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Elizabeth M. Whitehorn, Director

Provider Notice Issued 05/15/2018

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Date:  May 15, 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:     Automated Adjustment Process for the Long Term Care Direct Billing System

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This notice informs providers of the implementation of an automated adjustment process for claims billed by providers since the implementation of the Long Term Care Direct Billing System. The automated adjustment process will adjust claims with service periods beginning on and after December 1, 2016. It is anticipated that adjustments will process on the second weekend of each month.

 

The system will process outstanding adjustments due to Patient Credit changes that have been processed by the Department of Human Services as well as retroactive changes to the Medicaid per diem rate.

 

The system will provide detailed information regarding the adjustments and identify each on the Remittance Advice by Recipient Identification Number, Service Period through Date of the Claim, and Adjustment Reason Code.

 

The Remittance Advice will use the following reason codes for the adjustments:

·       0001 – Change of Patient Income

·       0205 – Facility Per Diem Change

·       3012 – Dev Training Adjustment Amount

 

The current Mass-to-Detail adjustment process will continue to adjust claims for services periods prior to December 1, 2016.

 

For questions regarding this notice, contact the Bureau of Long Term Care toll-free at 844-528-8444.

 

Felicia F. Norwood

Director