AGING AND DISABILITY SERVICES ADMINISTRATION

2007 NH "Dear Administrator" Letters

September 4, 2007

ADSA: NH #2007-022
CHANGE OF POLICY REGARDING BILLING FOR MEDICAID CLIENTS WHO HAVE PRIVATE INSURANCE

Dear Nursing Facility/Home Administrator:

Beginning October 1, 2007, any claim submission for a Medicaid resident who has private insurance must include a comment on the submission or the claim will be automatically denied. The only exception to this change in policy is for Medicare Supplement policies. No comment will be needed for standard Medicare Supplement plans A through L.

This change in policy could potentially affect payments that you are now receiving. Currently you may be receiving payment for claims that have an Explanation of Benefit (EOB) as 464. Beginning October 1, 2007 claims with an EOB 464 will be denied for payment unless an appropriate comment has been entered.

I have heard that some nursing homes are having problems with receiving payments or insurance denials timely from both insurance companies and Medicare intermediaries. I would like to remind you that the helpful hints packet that was sent to each facility contains valuable information regarding the steps to take in order to expedite the processing of claims. Please encourage your staff to review the information and to refer to it when billing for claims. Further, if you have questions please call your Coordination of Benefits experts listed below. They will also be able to send you another hints packet upon request.

Your Coordination of Benefits experts Cyndy Mills and Susan Pemberton will continue to assist you in determining the best way to proceed in this endeavor. If you would like assistance in preparing a comment or with an unusual insurance issue, please call (800) 562-6136. For clients whose last name begins with letters A through G, call Cyndy Mills at extension 51936. For clients whose last name begins with letters H through Z call Susan Pemberton at extension 51164.

If you have any questions regarding claims please call either Cyndy or Susan at the phone numbers listed above.

Sincerely,

Ken Callaghan, Chief
Office of Rates Management