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Reminders for Leave of Absence, Supporting Living Facilities, Specialized Mental Health Rehabilitation Centers, and Nursing Facilities Billing Requirements

Date: 09/25/25

Below find detailed examples for Leave of Absence (LOA), Supporting Living Facilities (SLF), Specialized Mental Health Rehabilitation Centers (SMRFHs), and Nursing Facilities (NF) billing requirements.

Effective October 1, 2025, Meridian will validate all Leave of Absence (LOA) claims with values on the UB04/837I based on regulatory rules implemented by Illinois Healthcare and Family Services (HFS) since 2019.

For those registered with HFS as provider types 028, 038 or 033, please follow the required LOA rules as noted in the Illinois Association of Medicaid Health Plans (IAMHP) Comprehensive Billing Guide, Section F – Coding Requirements. Read more.

Key Field Highlights from the IAMHP Billing Manual

Form Locator Field

Explanation

Completion Needed

Comments

35-36

Occurrence Span Code

Conditional

74 only when billing a LOA. must have a LOA revenue code on the claim 018x

39-41

Value Codes

Required

80 = must equal "covered days"

81 = any non-covered days and all LOA days (whether payable or not)

Example 1: 3/1-3/31/19 No LOA days, therefore value code 80 should be reported with a unit value of 31

Example 2: 3/1-3/31/19 5 LOA days, therefore value code 80 should be reported with a unit value of 26 and value code 81 should be reported with a unit of 5 and the required Occurrence Code and/or Occurrence Span Code

Both scenarios created a total of 31 units

42

Revenue Codes

Required

LOA Revenue Codes defined

Rev code 0182: Leave of Absence Patient Convenience
Rev code 0183: Leave of Absence Therapeutic Leave
Rev code 0185: Hospitalization

When a member has LOA, the dates must match in the occurrence span code fields with the associated value code “81 value.”

Examples of correctly and incorrectly billed scenarios

Example 1 – Correctly Billed Claim Value Code 81 Units – Single LOA

Monthly bill for services in a nursing facility for September 2023 billed:
A hospitalization LOA from 9/6 through 9/7/2023 for this member’s month stay at a nursing facility is shown below.

  1. The occurrence span code is completed with 74 and the date span of 9/6/2023 – 9/7/2023, and value code 81 is present with a unit value of two days.
  2. The remaining room and board sum of up to 28 for value code 80 for a total of 30 days billed of value code 80 and 81 units for the month of September.

Example 2 – Correctly Billed Claim Value Code 81 Units – Multiple LOAs

example of correctly billed claim value code 81 units

Monthly bill for services in a nursing facility for April 2024 billed.

There were multiple therapeutic LOAs that occurred for this monthly stay at a nursing facility, shown below.

  1. Multiple occurrence span codes were completed with 74 and each date spans of LOA recorded on the claim
  2. The sum of value code 81 equals all the units for the LOAs equal to 6 units
  3. The revenue code 0183 was billed with each service date with corresponding units
  4. The remaining room and board sum up to 24 for value code 80 for 30 total days billed as value code 80 and 81 units for the month of April.

Example 3 – Incorrectly Billed Value Code 81

Monthly bill for services in a nursing facility for December 2024 billed.

  1. Provider tried to communicate some type of LOA using value code 81 but did not bill correctly at the line level
  2. Missing 0182, 0183 or 0185 revenue code at the line level
  3. There are 31 days in the month of December and the units at the line level (28) do not match the value codes

incorrectly billed value code 81

Example 4 – Incorrectly Billing Value Code

Please note that HFS Provider Type 038, Specialized Mental Health Rehabilitation Centers (SMHRFs) have additional line level requirements that should be reviewed in this provider notice.

Effective October 1, 2025, if submitted claims fail this validation check, it will deny EXc0 – LOA (018X REV CODES). DAYS MUST BE INCLUDED IN TOTAL VALUE CODE 81 REPORT*.

For questions please contact Provider Services at 866-606-3700 or reach out to your Provider Engagement contact. For more information on billing requirements download the IAMHP Billing Guide (PDF).

*CARC 16/ RARC M49