TB Billing and Payments

Key Information for Providers

• Providers must NOT directly bill patients for TB services for which they have requested reimbursement from the State of Connecticut.
• Providers must NOT deny patients TB-related care due to their inability to pay for care.
• Incorrect invoices will be rejected and returned for correction and resubmission.
• You may submit multiple claims under one TB Vendor form and one CO-17 form.
• Each claim does not need its own CO-17.

Essential Documents

Policy

• Tuberculosis Treatment and Care Payment Policy

Instructions

• How to Submit a Request for Reimbursement
• How to Find a Medicaid Rate

Forms

• Vendor Attestation/Contact Form and Invoice Form (CO-17)
• Request for Taxpayer Identification Number and Certification (Form W-9)

Examples of Acceptable Invoices

1. Hospital Inpatient
2. Hospital Outpatient
3. Laboratory
4. Local Health Department
5. Pharmacy
6. Physician
7. Radiology

Contact Us

Fax: 860-706-1232

Phone: 860-509-7722

Updated 11/24/2025