Provider Notice issued 11/30/12

Medical Electronic Data Interchange (MEDI)

The purpose of this informational notice is to remind all providers of Long Term Care that admissions and changes in status of Medicaid-eligible long term care residents must be reported electronically to the Department using the Medical Electronic Data Interchange (MEDI) or Recipient Eligibility Verification (REV) system vendors. The requirement to submit this data as outlined in the 89 IL Admin. Code, Section 140.513. Failure to comply may result in the delay or denial of payment or suspension or termination of the facility's Medicaid certification.

• All admissions and changes in the resident's status including discharges must be reported within five working days through the MEDI or REV systems. All supporting documentation must be submitted within 30 days.

• All claims for payment including resubmitted claims (requests for payment) must be submitted no later than 180 days after the date of service or admission transaction has been completed.

• All Medicare coverage, bed reserves and temporary absences must be reported by the 13th of the month following the service month affected.

• Patient credit updates can only be processed electronically for the current month or the next month. Changes for past months must be made by submitting paper HFS 1156, to the Department of Human Services Family and Community Resource Center (DHS FCRC).

• To report nonpayments, overpayments or underpayments, a provider should submit HFS 3725, Payment Review Request Form which serves as documentation of request for payment correction. Guidelines for submitting HFS 3725 can be found in the Nursing Home Handbook at C-265.

Facilities can access MEDI through the MEDI Web site or through REV system vendors Emdeon or Nebo whose contact information can be found on the HFS Web site. HFS requires authorization for applications provided through the Internet. In order to gain access to these applications, a person must register in the MEDI System and receive authorization. The MEDI Training page is also available at the HFS Web site. MEDI registration is not required to access the training tutorial.

Authorized users for each provider can also verify recipient eligibility and access claim status information through the MEDI and REV systems. Remittance advices are available on the Department's MEDI system upon request. For assistance with the registration process or making electronic remittance advices available, please submit an inquiry electronically using the "Contact Us" link on the MEDI Web site or by calling the MEDI help desk at 1-800-366-8768.

Questions regarding this notice may be directed to the Bureau of Long Term Care at 217-782-0545.

Theresa A. Eagleson, Administrator

Division of Medical Programs