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Elizabeth M. Whitehorn, Director

Provider Notice issued 03/14/16

Requirement for Providers to Submit Monthly Billing for Reimbursement Purposes - Effective July 1, 2016

To: Long Term Care Facilities – Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities
Date: March 14, 2016
Re: Requirement for Providers to Submit Monthly Billing for Reimbursement Purposes - Effective July 1, 2016

 

A March 18, 2015 notice entitled Monthly Billing Requirement provided introductory information regarding the provisions of P.A. 98-0104 which requires certain long term care providers to submit monthly billings for reimbursement purposes. P.A. 98-0963 extends this requirement to providers of facilities licensed under the ID/DD Community Care Act.  

Healthcare and Family Services (HFS) will be implementing this process, following national billing standards, for Long Term Care providers, including Intermediate Care Facilities beginning July 1, 2016. This billing process will follow the UB04 and 837I Implementation guidelines. Providers or their billing agents will be required to electronically submit monthly claims for dates of service beginning July 1, 2016, using the Health Insurance Portability and Accountability Act (HIPAA)-compliant 837I Institutional Health Care Claim. The monthly claim will be submitted via an X12 file transfer or direct data entry following the UB-04 format. Paper claims will not be accepted. 

Providers will be able to submit claims for consideration through the HFS Internet Electronic Claim (IEC) system which is accessible through the Medical Electronic Data Interchange (MEDI). HFS currently supports HIPAA version 005010XX223A2 for 837I claims in X12 format.
 
Other Changes include:

  • Pre-payment reports will no longer be generated for service periods after June 30, 2016.
  • Bed reserves must be reported on the monthly claim. Providers will no longer be required to report bed reserves through the LTC EDI transactions for dates of service after June 30, 2016. However, resident admissions, income changes, and discharges should continue to be entered using MEDI or one of the EDI (formerly referred to as REV) vendors.
  • Incorrect billings due to changes in recipient information will require providers to submit Form HFS 2249, Adjustment to void a claim. Once the void has been processed, providers must submit a new claim with corrected information for payment consideration. Adjustments for rate changes will continue to be completed by HFS.
  • HFS is in discussion with DHS staff regarding reimbursement for day training services and exploring the option of including in the direct billing process.  Information will be provided as decisions are made.

The billing system currently in place for providers to access and process claims will not change until the new billing process is fully implemented. Claims for dates of service prior to July 1, 2016 will continue to be generated and facilities must continue to meet all requirements of timely submittal through MEDI or EDI vendor.

The requirement for providers to submit monthly billings for reimbursement purposes does not impact the reimbursement rates paid to providers.  Providers will continue to be reimbursed in accordance with their Medicaid approved reimbursement methodology.

Future notices will provide more detailed billing instructions, list of acceptable codes, and information on training sessions.

Felicia F. Norwood
Director