Policies & Procedures
The policies and procedures page provides information to providers in the form of administrative and clinical policies.
Administrative policies are policies which address the administrative processes and procedures of the Medical Administrative Services Organization (ASO) program.
Clinical policies and guidelines are utilized by the DSS contractor, Community Health Network of Connecticut (CHNCT), when reviewing requests for the prior authorization (PA) of various goods and services. The criteria, included in the policies, are based on the best clinical evidence available. All requests are reviewed in accordance with the Department of Social Services' (DSS) definition of medical necessity. Prior authorization means the approval from the Department of Social Services (DSS), or a contracted agent (in this case CHNCT), of a service or the delivery of goods before the provider actually performs the service or delivers the goods. To receive reimbursement from the DSS, a provider must comply with all prior authorization requirements. Obtaining PA does not guarantee payment or ensure client eligibility. It is the responsibility of the provider to verify client eligibility for the appropriate date(s) of service.
There are no Administrative Policies & Procedures online at this time. If you have any questions please contact Provider Relations at 1.800.440.5071.