Provider Notice Issued 03/11/2020

​Date:   March 11, 2020

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

Re:      Implementation of New Policy for Systematic Processing of Facility to Facility Transfer Long Term Care Admissions and Additional MEDI Edits

This notice informs Long Term Care (LTC) providers that the Department of Healthcare and Family Services (HFS) is implementing new system changes for the processing of LTC admission transactions when an individual is transferring from one LTC provider to another.  LTC admissions that qualify as transfers will be systematically processed and entered into the State’s payment system.  Providers will be able to begin billing immediately for these transactions.

In addition, HFS is incorporating additional front-end edits into the MEDI LTC Admission process to more quickly notify providers of issues that will affect the processing of admission transactions.

Admissions Qualifying as Transfers

A submitted admission transaction will be considered a transfer, that may qualify for systematic processing, if the recipient has a prior LTC admission already on the system that:

Ø  is for a period of 60 days or more, and

Ø  has a discharge date that is within 60 days of the requested admission date.

If the admission qualifies as a transfer and is systematically processed, the message ‘Transaction Accepted and Processed’ will be returned on the MEDI LTC Admission Results above the Transaction Audit Number.

NOTE:  Previous admissions that are Provisional Eligibility admissions, Medicare Only admissions or admissions to a State Operated Facility are not considered prior qualifying admissions.

Admission Submission Requirements

RINs / SSNs:

Ø  In order to systematically process a transfer admission, the admission must be submitted with either a Recipient Identification Number (RIN) or a Social Security Number (SSN).

Ø  Using the resident’s RIN will provide the greatest assurance that the admission can be systematically processed.

Ø  For admission transactions submitted using only the SSN, it is required that the date of birth also be submitted to be eligible for systematic processing.  This will allow HFS to search and locate the correct RIN.  If a match is located, the RIN will be populated on the MEDI LTC Admission Results.  If the admission qualifies as a transfer, the matching RIN will be used to process the admission.

Ø  SSNs that are associated with multiple RINs will not be systematically processed.

Screening Information for Non-Transfers:

For admissions that do not qualify as a transfer, the following fields must be completed:

Ø  Date of Screening

Ø  Screening Results Received Date

Ø  Date of Admission to Facility

Ø  The Screening Attestation Checkbox

Ø  The ‘Screening Certified By’ information

NOTE:  Screening information is not required if the person will be receiving hospice services upon admission or if one of the ‘Post Screening Circumstance Boxes’ is selected, which includes, placement from out-of-state, hospital emergency, or due to loss of caregiver with a pre-existing condition of need for a caregiver.

If the screening information is required but is not submitted, the admission transaction will be rejected with the error message ‘448 – Screening Information Required’.  Providers receiving this message will need to submit an accepted admission transaction with the required screening information.

Ø  Only “Accepted” or “Accepted and Processed” transactions are considered valid.

Ø  All transactions that receive an error code are considered invalid and are not eligible for any further consideration. 

New Screening May be Needed  for Transfers:

For admissions that qualify as a transfer, the previous admission provider type is used to determine if a new screening is required (see the chart below).