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Attention Skilled Nursing Facility Providers: Changes to Custodial Claim Billing Requirements for Medicaid Members

Posted September 24, 2019

Effective immediately, Blue Cross and Blue Shield of Illinois (BCBSIL) will require a full monthly bill from Skilled Nursing Facility (SNF) providers that accounts for all days, including Leave of Absence days (billed with revenue codes 183-185), on a single claim. This requirement applies to SNF providers who provide care and services to our Blue Cross Community Health PlansSM (BCCHPSM) and/or Blue Cross Community MMAI (Medicare-Medicaid Plan)SM (MMAI) members.

What is the reason for this requirement? The submission of multiple claims for the same member may leave room for claim processing errors due to over-application of the Patient Credit File (PCF) to be applied when multiple claims are submitted. Therefore, to help prevent PCF payment errors, SNF providers are required to submit one claim for the whole month, including Leave of Absence codes (if applicable).

Please note that SNF Custodial Claims may be submitted with Bill Type 021X (Skilled Nursing) and 065X (Intermediate Care) and Revenue Codes 110-160, 183-185 (bed holds only).

The billing guidelines referenced above are in alignment with the Long Term Care Service Billing Requirements and Coding guidelines set forth by the Illinois Department of Healthcare and Family Services (HFS). The billing guidelines are also outlined in the Illinois Association of Medicaid Health Plans (IAMHP) Comprehensive Billing Guide.  

If you have any questions regarding this notice, contact our Provider Network team at govproviders@bcbsil.com or 855-653-8126. 

This material is provided for educational purposes only and is not intended to be a definitive source for coding claims. Health care providers are instructed to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials.