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IMPORTANT MEDICAID UPDATES
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LTC Crossover Claims
The Indiana Health Coverage Programs (IHCP) has identified LTC Crossover claims being denied because the member's Level of Care does not match the billing provider information. Providers, when this occurs, please see Explanation of Benefits (EOB) 2008 - MEMBER NOT ELIGIBLE FOR THIS LEVEL OF CARE FOR DATES OF SERVICE.
PER POLICY, LOC is still required on these crossover claims, however at the request of FSSA, HPE has temporarily modified the system to bypass this editing. This will allow claims for nursing home members with a level of care that does not align with the billing provider on the claim to pay. This is only applicable to LTC Crossover (Medicare/Medicaid) claims. Regular LTC claims remain active for this EOB. This EOB will remain in this status until further notice. Future changes to this EOB will be communicated in upcoming IHCP publications.
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Maintaining Accurate Demographics
It is also very important that you have used accurate demographic information in AssessmentPro including:
- First and Last Name
- Gender
- Date of Birth
- Social Security Number
- Medicaid (RID) Number - When Available
Missing or inaccurate information will prevent or delay entry of the authorization, which will cause you to experience claim denials. Furthermore, your LOC entry needs to be made in a timely manner. This assures that LOC at time of service can be documented. Entries over 120 days from the date of service will NOT be made. For example, if an individual became eligible for Medicaid 8/1/16, a LOC submitted 3/1/17 will typically only back date to 11/1/16. Please act in a timely manner in submitting your LOC request as soon as you expect that you will be submitting a claim to Medicaid.
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Clarifying Level of Care (LOC) Instructions
To further clarify instructions provided in the AssessmentPro manual and FAQ documents, Level of Care must be completed any time the nursing facility expects to submit a claim to Medicaid for reimbursement. This includes Crossover claims that go first to Medicare and then come to Medicaid. Any time a claim will be submitted to Medicaid, there needs to be an approved level of care in place.
These level of care entries are still made manually by Division of Aging staff.
Currently, you need to allow at least 15 working days AFTER all of the following criteria are in place:
- Approved LOC
- PathTracker Entry
- Medicaid Eligibility
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Log into AssessmentPro Every Month. Please remember to log into AssessmentPro at least once a month in order to avoid becoming inactive / terminated. If this happens, you can use the Forgot Password link to reactivate. Keep in mind, after 6 months of inactivity, your account will be terminated. If this occurs, you must contact the Help Desk to be reinstated.
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When Completing Level I / LOC Referral Process:
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①
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A
Level of Care (LOC) is required for:
- Persons seeking Medicaid payment for a Nursing Facility stay
- Anyone referred for a Level II PASRR, regardless of payer source
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②
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Please do not mark N/A or use zeros for the ID Number, when completing a referral. This will result in a delay in completing the review.
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③
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The question,
"Are the individual's behaviors/symptoms stable (meaning that there is no evidence of dangerousness / risk to self or others)?" is specifically asking about
mental/behavioral health and
NOT MEDICAL STABILITY. Incorrectly answering this question will result in a delay.
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④
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If a reviewer has asked multiple questions in the Communication field, please
respond to each question or request. If all are not addressed the review cannot be completed.
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⑤
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If an individual has a
Seizure DO and / or TBI, you must note it on the LI PASRR screening form. Many times, supporting documentation has a diagnosis listed, but not included on the referral. You must indicate if this diagnosis did, or did not, occur
prior to the age of 22. In addition, if there are any
functional limitations related to the diagnosis.
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⑥
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After a person receives a Level I review and the provider identifies inaccuracies within that review, a subsequent review must be submitted as a Status Change. This applies even if the individual has not, yet, admitted to the NF.
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⑦
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Providing documentation at the time of the Level I and LOC referral will assure the review is completed as quickly as possible and can significantly reduce the six hour turnaround time. |
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For more information about the Indiana PAS / PASRR process, visit the
Ascend Indiana PASRR website
. This site contains a variety of tools and resources, including:
- Training Checklist
- Provider Manual
- Frequently Asked Questions
- Training Videos
- User Guides
- Past Newsletters
- Past Webinars
- Glossary of Terms
- System Administrator Information
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Ascend will continue to reach out via email to provide you with helpful reminders, detailed information on policy or procedural updates, as well as ongoing training and professional enrichment opportunities. We invite you to visit our website to learn more about Ascend.
We are privileged to work with you to ensure individuals in Indiana receive the services and support they need and deserve.
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