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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/12/04

Long Term Care Electronic Data Interchange System

To:​

Providers of Long Term Care (Nursing Facilities and Intermediate Care Facilities for the Developmentally Disabled) ​

Date:​ July 12, 2004​
Re:​ Long Term Care Electronic Data Interchange System​

Effective June 15, 2004, DPA implemented Phase 3 of the Long Term Care Electronic Data Interchange System (LTC/EDI) statewide. The LTC/EDI system allows electronic information to be submitted to DPA through companies known as REV vendors. Phase 3 provides for the electronic reporting of admission, income, third party liability (TPL) information and, in certain cases, updating of the patient credit. Phase 1 and Phase 2 of the LTC/EDI system, which were described in DPA’s provider notices dated July 13, 1999 and June 30, 2000, respectively, allow for the electronic reporting of bed reserve, discharge, and Medicare covered services. The goals of the LTC/EDI system are to reduce the number of adjustments to payments, the time needed to enter information into DPA’s data bases, and the amount of paper flowing between facilities, DPA and DHS. It also provides DHS and DPA with a better mechanism to track the transactions submitted to DPA.

 

A facility using the LTC/EDI system does not mail the forms listed below to the Department of Human Services (DHS) local office as they are automatically printed at the corresponding local office:

  • DPA 26, Report of Resident of Private Long Term Care Facility
  • DPA 1156, Long Term Care Facility Notification
  • DPA 2448, Physician Certification
  • DPA 2536, Interagency Certification of Screening Results

Central Updating of Patient Credit

  • The LTC/EDI system can be used for reporting and updating an increase to the resident income for the current month or next month.
  • Automatic updates for decreases in patient income through LTC/EDI are not being allowed by the Department at this time. Decreases may only be reported through the LTC/EDI system. The reported changes will be passed-through to the DHS local office.
  • A facility is not to use the LTC/EDI system for the central updating of patient credit changes due to an earned income change. Earned income changes may be reported through the LTC/EDI system. The reported changes will be passed-through to the DHS local office.
  • Income verification must be submitted to the DHS local office for any patient credit change.
  • Date of submission to the DHS local office must be entered onto the LTC/EDI system.

 

A Notice of Change in the Amount Owed for Care (Form 2434F) is centrally mailed to each client whose credit amount was centrally updated. Form 2434F informs the client of the amount available to apply to the cost of care.

Reporting Resident Death

Facilities who contract with a Recipient Eligibility Verification (REV) vendor will not be required to report resident deaths to DHS, Exception Processing Unit, or DHS local office, as described in DPA’s provider notices dated April 3, 1998 and July 14, 2000 and provider bulletin dated August 12, 1999. Deaths are to be reported via LTC/EDI. As required under 89 Illinois Administrative Code 140.513, any change in a resident’s status shall be reported to the Department within five working days after the change.

Locating a REV Vendor

The list of REV vendors can be found on the department’s Web site at <www.dpaillinois.com/rev/>. At this time only one REV vendor, Medi, Inc. has the capability to accept the LTC/EDI transactions. Long term care providers desiring to participate in the LTC/EDI system will incur charges from the REV vendor.

If you have any questions concerning the LTC/EDI system, please contact the Bureau of Long Term Care at 217-524-7244.

 

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs