Effective April 1, 2019, Skilled Nursing Facilities billing for authorized RUG stays will be able to consolidate the CMS SNF PPS and AHCCCS billing methodologies. Once the claim has been processed under the MCA line of business, the processing system will create a new claim under the Medicaid line of business with the COB information needed to accurately coordinate the claim.
The SNF community has requested Mercy Care accommodate consolidation for many years and recent claims processing system enhancements allow us to finally make this change.
This is a completely optional way for the SNF community to bill Mercy Care Advantage and Mercy Care for this claim scenario. SNFs may choose to use the existing process of billing MCA for RUG payment and then resubmitting with the MCA remittance to coordinate the Mercy Care line of business.
- To submit your claim using the new process, you will need to do the following:
- Claims must be submitted on a UB-04 claim form.
- The first lines of the claim must contain revenue code(s) 0022 with the appropriate RUG codes.
- The room and board lines of the claim must be billed with the appropriate 019X SNF revenue code.
- If the SNF is able to bill the condition or value code associated with the member’s level of care, they are encouraged to do so. This again is completely optional.
It's important to note that you may still submit your claim the way you have in the past. However, billing with this new enhanced methodology will:
- Allow less administrative burden on your part, as you will not have to complete a second submission.
- Allow faster payment of your claim with less work on your part.
As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our
Mercy Care website
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