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Provider Notice Issued 05/28/2021

Date:     May 28. 2021

 

To:       Enrolled Hospice Agencies

 

Re:      Hospice Nursing Home Room and Board N39 Rejections

 

 

This notice is a reminder to hospice agencies to bill the appropriate HealthChoice Illinois managed care plan for managed care hospice patients’ nursing home room and board charges. This includes room and board charges for customers enrolled in the Managed Long Term Services and Supports (MLTSS) program.

 

Per informational notice dated September 20, 2018 and the IAMHP Billing Guide, hospice agencies are to bill the appropriate managed care plan for both the hospice services and also nursing home room and board charges, if the patient is in managed care and resides in a nursing facility. Some hospices have billed the Department directly for nursing home room and board charges, and due to a system editing issue, those claims were erroneously paid. The editing issue was fixed as of March 30, 2021, and claims are now rejecting appropriately for the N39 - Recipient in MCO-MMCP error code, if room and board charges for a managed care customer are billed to the Department.

 

The Department and the managed care plans will internally reconcile the inappropriate room and board payments made. No action is required by the hospice agencies.

 

Questions regarding this notice may be directed to the applicable HealthChoice Illinois managed care plan.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs​


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JB Pritzker, Governor • Theresa Eagleson, Director