. Commercial claims are in 06105.
Q8. Does Anthem Connecticut require cardiologist authorization?
Anthem Blue Cross and Blue Shield determine the standards per plan and certain requests go to a review vendor rather than Anthem. We confirm each member’s benefits and the precertification lookup in Availity prior to scheduling service.
Q9. Who is Connecticut’s Medicare Administrative Contractor?
Connecticut is in Medicare A/B MAC Jurisdiction K.
Q10. Will Cardiology Billing work on denials and old A/R?
Yes. Each refusal is traced back to source and corrected and resubmitted or appealed. Each payer has different appeal periods, therefore we monitor by plan and continue to process the older cases.
Billing for Cardiology in CT
Help with cardiology billing in Connecticut
A free billing assessment analyzes payer mix, recent denials and aging balances to reveal where Connecticut claims are getting stuck.
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