Date: October 16, 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: Admission Transaction Submission Guidelines
Long Term Care (LTC) providers are reminded that, effective 01/01/2018, all admission transactions must be submitted electronically within 45 days of the admission date or within 45 days of their receipt of form HFS 2536, Interagency Certification of Screening Results, or form HFS 3864, Screening Verification from the screening agent, if not received at admission. The requested admit date on the 1156/26 section of the admission transaction submission should be the date the LTC provider requests Medicaid to be the payor of the LTC services. This includes residents transitioning from private pay to Medicaid (a TAN needs to be submitted within 45 days from the last private payment). If a screening is required, use the actual date of admission on the 2536 section of the admission transaction.
All admission transactions submitted electronically through Medical Electronic Data Interchange (MEDI) are assigned a Transaction Audit Number (TAN). Transactions which display an error message at the top of the Results Page are not successfully submitted and are considered “rejected”. These transactions cannot be processed. The error message provides a description of the field that requires correction. The transaction should be resubmitted with the correct information. A successfully submitted transaction will display a “Transaction Accepted” message. A copy of the accepted TAN should be retained for future reference.
Once a transaction is received, the Department of Human Services (DHS) caseworker will review the transaction to determine if the admission submission should be accepted or rejected.
TANs rejected for the following reasons can be PROCESSEd. A new transaction submission is not needed when:
- The TAN was rejected due to denial of a medical application or requirements were not met to approve LTC Services AND all the requested information was submitted within 60 days of the application denial date. In this instance, the application and/or an eligibility determination of LTC services may be reopened. The TAN is still valid. The provider should not submit a new admission transaction.
- The TAN was rejected due to no active Medicaid case with full coverage or no pending application AND the individual applies for Medicaid within 90 days of the TAN submission. The TAN is still valid. Provider should not submit a new admission transaction.
TANs rejected for the following reasons will require a new ADMISSION transaction SUBMISSION when:
- The TAN was rejected due to denial of the medical application or requirements were not met to approve LTC Services AND all the requested information was NOT submitted within 60 days of the application denial date. A new application is required. A new admission transaction is required.
- The TAN was rejected due to missing or incorrect information on the admission submission; a new admission transaction is required. Examples may include:
o Screening information was required but not provided
o Incorrect recipient identification number (RIN)
o Incorrect social security number (SSN)
· NOTE: The new admission submission needs to be submitted within 30 days of the date on the rejection letter in order to preserve the original request date. Timely submission rules will be applied to any TANS submitted more than 30 days after the date of the rejection letter.
Cases cancelled due to non-compliance with the redetermination (REDE) process:
· When Medicaid eligibility ends due to non-compliance with the REDE process AND all required information is submitted within 90 days of the cancellation, DHS will determine ongoing eligibility. If continuing eligibility exists, the caseworker will reinstate the case and reopen LTC admission segment. The original TAN is still valid. The provider should not submit a new admission transaction.
· When Medicaid eligibility ends due to non-compliance with the REDE process AND the missing REDE form and/or required information is not received within 90 days of cancellation, a new Medicaid application must be submitted. In this instance, a new admission transaction must be submitted. The original TAN is no longer valid. The new admission transaction is subject to timely reporting requirements.
Reminder: Check resident eligibility frequently and review the monthly Patient Roster Instructions
BEGINNING DATE OF PAYMENT
The beginning date of payment is based upon the Medicaid eligibility date AND the requested admission date, the date of the pre-admission screening, the date the provider receives the required pre-admission screening results, and the date the transaction is electronically submitted. If the admission transaction is not submitted timely, the DHS caseworker will use the date the provider entered the information in MEDI as the date of admission.
See flow chart for applying timely submission rules:
Note: When a new application is required, a new admission transaction is required.