Date: August 23, 2021
To: Long Term Care Providers - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program providers (SLP), Medically Complex for the Developmentally Disabled Facilities (MC/DD), and Specialized Mental Health Rehabilitation Facilities (SMHRF)
Re: Implementation of New Policy for Systematic Processing of Long Term Care Admissions and Additional MEDI Edits
This notice informs Long Term Care (LTC) providers that the Department of Healthcare and Family Services (HFS) is implementing new system changes for the processing of LTC admission transactions. This notice replaces the notice issued 03/11/2020. Qualifying LTC admissions will be systematically processed upon entry into the MEDI LTC Admission link and entered into the State's payment system. Providers will be able to begin billing immediately for these transactions.
Admissions that are systematically processed based on this change will be considered either a Transfer admission or an admission that does not qualify as a transfer, which will be referred to as a Non-Transfer 'HFS3654' admission and are based on the policy change outlined in the notice issued 02/27/2020. Admissions that do not qualify for systematic processing will continue to be reported to DHS for processing.
In addition, HFS is incorporating additional front-end edits into the MEDI LTC Admission process to more quickly notify providers of issues that will affect the processing of admission transactions.
Admission Submission Requirements for Systematic Processing RINs/SSNs:
- All admissions must be submitted with either a valid Recipient Identification Number (RIN) or a valid Social Security Number (SSN). This includes admissions that will not be systematically processed.
- Using the resident's RIN will provide the greatest assurance that the admission can be systematically processed.
- For admission transactions submitted using only the SSN, it is required that the date of birth also be submitted to be eligible for systematic processing. This will allow HFS to search and locate the correct RIN. If a match is located, the RIN will be populated on the MEDI LTC Admission Results. If the admission qualifies for systematic processing, the matching RIN will be used to process the admission.
- SSNs that are associated with multiple RINs will not be systematically processed.
Qualification as a Transfer or Non-Transfer Admission
Medicaid eligibility must exist on the system for an admission transaction to qualify for systematic processing, regardless of admission type. This can be verified via the MEDI IEC Eligibility Inquiry.
A submitted admission transaction will be considered a Transfer, that may qualify for systematic processing, if the recipient has a prior LTC admission already on the system that:
- is for a period of 60 days or more, and
- has a discharge date that is within 60 days of the requested admission date.
NOTE: Previous admissions that are Provisional Eligibility admissions, Medicare Only admissions, HFS3654 admissions or admissions to a State Operated Facility are not considered prior qualifying admissions.
If a submitted admission transaction does not qualify as a Transfer, it may qualify for systematic processing as a Non-Transfer.
Screening Information for Admissions that do not qualify as a Transfer
For admissions that do not qualify as a transfer due to no prior admission on the system for a period of at least 60 days with a discharge date within 60 days of the requested admission date or if the prior admission is a Medicare Only admission, a new screening is required and the following 2536 fields must be completed:
- Date of Screening
- Screening Results Received Date
- Date of Admission to Facility
- The Screening Attestation Checkbox
- The 'Screening Certified By' information
For admissions that do not qualify
as a transfer due to the prior admission on the system for a period of 60 days or more and with a discharge date within 60 days of the requested admission date being a Provisional Eligibility admission, an HFS 3654 admission or an admission to a State Operated Facility, the previous admission provider type is used to determine if a new screening is required. These admissions follow the same screening requirements as Transfers, which is described in the following section, but will be processed as Non-Transfer admissions.
New Screening May be Needed for Transfers
For admissions that qualify as a transfer, the previous admission provider type is used to determine if a new screening is required (see the chart below).
|From Facility ||To Facility||Screening Required|
|Nursing Facility||Nursing Facility||No|
Additional Screening Considerations
- Screening information is not required if the person will be receiving hospice services upon admission.
- If a screening is required and the screening date is after the requested admission date, the admission date of the systematically processed admission will be assigned as the screening date.
- If a screening is required and one of the 'Post Screening Circumstance Boxes' is selected, which includes, placement from out-of-state, hospital emergency/COVID 19/outpatient services, or due to loss of caregiver with a pre-existing condition of need for a caregiver, the screening information is still required. However, the systematically processed admission will not assign the admission date based on the later screening date. The admission will be processed using the admission date submitted.
Transactions Systematically Processed as Transfer or Non-Transfer Admissions
- The Screening Attestation Checkbox must be selected even when screening information is not required for the transaction. This assures that screening requirements have been adhered to in accordance with 89 Ill. Adm. Code 140.642. This does not apply if the person will be receiving hospice services upon admission. If the screening information is required but is not submitted, the admission transaction will be rejected with the error message '448 – Screening Information Required'. Providers receiving this message will need to submit an accepted admission transaction with the required screening information.
- The submitted transaction should include a requested admission date on the 1156/26 section that is date the LTC provider is requesting Medicaid to be the payor of the LTC services. The admission date entered on the 2536 section should be the actual date the resident admitted to the facility. This most commonly applies to residents transitioning from private pay to Medicaid.
- If the screening date is greater than 90 days prior to the admission date entered, the admission transaction will be rejected with the error message '361 – The Screening Date is Missing or Invalid'. Please note that the following question was added, 'Has this resident been private pay for more than three months in your facility and applied for Medicaid coverage within three months of this admission transaction submission?' along with the option to select 'Yes' or 'No'. If 'Yes' is selected, the admission transaction will not be considered a Transfer but may still qualify to be systematically processed as a Non-Transfer admission. A 'Yes' selection will bypass the edit requiring the screening date to be no more than 90 days prior to the admission date.
- Only "Accepted" or "Accepted and Processed" transactions are considered valid. All transactions that receive an error code are considered invalid and are not eligible for any further consideration. Transactions that are 'Accepted' but are not processed systematically will continue to be reported to DHS for processing.
The systematic processing of admission transactions will take into consideration the recipient's eligibility, timely filing rules and previously processed admission records in the system, which may result in the processed admission and discharge dates being modified from those submitted on the transaction. If the admission qualifies and is systematically processed, the message 'Transaction Accepted and Processed' will be returned on the MEDI LTC Admission Results above the Transaction Audit Number. The provider should view the results of the accepted and processed admission transaction immediately via the MEDI LTC Inquiry and note the admission and discharges dates processed. The MEDI LTC Inquiry will also display the provider reference field or 'REF' field. The systematically processed admission will indicate either 'TRANSFER' or 'HFS3654' in this field.
Assignment of Admission and Discharge Dates
If the previous admission is still open, a discharge date will be populated on the previous admission record that is equal to the newly submitted admission date.
If the previous admission is closed, but overlaps the new admission transaction, the submitted admission transaction will not be systematically processed. It will be accepted and sent to a DHS MFO LTC Unit for processing consideration.
A discharge date may be assigned if there is a subsequent admission on the system and a discharge date was not provided with the admission transaction or was greater than the subsequent admission record. In both instances the discharge date assigned to the accepted and processed admissions will be equal to the admission date of the subsequent admission record.
Admission transactions that are not supported by established Medicaid eligibility for the entire admission period will not be systematically processed. They will be accepted and sent to a DHS MFO LTC Unit for processing consideration.
All admissions will be interrogated to determine if they were submitted timely. Timely submission guidelines listed in 89 Ill. Admin. Code 140.513 require the admission transaction to be submitted within 45 days of the admission date or, if a screening is required, within 45 days of the screening results received date, whichever is greater. If the admission was not submitted timely and qualifies to be systematically processed it will be processed using the submittal date as the assigned admission date. If the admission was not submitted timely and a discharge date was also submitted that is prior to the submittal date, the admission transaction will be rejected with the error message '445 Denied – Timely Filing Requirement Not Met'. No further consideration will be made for rejected transactions.
Patient Credit Assignment
For admissions that qualify as Transfers, the patient credit amount assigned to the accepted and processed admission transaction is calculated based on the last patient credit amount listed for the prior admission. The first partial month will be assigned $0.00 patient credit. The calculated amount will begin the first day of the first full month following the admission date. For admissions that qualify as Non-Transfers, the patient credit amount assigned will be $0.00. If the assigned patient credit amount is incorrect, the provider can immediately submit an LTC Change in Income via MEDI. The patient credit amount can be updated automatically for the current or next month by following these instructions.
Edits have been added in MEDI to reject admission transactions that are duplicates of admissions already on the system. If there is an admission on the system for the same provider and admission date, the submitted transaction will be rejected with the error message '447 – Admission Already on System for Requested Admission Date'.
The following note was added below the SSN field, 'Note: All admission transactions require a valid Recipient Identification Number or a valid Social Security Number.'
The checkbox to request that the admission transaction be systematically processed as a Medicare Only admission has been removed. These admissions will now be processed as either a Transfer or Non-Transfer admission. Billing for Medicaid and/or Medicare covered days will be permitted.
Level of Care selections are updated. The options are SNF (Skilled Nursing Facility), ICF (Intermediate Care Facility), ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities), SLP (Supportive Living Program providers), and SLP Dementia.
The Determination of Need Score and the Appropriate/Not Appropriate Service Boxes were replaced with the Screening Attestation Checkbox.
If the resident has discharged from the facility prior to submitting the admission transaction it is important that the discharge date be included in the transaction. If it is not included and the transaction is determined to be untimely this will result in the admission date being processed as the submittal date. The result would be an admission record added to the system for a time period that begins after the resident has already discharged. If this should occur, contact the Bureau of Long Term Care to request that the record be deleted from the system.
If the LTC facility staff member submitting the admission transaction has access to submit for multiple facilities it is very important that the correct facility is selected at the top of the MEDI LTC Admission transaction. If the incorrect facility is selected it will be used to process the transaction, resulting in incorrect admission records. If this should occur, contact the Bureau of Long Term Care to request that the record be deleted from the system. Once the record is deleted you may submit a new transaction using the correct facility. No exceptions to timely submittal will be considered due to this error.
If the transaction receives a rejection message you feel is in error or if the dates used in processing the systematically processed admission are not understood after reviewing the submitted transaction and the information provided in this notice, please contact the Bureau of Long Term Care. The MEDI Helpdesk and the DHS MFO LTC Units are not the correct contact for this type of inquiry.
Please contact the Bureau of Long Term Care in a timely manner to request the resolution of errors. BLTC will only correct a data entry error resulting in loss of payment if contact is made within 30 days of the error. Please send a secure email to HFS.LTC.MEDIadmissions@illinois.gov with any questions or to report potential errors. Please include the Transaction Audit Number (TAN) in the subject line of the email.
HFS has set up a Webex meeting to discuss these changes with providers on Wednesday, August 25th from 1-3pm. Following is a link to the meeting: HFS Webex on New Admission Processing 8-25-21
Questions regarding this notice may be directed to the Bureau of Long Term Care at
Kelly Cunningham, Administrator
Division of Medical Programs