MEDICAID INFORMATION RELEASE MA05-01  (ELECTRONIC BILLING INSTRUCTIONS) 

 

TO:                  Nursing Facility Providers

 

FROM: Randy May, Deputy Administrator

 

 

Effective January 1, 2005, the requirements for billing long term care on the 837I transaction will change.  A new edit will validate the units submitted on the detail and compare against the dates of service for that detail.  This will facilitate claims processing and the audit settlement process.

 

            EXAMPLE: To bill for a patient residing in a Long Term Care facility who is not discharged, enter the claim detail units and dates of service as follows:

 

          The header dates of service are:  from 01/01/2004 to 01/31/2004

          The detail dates of service are:

 

          Line 1  100                        01/01/2004    01/20/2004    20

          Line 2  183                        01/21/2004    01/23/2004    3

          Line 3  100                        01/24/2004    01/31/2004    8

 

Those claims submitted on the paper form UB92 are not affected because there is not a TO date of service on that form. 

 

 

If you have any questions regarding this information, please call EDS at 1-800-685-3757 or in the Boise area at 383-4310.  Thank you for your continued participation in the Medicaid program.

 

RM/rlc