Provider Notice Issued 04/11/2019

Date:   April 11, 2019                                                            
 
To:      Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Medically Complex for the Developmentally Disabled Facilities (MC/DD), Supportive Living Program (SLP) Providers, and Specialized Mental Health Rehabilitation Facilities (SMHRF)
 
Re:      Patient Credit File Download through the Medical Electronic Data Interchange (MEDI) System
______________________________________________________________________
 
Registered Medical Electronic Data Interchange (MEDI) users can access the Patient Credit File for their facilities by following the MEDI IEC Download link, and choosing a file and a directory to designate where the downloaded file is distributed in the user’s system. The user must go to the designated location and choose a program to open the file. WordPad is recommended. To access and download the Patient Credit File follow these steps:
 
1.    Login to MEDI
2.    Select Internet Electronic Claims (IEC)
3.    Select Download File(s)
4.    Choose the “Entity” from the drop down box
5.    Select the file you wish to down load from the “Available Files” listed
6.    Enter a “Local Directory Location” (a folder created on your computer or network) to accept the downloaded file
7.    Click “Download Files” button
8.    Go to your designated directory location
9.    Open the downloaded file (recommended program is WordPad)
 
The Patient Credit file contains recipient specific information for facility residents enrolled in managed care plans at the time the file is generated by Healthcare and Family Services. This is the same information that is available to each Managed Care Organization (MCO) plan. Currently this information is updated monthly on the sixth of each month.  Programming is in development to add an indicator for Provisional Eligibility and to make the file available on a weekly basis.
 
The file layout of the Patient Credit file is provided below.  All patient credit segments from the previous 36 months are available on this file for each individual.  Below the file layout are two tables which detail the codes that will be populated in the MCO Project Code and the MCO Plan Type Code.
 
 
 
Patient Credit File Layout
Data Element
Description/Rules
Data Type
Data Length
Starting Position
Ending Position
Recipient Identification Number
Recipient ID Number
Varchar
9
1
9
Recipient Last Name
Clients Last Name
Varchar
14
10
23
Recipient First Name
Clients First Name
Varchar
9
24
32
Long Term Care Provider Number
LTC Facility ID
Varchar
12
33
44
Hospice Provider Number
Hospice Provider Number
Varchar
12
45
56
Patient Credit Begin Julian Date
Patient Credit Effective Date CCYYDDD
Date
7
57
63
Patient Credit End Julian Date
Patient Credit End Date CCYYDDD
Date
7
64
70
Patient Credit Amount
Patient Credit Amount 0000000.00
Numeric
9
71
79
Level of Care Category of Service
LTC Level of Care Category of Service Code
Varchar
3
80
82
Level of Care Effective Date
LTC Level of Care Begin Date CCYYDDD
Date
7
83
89
Level of Care End Date
LTC Level of Care End Date CCYYDDD
Date
7
90
96
Managed Care Project Code
Varchar
2
97
98
MCO Plan Type Code
Managed Care Plan Type Code
Varchar
1
99
99
Filler
Spaces
Varchar
1
100
100
 
 
MCO Project Code
MCO Project Code Description
10
Humana Health Plan
15
Harmony Health Plan
19
Meridian Health Plan, Inc
23
Aetna Better Health, Inc
24
IlliniCare Health Plan, Inc
25
Molina
26
Health Alliance
27
HealthSpring
28
Blue Cross/Blue Shield of Illinois
52
Family Health Network
56
County Care (Cook County Only)
57
CCAI - Community Care Alliance of Illinois
59
NextLevel
 
 
 
 
 
 
 
 
MCO Plan Type Code
MCO Plan Type Code Description
4
Family Health Program (Inactive 12/31/17)
5
Family Health Program (Inactive 12/31/17)
6
Mandatory Managed Care Program
7
Integrated Care (Inactive 12/31/17)
8
Medicare Medicaid Alignment Initiative
9
Managed Long Term Services and Supports (Inactive 12/31/17)
 
 
Questions regarding this notice may be directed to the Bureau of Long Term Care at
1-844-528-8444.
 
 
Doug Elwell
Medicaid Director
 
 

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