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Friday, April 19, 2024, 1:47 AM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
NURSING HOME

Should claims returned on Form 017 or 017CI without processing be re-filed?

Yes. Once corrections are made, Medicaid claims should be re-billed using the CRCF-01 form for OSS and the DHHS 181 for NFs. Coinsurance claims can be submitted at any time of the month once corrections are made.

What happens if my DHHS Form 181, CRCF 01 or IPC form is not received on time or is not received at all?

No changes will be made regarding beneficiaries’ income, IPC/CRCF status, etc., for the current billing month if change forms are not received by MCCS. However, changes can be made during the next month’s billing process.

What happens if the NF or ICF/MR* accepts a hospice resident while Medicaid eligibility is pending and it is later determined that the resident is not eligible? Who is responsible for room and board payment to the NF or ICF/MR?

The hospice is responsible for the room and board amount.

It is imperative that the hospice social worker continues to pursue eligibility for the resident to decrease the financial risk in the event the resident is ultimately not eligible for nursing facility benefits. 

*Nursing Facility (NF) or Intermediate Care Facility (ICF) / Mental Retardation (MR)

What happens if the Nursing Facility (NF) or Intermediate Care Facility (ICF) / Mental Retardation (MR) is paid in error for hospice dates of service?

The nursing facility must submit a request for an adjustment. The adjustment process must be completed before the hospice can be paid for room and board dates of service.

What is the physical address to over-night a TAD?

The PO boxes and physical address are included in the Provider manual as well as on the mailing envelope.

For regular mail:
Medicaid Claims Receipt – NF Claims Section
Nursing Homes
P.O. Box 100122
Columbia, SC 29202-3122
 
Medicaid Claims Receipt – NF Claims Section
OSS/IPC/Hospice:
P.O. Box 67
Columbia, SC 29202
 
For UPS, FedEx, etc.
Medicaid Claims Receipt – NF Claims Section or CRCF Claims Section
8901 Farrow Road
Columbia, SC 29203

NOTE: Late change forms should be sent overnight or faxed, with all attachments, to (803) 870-9020. Forms should not be faxed unless they are sent past the deadline. Faxed corrections should be received no later than the third working day of each month for Nursing Home providers and the 17th day of the month for OSS providers.

When are TADs available for providers to view on the Web Tool?

TADs are not yet available on the Web Tool. Medicaid will continue to send copies of the TADs to providers until the TADs are available on the Web Tool.

When are the DHHS Form 181, CRCF 01 and IPC forms due back to MCCS?

Nursing Home change forms are due to MCCS on the first working day of each month. OSS change forms are due no later than the 17th of each month. These dates are subject to change based on holidays, etc.

Who is responsible for pharmaceutical costs as it relates to the terminal illness?

The hospice agency is responsible for pharmaceutical costs related to pain management and symptom control of the terminal illness.

Why would a Nursing Facility provider receive a 951 rejection if the beneficiary had always been eligible for NF Medicaid since entering the facility?

A 951 Edit Code means the beneficiary was not eligible for Medicaid on the date of service. The beneficiary and/or responsible party for the beneficiary might not have completed the annual Medicaid eligibility review. Inform the nursing facility caller to contact the beneficiary’s eligibility caseworker.                                                                                                                                                                                

Will every Nursing Facility or Intermediate Care Facility (ICF) / Mental Retardation (MR) have the same rate?

No.