Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 12/17/14

Clarification on MCO Hospital Encounter Claim Submittal

To:​ Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers​
​Date: ​December 17, 2014
​Re: Clarification on MCO Hospital Encounter Claim Submittal​

This notice is to inform Institutional providers about specific encounter submission formatting for ancillary services.

The Department of Healthcare and Family Services (HFS) mandates Managed Care Organizations (MCOs) to submit outpatient encounters via an HFS 837I (pdf) and shall include one of the following:

  • Ambulatory Procedure Listing (APL) procedure code,

  • Emergency room revenue code, or

  • Observation revenue code

In all cases where one of these three criteria is not met, MCOs must submit the encounters to HFS via an HFS 837P (pdf). The Medicaid Management Information System (MMIS) system will reject these types of encounters if the above protocol is not followed.

 

Dan Jenkins, Chief

Bureau of Rate Development and Analysis

Division of Medical Programs