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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/16/10

Pay-To Provider (Payee) Billing Changes for Handbook for Hospice Agencies

 

To:​ Participating Hospices​
Date:​ November 16, 2010​
Re:​ Pay-To Provider (Payee) Billing Changes for Handbook for Hospice Agencies​

 

The department has updated billing instructions for paper UB-04 hospice claims, to conform to new billing requirements related to the Pay-To Provider (Payee) in Form Locator 2.

 

Per the department's Informational Notice dated April 28, 2010, (Elimination of the One-Digit Payee Code) effective with claims received on and after October 1, 2010, providers must utilize the Pay-to Provider NPI. The department will no longer accept the one-digit payee code to designate the appropriate payee. Providers should use the billing guidelines in the Handbook for Hospice Agencies, Appendix K-2, in conjunction with the UB-04 Data Specifications Manual. To become a UB-04 Subscriber, refer to the National Uniform Billing Committee (NUBC) Web site.

Appendix K-2 in the Handbook for Hospice Agencies has been updated and is available on the department's Web site. Printed copies of this bulletin and replacement pages for the handbook are available upon written request. To ensure delivery, specify a physical street address when making a request for a paper copy. Submit your written request or fax to:

 

Illinois Department of Healthcare and Family Services

Provider Participation Unit

Post Office Box 19114

Springfield, Illinois 62794-9114

Fax Number 217-557-8800

E-mail the Provider Participation Unit

 

Any questions regarding this bulletin should be directed to your facility's medical assistance consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

Instructions for updating the Handbook for Hospice Agencies:

Remove Appendix Page K-2 (1) dated October 2008 and insert updated Page K-2 (1) with revision date November 2010.

 

Appendix K-2

 

UB-04 Requirements for HFS Adjudication

Instructions for completion of this form follow in the order entries appear on the form. Mailing instructions follow the claim preparation instructions. All hospices should have a copy of the UB-04 Data Specifications Manual for reference. To become a UB-04 Subscriber, refer to the National Uniform Billing Committee (NUBC) Web site. The UB-04 Data Specifications Manual contains a blank facsimile of the UB-04. Providers may also view a UB-04 facsimile on the department's Web site. For billing purposes, providers must still submit an original UB-04.

The left hand column of the following instructions identifies mandatory and optional items for form completion as follows:

Required = Entry always required.

Optional = Entry optional – In some cases failure to include an entry will result in certain assumptions by the department and will preclude corrections of certain claiming errors by the department.

Conditionally Required = Entries that are required based on certain circumstances. Conditions of the requirement are identified in the instruction text.

Completion Form Locator Form Locator Explanation and Instructions for Hospice Claims
Required 1. Provider Name – Enter the provider’s name exactly as it appears on the Provider Information Sheet.
Conditionally Required
Revised November 2010 – Effective October 2010		 2.

Pay-To Name and Address – Effective with claims received August 1, 2009, through September 30, 2010, HFS allowed a dual process for reporting the payee. The dual process period allowed providers to transition from using the one-digit payee code to using the Pay-To Provider (Payee) NPI.

 

For claims received on and after October 1, 2010, the department will only accept the Pay-To Provider (Payee) NPI. Report the Pay-To Provider (Payee) NPI, which is registered to the appropriate 16-digit payee number, on Line 4

.

Payee information is only required when the payee is a different entity than the Billing Provider. Refer to the Provider Information Sheet for payee information.

The Pay-To Address is required when the address for payment is different than that of the Billing Provider in FL1.
Optional 3a. Patient Control Number
Optional 3b. Medical Record Number
Required 4. Type of Bill – A 4-digit field is required. Do not drop the leading zero in this field.
Optional 5. Fed. Tax No.
Required 6. Statement Covers Period
Optional 10. Patient Birth Date - If the birth date is entered, the department will, where possible, correct claims suspended due to recipient name and number errors. If the birth date is not entered, the department will not attempt corrections.
Required 12. Admission Date
Required 17. Patient Discharge Status
Conditionally Required 35. - 36. Occurrence Span Code/From/Through – Indicate the non-covered date span.
Required 39. - 41.

Value Codes – Value Code 80 is required for all hospice claims (the number of days covered by the primary payer). The other value codes below are conditionally required based upon the particular claim:

 

Value Code 81 – The number of days of care not covered by the primary payer.

 

Value Code G8 - For dates of service beginning January 1, 2008, providers must use Value Code G8 in the code field with the appropriate CBSA in the amount field on their claims to identify the location of the inpatient facility where inpatient respite (Revenue Code 0655) or general inpatient (Revenue Code 0656) care services were provided. The CBSA code is to be reported right justified to the left of the dollar/cents delimiter.

 

Value Code 61 - Providers must use Value Code 61 in the code field with the appropriate CBSA in the amount field on their claims to identify the location where routine home care (Revenue Code 0651) or continuous home care (Revenue Code 0652) services were provided. The CBSA code is to be reported right justified to the left of the dollar/cents delimiter.

 

Value Code 66 - Spenddown liability must be reported using Value Code 66 along with a dollar amount to identify the patient's Spenddown liability. The 2432, Split Billing Transmittal, must accompany the claim.