This is a reminder for nursing facilities submitting claims for PriorityMedicare Dual Premier (HIDE-SNP) members.
We recently updated our claims processing systems to align with existing MDHHS requirements. To help prevent claim denials, corrections and resubmissions, we recommend you review and follow the nursing facility billing requirements found in the Medicaid Provider Manual.
Section 8 of the chapter titled “Billing & Reimbursement For Institutional Providers” includes guidance on:
- Patient-Pay Amount
- One Facility – Two Claims in One Month
- Two Facilities – Two claims in One Month
- Offset to Patient Pay Amount for Non-covered Services
- Claim Documentation Requirements when Offsetting the Patient Pay Amount
Please confirm that claims for PriorityMedicare Dual Premier members follow these requirements before submission. Claims submitted incorrectly may deny and require correction and resubmission.