Section 17-2-77 - State department of social services policyA. Services Covered by Medicare. For services covered by Medicare, the Provider must complete the Form SSA-1490, Request for Medicare Payment, or Form SSA-1491, Request for Medicare Payment-Ambulance, and submit the Medicare Claim Form directly to Connecticut General, Medicare Claim Office, 200 Pratt Street, Meriden, Connecticut 06450. Please provide the recipient's health insurance claim number, current Social Services case number and signature.B. Acceptance of Assignment. An assignment for each bill must be accepted since the Social Services recipient has no other resources to meet medical expenses. The Department of Social Services will not be liable for any balance between the amount billed to Medicare and the total amount allowed by Medicare.
C. Prior Authorization. There are services which ordinarily require a Prior Authorization by the Department of Social Services. If the provider sends a Medicare claim for these services to the Connecticut General Medicare Claim Office and the claim is rejected because the individual is not covered under Medicare Part B, a prior authorization will not be required by this Department. However, these bills will be reviewed by the State Department of Social Services, Division of Health Services, for necessity of services provided and the charge for same.
D. Services Definitely Not Covered by Medicare. Claims for payment for those services which Medicare definitely does not cover, must be submitted directly to the State Department of Social Services on the Social Services Bill Form with the notation on the bill "SERVICE NOT COVERED BY MEDICARE." (For example, flu shots, hearing aids (cords, batteries), et cetera). In order to bill in this manner, it must be clearly evident to the provider that the service is definitely not covered by Medicare. If these non-covered services require a Prior Authorization, the Provider must submit a prior authorization to the Department of Social Services prior to the submission of the Social Services Bill. The provider must note on the prior authorization form "SERVICE NOT COVERED BY MEDICARE." This will alert the Department of Social Services that it is the intent of the provider to bill the Department directly.
IMPORTANT: If the Provider is aware that the services are definitely not covered by Medicare and continues to bill Medicare directly for these particular services, the Department of Social Services will not honor the bill(s) for payment.
Conn. Agencies Regs. § 17-2-77
Effective September 29, 1977