Prior authorization refers to the Community Health Network of Connecticut, Inc. (CHNCT) process for approving covered services prior to the delivery of the service or initiation of the plan of care based on a determination by CHNCT as to whether the requested service is medically necessary.
Prior authorization is NOT required for dual eligible members (Medicare/Medicaid coverage) unless the good or service is not covered by the member’s Medicare plan. Please use the links below or the main navigation menu to access all of the following:Medical Prior Authorizations
Help with Prior Authorization
CHNCT’s Medical Authorization Portal, Clear Coverage™, gives providers the ability to electronically submit prior authorization requests for urgent and emergent inpatient admissions, all durable medical equipment (DME), medical/surgical supplies, therapy services and home health visits. Through this secure portal, providers have the ability to request authorizations, submit clinical information and track requests.Medical Authorization Portal
To view CHNCT’s Medical Prior Authorization Portal training video, click here.
If you do not have a Medical Authorization Portal user account or would like to add users to an existing account, contact CHNCT support for more information at:
The portal allows providers to backdate the prior authorization request up to five (5) calendar days to accommodate for member retroactive enrollment and holidays.
To search for a provider name, requesting providers may be found only by entering the provider’s last name in the “last name“ lookup field.
The portal is now optimized for use with Internet Explorer (IE) 11, Google Chrome (version 38 and higher), and Mozilla Firefox (version 27 and higher). Users accessing the Medical Authorization Portal through an unsupported Internet browser should upgrade to a supported browser as soon as possible to avoid disruptions in access. If you use IE version 10 or earlier and experience any technical difficulties accessing or using Clear Coverage, please upgrade your browser to IE 11. If you use Google Chrome and Mozilla Firefox, please verify you are on the appropriate version to ensure compatibility. To do so, go to the Help menu on your IE toolbar to find information on your current version of IE and how to upgrade. You should also use Adobe Flash Player 17.x or later for best results.
If you are unable to upgrade or have issues submitting your authorizations, please fax your requests and clinical information to 203.265.3994.
To search for members, the member name may not be used. You may only use the member Connecticut Medicaid ID number and Date of Birth.
A member who displays with an “NA” under the eligibility column is not eligible and an authorization request cannot be created in Clear Coverage.
Please note: Behavioral Health inpatient authorizations should continue to be directed to Beacon Health Options via phone at 1.877.552.8247. Behavioral Health Home Health authorizations should continue to be directed to Beacon Health Options via ProviderConnect, an online registration application located on the “For Providers” homepage at www.ctbhp.com.
Prior Authorization Requirements
In an effort to streamline the process for prior authorization reviews, please review the list of requirements for the submission of initial authorization and reauthorization requests for non-radiology medical goods and services.
If you have any questions, please review our FAQs.
HUSKY Plus program (HUSKY Plus) is a HUSKY B supplemental program for medically eligible members, whose intensive physical health needs cannot be met within the HUSKY B package of services. HUSKY Plus supplements includes: long-term rehab, incontinence supplies, wheelchairs, hearing aids and diabetic shoes for members who have exhausted one or more of their HUSKY B benefits. Participation in HUSKY Plus continues as long as the member is enrolled with HUSKY B.
Beginning with date of service July 1, 2017, the HUSKY Plus program will be managed by Community Health Network of Connecticut, Inc. (CHNCT). The Connecticut Children’s Medical Center (CCMC) managed the program for services provided through June 30, 2017.
For questions about Prior Authorizations for dates of service, July 1, 2017 and forward, please call CHNCT at 1.800.440.5071 from 8:00 a.m. to 6:00 p.m.
For questions about Prior Authorizations, claims processing, and payments for dates of service prior to July 1, 2017, please call CCMC at 1.877.743.5516 from 8 a.m. to 4:30 p.m. or fax inquries to 860.837.6201.
For assistance with provider enrollment, claims processing, and payments for dates of service, July 1, 2017 and forward, please call DXC Technology at 1.800.842.8440 from 8 a.m. to 5 p.m.
Prior Authorization requests can be submitted via fax to 203.265.3994
Rehabilitation clinics and independent therapists must submit PA requests using a Procedure Code Group and number of units that identify the requested service.
CHNCT has contracted with eviCore healthcare to perform medical necessity reviews for high-tech radiology procedures (MRI, MRA, CT, CTA, PET, PET/CT). Prior authorization is required for HUSKY A, B, C, D and limited eligibility members who are 19 years of age and over at the time of service and those dual eligible members without Medicare Part B coverage. eviCore will perform medical necessity reviews for new and retrospective requests and process modifications to existing authorizations. Please reference DSS Provider Bulletin PB 2016-70 “Important Changes to the Radiology Benefit Management Program” for additional details.
eviCore’s Radiology Prior Authorization Portal gives providers the ability to electronically submit prior authorization requests for high-tech radiology procedures. Through this portal, providers have the ability to request authorizations, submit supporting clinical documentation and view the status of existing requests.Radiology Authorization Portal
Additional resources and forms are available at the following links:
For Technical Portal Support for the eviCore Portal please contact: 1.800.575.4594.
View your authorization units used by visiting the secure portal. Once you have logged in to the secure portal, click the "Authorizations" link to access this new feature. You will then be granted access via our Web Support Help Desk.
Please note: The authorization units used information is updated twice a month and coincides with the HPE check writes.If you are experiencing technical issues, please contact us at 1.877.606.5172, Monday through Friday 9:00 a.m. – 4:00 p.m.
To update your information, please select your HUSKY Health Program type. Once you select your program, you will need to login to access and review your personal information.
To see whether you belong to HUSKY A, B, C, D, or LB simply look at your HUSKY ID Card. The big, bold letter is your HUSKY program.