Date: January 10, 2017
To: Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP), and Nursing Facilities eligible to be licensed Specialized Mental Health Rehabilitation Facilities (SMHRF)
Re: Implementation of the Requirement for Long Term Care providers to Submit Monthly Billing for Reimbursement Purposes
As follow-up to previous Informational Notices on this topic, this notice informs Long Term Care (LTC) providers that the process to submit monthly billing to the Department for reimbursement purposes has been implemented and is effective for claims with dates of service on or after December 1, 2016. The Department is currently holding submitted claims and will release them for processing soon. A notification will be sent when all of the claims have been released and providers can view the claims status in the system.
Providers should follow the UB04 and 837I Implementation guidelines to submit claims electronically for reimbursement purposes. Electronic claims need to be submitted via an X12 file transfer or direct data entry (DDE) through the Department’s Internet Electronic Claims (IEC) system that is accessible through the Medical Electronic Data Interchange (MEDI) system. No paper claims will be accepted.
The Department will no longer generate claims for dates of service on and after December 1, 2016. However, the Department will continue to generate claims for dates of service prior to December 1, 2016. Providers should continue to submit admissions, discharges, TPL coverage, and changes in income through MEDI for all dates of service; but should only submit bed reserves and Medicare coverage for dates prior to December 1, 2016.
Providers may continue to submit test files to ensure claims are able to be successfully transmitted. The Department will process these test files in two batches. All files received by January 10th will be processed in the first batch, and files received between January 11th and January 24th will be processed in the second batch. Instructions for submitting test files can be found at: Testing X12 Claim Files
The Department encourages providers to visit the LTC Direct Billing webpage for informational material related to the direct billing process. Most recently, documents have been added detailing common billing issues seen on the provider test files, and the process to void and rebill incorrectly coded claims.
If you have questions regarding this process, contact the Bureau of Long Term Care at
Felicia F. Norwood