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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/24/16

Requirement for Long Term Care Providers to Submit Monthly Billing for Reimbursement Purposes – Delayed Implementation

 

​To:

​Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP), Nursing Facilities eligible to be licensed as Specialized Mental Health Rehabilitation Facilities (SMHRF) and State-Operated Facilities
​Date: ​October 24, 2016
​Re: ​Requirement for Long Term Care Providers to Submit Monthly Billing for Reimbursement Purposes – Delayed Implementation

 

For several months the Department has been meeting with Long Term Care (LTC) provider associations to discuss issues related to the new direct billing process. Two of the main issues have been provider system readiness to generate claim files and available time for adequate testing.

In an effort to be responsive to these issues and allow more time for provider testing, the Department is delaying the implementation of the direct billing process by two months. The new effective date for implementation will be for claims with service dates on and after December 1, 2016. The Department expects to start receiving these claims in January 2017.

All current system processing will remain in place until the new system is operational.  Leaves of absence (bed reserves) and Medicare coverage will continue to be entered by providers through the Medical Electronic Data Interchange (MEDI) or EDI Vendor (formerly known as REV) systems for dates of service in October and November 2016.

The Department will continue to meet with LTC provider associations as well as conduct technical assistance calls with providers to discuss specific billing issues. Billing, technical support and contact information for the direct billing process can be found on the Long Term Care Services and Supports (LTSS) Long Term Care Direct Billing webpage.

Questions regarding this notice may be directed to the Bureau of Long Term Care at  

1-844-528-8444 (toll free).

                                                

 

 

Felicia F. Norwood

Director