Skilled nursing facility claims are being incorrectly denied

Update 11/21/2019: The error for front-end rejections of skilled nursing facility (SNF) claims has been corrected. Facilities can now submit and resubmit claims that had been submitted since October 1, 2019. We apologize for the inconvenience.

How should SNFs bill Priority Health?

SNFs should submit their Medicare claims to us following CMS guidelines for the new Patient-Driven Payment Model (PDPM), including the five (5) day and discharge MDS assessments. SNFs should also continue to bill the appropriate tier charge line that we currently use to drive reimbursement. Report tier levels I-IV with revenue codes 0191-0194 to indicate the level of nursing care provided. Level I is the lowest tier, and level IV is the highest.

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We're experiencing front-end denials on skilled nursing facility claims with dates of service beginning Oct. 1, 2019. We're in the process of correcting our system. Please hold all claim submissions until we communicate the issue has been fixed. All claims submitted on Oct. 1, 2019, or after will need to be resubmitted once we have fixed our system.

We apologize for the inconvenience.