Policies, Procedures, & Guidelines

The policies, procedures, and guidelines page provides information to providers in the form of administrative and clinical policies and guidelines.

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 Community Health Network of Connecticut, Inc. (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.

This portion of the HUSKY Health website is managed by Community Health Network of Connecticut, Inc., the State of Connecticut’s Medical Administrative Services Organization for the HUSKY Health Program. For the general HUSKY website gateway, please visit www.ct.gov/husky. HUSKY Health includes Medicaid and the Children’s Health Insurance Program, and is administered by the Connecticut Department of Social Services.