FACILITY BILLING GUIDELINES

Date: 11/14/22

Meridian has found that some providers are seeking authorization for payment of claims for members in Supportive Living Facilities (SLF) Long Term Care (LTC), Skilled Nursing Facility (SNF), specialized mental health rehabilitation facility (SMHRF), and hospice (revenue code 658) when the member is not on the Patient Credit File (PCF). As the IAMHP manual outlines, the Illinois Department of Healthcare and Family Services requires a member to be on the PCF before an MCO reimburses these services.

Effective immediately, Meridian will no longer be authoring services for SLF, LTC,SNF, SMHRF and hospice (revenue code 658) when a member is not on the PCF. If a member is added to the PCF retroactively, claims may be reprocessed. Providers previously  reimbursed for member stays, when the member was not on the PCF, will receive notice of overpayment.

If you have any questions, please get in touch with provider relations at Provider Relations Intake (smartsheet.com).