Provider Notice Issued 05/07/2018

​

Date:  May 7, 2018                                                   

To:     Long Term Care (Nursing Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Specialized Mental Health Rehabilitation Facilities and Supportive Living Facilities)

Re:     MEDI Enhancements and Instructions for Medicare-Only Admission Transactions

______________________________________________________________________

The Department of Healthcare and Family Services (HFS) has added new data fields to the Medical Electronic Data Interchange (MEDI) LTC Admission link.  The new data fields will be used to streamline admission processing and allow providers to include discharge information when known at time of admission submittal.

New MEDI LTC changes provide fields to allow facilities to:

·       Report their Private Pay Rate (used to calculate spenddown amount and penalty period),

·       Enter Discharge Date, Destination Code, and Body Released To information at the time the admission is submitted (if appropriate),

·       Report Dwelling Type (Supportive Living Providers only),

·       Report the date the facility received the screening documentation.

·       Report Medicare Only admissions (with check box).

In addition to these new fields, a new automated admission approval process has been developed for dually-eligible (Medicare and Medicaid) individuals.  This streamlined process is only applicable to Medicare covered service periods in which the stay is anticipated to be short-term and covered by Medicare as the primary payer.  For individuals who qualify for this automated admission process, providers must identify the admission by selecting the new “Medicare Only” check box.  

This new process is only applicable to individuals who are either a Qualified Medicare Beneficiary (QMB)-only or QMB-dual.  This automated process will immediately enter the accepted admission transactions into the Long Term Care (LTC) eligibility systems.  Successful Medicare Only admission transactions will receive a message indicating the submission was “Accepted and Processed” in addition to the Transaction Audit Number (TAN).  The screen will also indicate that the admission is a “Medicare Only Admission.”  Providers will be able to immediately submit monthly Medicare primary claims to HFS for accepted Medicare only admissions.

The MEDI enhancements include a new restriction which requires a Medicare only admission should be submitted within 45 days of the admission date.  Not submitting the Medicare only transaction within 45 days of the date of admission will result in the denial of the transaction due to untimely filing. 

(Note: A non-Medicare only admission will also present this error if the admission date is in excess of 45 days from the admission date and no screening date is entered.)

If the individual remains after their Medicare benefits are exhausted, the provider must submit an additional admission transaction through MEDI for the Medicaid primary service period.  The admission date must be the date Medicaid primary coverage is to begin. This transaction will be processed using the normal Department of Human Services (DHS) review and approval procedures. 

Once approved by DHS the provider will be able to submit monthly claims to HFS for the individual’s care.

The Admission Page Help screen, Frequently Asked Questions (FAQ) document and MEDI Overview have been updated to reflect these revisions.

It is anticipated that HFS will use these MEDI enhancements to automate admissions for transfers between allowable facilities.  A provider notice will be sent out once that programming is completed.

If you have questions, contact the Bureau of Long Term Care toll-free at 844-528-8444.

Felicia F. Norwood

Director