TB Billing Policy

General Rules

• DPH may consider claims for individuals who are (1) uninsured, (2) underinsured, or (3) ineligible for TB Medicaid.
• Covered TB-related care can include office visits, radiology, laboratory tests, hospitalizations, and home visits for directly observed therapy (DOT).
• If a claim is accepted, DPH pays according to Medicaid rules and rates.
• For underinsured patients: if the insurance payment meets or exceeds the Medicaid rate, the bill is considered paid in full; if not, DPH may pay the difference up to the Medicaid rate.
• A patient’s inability to pay a co-pay must not result in denial of TB care; DPH may consider claims for co-pays the patient cannot afford.
• No balance billing for TB care (per Conn. Gen. Stat. § 19a-255(b)).
• Once a provider submits a claim for TB services to DPH, the patient or any other party may not be billed for those services.
• Before submitting to DPH, the provider must determine whether any third-party payers (insurers, etc.) are liable, including assessing Medicaid eligibility. Claims must first be submitted to liable payers.
• DPH will consider claims only when: (1) no third-party payers exist, or (2) a third-party denies payment after proper submission and all reasonable reimbursement efforts. Proof of denial must accompany the DPH claim.

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Claims Process

Your faxed packet must include all of the following:

1. A completed Vendor Attestation/Contact Form and Invoice Form (CO-17).
   • Find the program forms and instructions at TB Billing and Payments.
2. Proof of TB-related service:
   • Explanation of Benefits (EOB), Health Insurance Claim Form (HICF/HCFA/CMS-1500), or other documentation (e.g., DOT logs, contact investigation worksheet).
   • Documentation must include patient info, diagnostic code, procedure code, date(s) of service, and provider name/address.
3. Vendor enrollment with the State of Connecticut (required):
   • IRS Form W-9 (Rev. March 2024)
   • SP-26NB Agency Vendor Form
   • (Optional) Direct Deposit (ACH) Enrollment — include bank verification (voided check/bank letter/pre-printed deposit slip).

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Time Limits

Consistent with state Medicaid policy, all claims must be submitted within six (6) months of the date of service or the last date of service when services are consecutive or billed as a unit.

Exceptions:

• If health insurance/Medicaid eligibility is under a grievance process, submit as above or within six (6) months of the grievance resolution effective date, whichever is later.
• If a claim was submitted to a third-party insurer and no response within 60 days was received, the six-month expiration begins one (1) year from the date DPH receives the EOB (or other proof of service).

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Contact

TB Billing Submission Fax (secured): 860-706-1232

Program questions: DPH TB Control Program, 860-509-7722

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Updated 11/24/2025