Medicaid Managed Care Nursing Home Transition
- Claims and Billing Submission is also available in Portable Document Format (PDF, 229KB)
Claims/Billing submission
- Claims should be billed in accordance with the provider´s contract
- Claims are to be billed on a CMS 1450 (UB-92)
- Clean Claim sample can be found at https://www.emedny.org/ProviderManuals/ResidentialHealth/PDFS/Claim%20Sample-UB92R-Resid%20Health%20Care.pdf
Claims/Billing
What´s being denied?
- Usage of inappropriate revenue codes as per contract
(ex. 0100-0101 versus 0191-0194) - Timely filing is within 90 days from the discharge date
- When HP/AGP is the secondary payer we require a copy of OHI´s EOP along with claim billed to Healthplus Amerigroup for applicable coinsurance payment
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