Change in denial process for lack of prior authorization

CarePartners of Connecticut is offering a reminder of the change we previously announced pertaining to claim adjudication for ancillary and supporting services when they are billed in connection with services that require prior authorization and that authorization is not obtained, as the change is now in effect.

As we shared in previous issues of Provider Update, effective for dates of service beginning July 1, 2026, if a claim is denied due to lack of prior authorization, untimely authorization, or failure to meet medical necessity criteria, any related ancillary or supporting services or procedures associated with the denied service, whether billed on the same claim or on separate claims, will also be denied. This includes medications used to support the procedure requiring prior authorization.

Ambulance services as well as the reading of lab/pathology and radiology reports are excluded from this updated denial process.