Provider Notice Issued 05/21/19

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Date:   5/21/19                                                                       

To:      Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Specialized Mental Health Rehabilitation Facilities (SMHRF), and Supportive Living Program (SLP) providers

Re:      Instructions to Long Term Care Providers for Locating the Redetermination Date of Medicaid Eligible Residents in the Medical Electronic Data Interchange (MEDI) System

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This notice supersedes the March 18, 2015 informational notice, titled “Facility Notification of Redeterminations of Eligibility”. The interim process, where Long Term Care (LTC) providers had registered with the Bureau of Long Term Care to receive the monthly email notification of residents coming due for their Medicaid redetermination (REDE), has been discontinued.

This notice informs LTC providers of the processes available to locate the date an LTC resident is scheduled for their annual REDE of Medicaid eligibility utilizing the Medical Electronic Data Interchange (MEDI) system.

• Option 1: LTC providers may complete a Medicaid eligibility inquiry for ‘each’ resident through the Internet Electronic Claims (IEC) system link found on the MEDI Home Page through the Eligibility Inquiry function.

Below is an example of a MEDI response that is returned upon the submission of the provider and resident identifying information. The Renewal Due Date field is the date the REDE form should be returned to avoid an interruption in Medicaid eligibility.

• Option 2:  LTC providers may upload a HIPAA X12N 270 Eligibility Inquiry for a ‘group’ of residents through the IEC link found on the MEDI Home Page.
  

Instructions for completing the inquiry can be found in Chapter 300 of the Companion Guide HIPAA 5010 - Health Care Eligibility Benefit Inquiry and Response: 270/271 Standard Companion Guide

Below is an example of a HIPAA X12N 271 Eligibility Response that is returned upon the submission of the requested information through the Upload/Download HIPAA-compliant transaction. The DTP01 458 is the ‘certification’ date, also known as Renewal Due Date. This is the date the REDE form should be returned to avoid an interruption in Medicaid eligibility.

ISA*00*          *00*          *ZZ*37-1320188     *ZZ*123456789DPA001*180521*0958*^*00501*000000120*0*P*:~

GS*HB*37-1320188*6060301*20180521*09583250*1*X*005010X279A1~

ST*271*1   *005010X279A1~

BHT*0022*11*EPIC50260012345*20180521*13520985~

HL*1**20*1~

NM1*PR*2*ILLINOIS MEDICAID*****FI*37-1320188~

HL*2*1*21*1~

NM1*1P*2*ACME LTC BILLING AGENT*****XX*1234567800~

HL*3*2*22*0~

TRN*1*201814113520976*1371320188*ILLINOIS MEDICAID~

TRN*2*123456789001*1371320188*AMBDEF~

NM1*IL*1*DOE*JOHN****MI*012345678~

N3*555 NORTH STREET ~

N4*CHICAGO*IL*606141502~

DMG*D8*19620822*M~

DTP*458*D8*20181001~ 
EB*1*IND*AD^AF^AG^AI^AL^A6^A7^A8^BG^BH^MH^UC^1^12^13^18^2^20^30^35^4^40^42^45^47^48^5^50^51^52^53^6^62^65^68^7^73^76^78^8^80^82^86^88^91^92^93^98^*MC*MEDICAID ELIGIBLE, FULL COVERAGE~

REF*M7*94200123456789~

DTP*636*D8*20180425~

DTP*307*RD8*20170901-20170930~

MSG*SEE COMPANION GUIDE MESSAGE - 10 19~

MSG*38 RECIPIENT IS IN A LONG TERM CARE FACILITY FOR THE DATE RANGE REQUESTED~

SE*21*1   ~

GE*1*1~

IEA*1*000000120~

This notice serves as a reminder that LTC providers should use the mailing address or fax number of the appropriate Department of Human Services (DHS) Medical Field Operations (MFO) office to submit all REDE forms and supporting verifications. 

Recipients and/or their authorized representative, may also utilize the Application for Benefits Eligibility (ABE) Manage My Case function to upload the REDE form and supporting documentation. The Renew My Benefits button will only appear if it is time for the redetermination.

For a complete list of counties served by each DHS MFO office, please refer to the May 10, 2017 informational notice titled “Department of Human Services Medical Field Operations Changes".

Resident information is based upon the latest action(s) completed by the DHS caseworkers.

In addition, the Managed Care Organization the resident is enrolled with may contact the facility, resident, or their authorized representative to coordinate efforts to complete the REDE process.

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

Doug Elwell,

Medicaid Director