Tuesday, November 5, 2024, 11:10 AM
Site: Healthy Connections Medicaid E-Learning
Course: Learning Resources (Learning Resources)
Glossary: Frequently Asked Questions
NURSING HOME

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 member had always been eligible for NF Medicaid since entering the facility?

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

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

No.

Will the hospice agency receive a copy of the DHHS Form 181 when the recurring income changes?

Yes, they will receive a copy of the 181 to verify the income change. It is recommended that the NF or ICF/MR attach a copy of the most current 181 when invoicing the hospice. Recurring income is noted in Section III of DHHS Form 181. Medicaid Eligibility is responsible for determining recurring income.

REVALIDATION

Can a customer service advocate tell me if another provider has started and saved a provider revalidation application?

No. The only information that the provider service center has is if a provider revalidation application has been completed and submitted. The provider service center cannot see if a provider has started the application process but not completed it. If you have the revalidation reference number, NPI and Medicaid ID of the provider in question, you can access the application to see if there is any work in progress. Revalidation FAQs PDF

Can I check on the status of my provider revalidation application?

Yes. You can check on the status of your provider revalidation application by calling the Provider Service Center at (888) 289-0709, option 4. You will need your revalidation reference number in order to check on the status of your provider revalidation application. Revalidation FAQs PDF