MedStats Billing delivers end-to-end revenue cycle management built for Connecticut practices. We hold payers to the 20-day electronic and 60-day paper limits in C.G.S. § 38a-816(15), pursue the 15% interest that attaches when they slip, bill HUSKY Health through the state’s administrative services structure, and price work injury care to the correct practitioner and facility fee schedules.
Connecticut runs the tightest payment clock in the northeast and pays the highest simple interest rate of any state on this list. An electronic claim is due in 20 days, a paper claim in 60, and late payment carries 15% per annum. The state is also unusual in two structural ways: Medicaid has no managed care organizations at all, it is self-insured and administered through single statewide entities, and workers’ compensation runs on two separately published fee schedules with different effective dates and a percentile-based pricing method rather than a Medicare multiplier. Auto injury has no fee schedule and no PIP at all.
Connecticut Billing Specializations:
Prompt Payment of Health Claims (C.G.S. § 38a-816(15)) — An insurer, or any entity responsible for paying a provider under a policy, must pay an accident and health claim within 20 days of receipt when filed electronically and 60 days when filed on paper. Failure to pay inside those windows is an unfair insurance practice, not merely a delay.
15% Statutory Interest — A payer that misses the statutory window owes the claim amount plus interest at 15% per annum, in addition to any other penalty the Insurance Department may impose. It is the highest simple annual rate among the states we serve.
The Information-Request Deadlines — Where a claim lacks information needed to process it, the payer must request that information in writing within 10 days for an electronic claim and 30 days for a paper claim, and must then pay within 10 days, or 30 days respectively, of receiving it. Missing the request window does not restart the clock in the payer’s favour.
Legitimate Dispute Status — Delay is excused only where the Insurance Commissioner determines a legitimate dispute exists as to coverage, liability or damages. Under Department guidance, settlement delays from other investigations are not a legitimate dispute unless the payer obtains prior approval for that specific claim, which gives providers a strong position on pended claims.
HUSKY Health Without MCOs — Connecticut is one of the few states with no Medicaid managed care organizations. HUSKY Health is self-insured and administered through statewide administrative services organizations for medical, behavioural health and dental care, with claims adjudicated through the Connecticut Medical Assistance Program. Enrollment, authorization and appeals all run through that single structure rather than five competing plans.
Official Connecticut Practitioner Fee Schedule — Workers’ compensation professional fees are set by the Workers’ Compensation Commission and published annually, effective in mid-July. Physician fees are set at the 74th percentile of a statewide charge database, and non-physician practitioners billing the same CPT code are paid at 70% of the physician fee, except in physical medicine. The fee follows the licensure of the practitioner who performed the service.
Hospital & ASC Fee Schedule — Facility reimbursement runs on a separate Official Connecticut Fee Schedule for Hospitals and Ambulatory Surgical Centers, published by FAIR Health and effective 1 April each year for services rendered on or after that date regardless of date of injury, computed from Medicare-based formulae under § 31-294d(d).
Workers’ Compensation Documentation Rules — Bills are submitted on the CMS-1500 priced to the practitioner schedule with supporting records, treating providers must furnish medical reports to the payer and the worker within 30 days of completion, balance billing the injured worker is prohibited, and disputes are resolved before the Commission.
Auto Injury Without PIP — Connecticut repealed no-fault, so there is no mandatory personal injury protection and no auto medical fee schedule. Auto injury care is billed to optional medical payments coverage, the patient’s health plan or third-party liability, which makes coordination of benefits order and lien tracking the whole exercise.
Major Connecticut Payers — Anthem Blue Cross and Blue Shield of Connecticut, ConnectiCare, Cigna, Aetna, UnitedHealthcare, Harvard Pilgrim and the State of Connecticut employee plans.
Built to bring clarity, control and consistency to your Connecticut practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for Connecticut providers — from Connecticut Medical Assistance Program enrollment and commercial credentialing, through coding, claim scrubbing and submission, to denial resolution, 15% interest recovery, Insurance Department complaints and workers’ compensation fee disputes before the Commission.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceConnecticut practices lose most of their recoverable revenue to a clock that runs faster than they expect and two fee schedules that change on different dates. These are the four we eliminate:
Connecticut tightened its electronic claim window to 20 days and extended paper claims to 60. Practices still working the old 45-day assumption chase claims late, miss the point at which interest began accruing and lose the leverage the statute gives them.
A payer that misses the statutory window owes the claim amount plus 15% per annum, on top of any penalty the Insurance Department imposes. Practices treat late payment as merely late. At 15% simple interest, a quarter of aged AR is worth a dedicated audit.
Delay is only excused where the Commissioner finds a legitimate dispute as to coverage, liability or damages, and Department guidance says other investigations do not qualify without prior approval for that specific claim. Practices that accept an open-ended pend give up a claim the statute already treats as overdue.
Connecticut publishes two work injury fee schedules with different effective dates: the practitioner schedule in mid-July and the hospital and ASC schedule on 1 April, the latter applying to services rendered on or after that date regardless of date of injury. Billing a facility service off the practitioner schedule, or either off last year’s edition, produces reductions that are hard to reverse.
An insurer or other entity responsible for paying a provider must pay an accident and health claim within 20 days of receipt for an electronic submission and 60 days for a paper submission. Where information is missing, the request must go out within 10 days for electronic claims and 30 for paper, with payment due 10 or 30 days after it arrives. Late payment carries the claim amount plus 15% per annum.
Connecticut is one of very few states with no Medicaid MCOs. HUSKY Health is self-insured and administered through statewide administrative services organizations covering medical, behavioural health and dental care, with claims adjudicated through the Connecticut Medical Assistance Program. That removes plan-shopping denials and concentrates everything into one set of rules, which is an advantage only for practices that know them.
Professional services are priced from the Official Connecticut Practitioner Fee Schedule, published annually and effective in mid-July, with physician fees set at the 74th percentile of a statewide charge database and non-physician practitioners at 70% of the physician fee except in physical medicine. Facility services follow the separate Official Connecticut Fee Schedule for Hospitals and Ambulatory Surgical Centers, effective 1 April each year on Medicare-based formulae. Balance billing the injured worker is prohibited.
Connecticut repealed no-fault, so there is no mandatory personal injury protection and no auto medical fee schedule. Auto injury care is billed to optional medical payments coverage, the patient’s health plan or third-party liability at reasonable and customary rates, and the order of coordination determines who pays first. Getting that order right, and tracking any attorney lien, is what protects the balance.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles Connecticut Medical Assistance Program enrollment, commercial credentialing, 20 and 60-day clock tracking, 15% interest recovery, work injury fee schedule pricing and Commission disputes across Connecticut, giving practices end-to-end RCM support in the fastest-clock state in the region.
Claims are scrubbed against HUSKY Health and commercial carrier edits before submission to drive clean first-pass reimbursement.
Work injury claims are priced against the correct schedule and the correct edition — practitioner from mid-July, hospital and ASC from 1 April — rather than last year’s figures.
We track the 20-day electronic and 60-day paper clocks on every claim and pursue the 15% interest Connecticut attaches to late payment, rather than absorbing it.
Working knowledge of Anthem Blue Cross and Blue Shield of Connecticut, ConnectiCare, Cigna, Aetna, UnitedHealthcare, Harvard Pilgrim and HUSKY Health submission protocols.
Whether you practise in Hartford, New Haven, Stamford, Bridgeport or Norwich, our workflows adjust seamlessly as your group grows across the state.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, review whether your pended claims meet the legitimate dispute standard, and quantify the 15% interest your practice is owed on claims paid outside the statutory window.
Under C.G.S. § 38a-816(15) an insurer, or any other entity responsible for paying a health care provider under a policy, must pay an accident and health claim within 20 days of receipt where the claim was submitted electronically, or within 60 days where it was submitted on paper. Failure to pay within those periods is itself an unfair insurance practice, and the payer owes the claim amount plus interest at 15% per annum.
The payer must request the missing information in writing within 10 days for an electronic claim or 30 days for a paper claim, and must then pay within 10 days, or 30 days respectively, of receiving what it asked for. Department guidance also expects payers to follow up within ten days where requested information has not arrived. A payer that never made a timely, specific request cannot rely on the missing information to excuse the delay.
Only where the Insurance Commissioner determines that a legitimate dispute exists as to coverage, liability or damages, or that the claimant fraudulently caused or contributed to the loss. Department guidance is explicit that delays arising from other investigations or inquiries are not a legitimate dispute unless the payer sought and obtained the Commissioner’s prior approval for that specific claim, which is why an open-ended pend should be challenged rather than accepted.
Connecticut does not use Medicaid managed care organizations. HUSKY Health is self-insured by the state and administered through statewide administrative services organizations for medical, behavioural health and dental care, with claims adjudicated through the Connecticut Medical Assistance Program. Practices deal with one set of enrollment, authorization and appeal rules rather than several competing plans, and there is no MCO assignment to verify before a visit.
Professional services are priced from the Official Connecticut Practitioner Fee Schedule, published by the Workers’ Compensation Commission and effective in mid-July each year. Physician fees are set at the 74th percentile of a statewide charge database, and non-physician practitioners billing the same CPT code are reimbursed at 70% of the physician fee, except in physical medicine, based on the licensure of the practitioner who performed the service. Hospital and ambulatory surgical centre services follow a separate schedule effective 1 April.
Connecticut is an at-fault state with no mandatory personal injury protection and no auto medical fee schedule, so auto injury care is billed at reasonable and customary rates to optional medical payments coverage, the patient’s health plan or the at-fault driver’s liability coverage. There is no administrative fee dispute forum for auto claims as there is in workers’ compensation, so coordination of benefits order, documentation and lien tracking carry the balance.
We serve practices and healthcare facilities statewide, including Bridgeport, New Haven, Stamford, Hartford, Waterbury, Norwalk, Danbury, New Britain, Bristol, Meriden, Milford, West Hartford, Middletown and Norwich.
