03/01/13
Summary:
- Admissions and changes in status of Medicaid-eligible long term care residents must be reported to the department using approved electronic systems;
- Submitting a hard copy to notify the DHS FCRC of admissions and status changes is no longer permitted with the exception of limited case-by-case exceptions for corrective admit actions only.
Use of MEDI or REV
Illinois law (PA 95-458) and administrative rules (Title 89, Section 140.513) require admissions and changes in status of Medicaid-eligible long term care residents to be reported to the department using the Medical Electronic Data Interchange (MEDI) or the Recipient Eligibility Verification (REV) system vendors.
Submitting a hard copy of the Long Term Care Facility Notification (Form 1156) to notify the FCRC of current admissions and status changes is no longer permitted. A caseworker may make limited case-by-case exceptions for corrective admit actions only.
Failure of an LTC provider to comply with these requirements may result in denial, delay of payment, or termination or suspension of the facility's participation in the medical assistance program.
Benefits and Advantages of Systems Enhancement
The following benefits and advantages may be realized due to this systems enhancement:
- MEDI is cost-free to providers of long term care services and may be accessed through the MEDI web site;
- By using MEDI, the backlog in DHS FCRCs may be reduced due to improved timelines for entering changes in the Recipient Data Base. Including the new address, phone number, etc. when a person is discharged is also helpful in assuring customers receive notices and other important information;
- MEDI allows the same transactions as those provided by the Long Term Care Electronic Interchange System, previously available only via REV vendors. Those transactions are:
- admissions;
- third party liability (TPL);
- bed reserve and temporary absence;
- discharge, including death;
- Medicare-covered services; and
- changes in the customer credit.
- The MEDI authorization system is available 24 hours a day, 7 days a week (excluding daily maintenance between 3:00 am and 3:30 am). The long term care databases are accessible 8:00 a.m. to 5:00 p.m. on State of Illinois work days. Facilities should exit the long term care page by 5:00 p.m. to avoid access problems the next day;
- Each accepted LTC transaction is assigned a tracking number and the date the transaction was accepted. The provider may retain this in their records to verify timely submittal.
Other information regarding MEDI and REV
- All admissions and changes in resident status must be reported by the LTC provider within five working days after occurrence. [This includes death of a resident so a notice of death is no longer sent to the Exception Processing Unit (EPU) via fax.] Supporting documentation, such as income verification records, must be submitted to the DHS FCRC within 30 days.
- All claims for payment from LTC providers, including resubmitted claims, must be submitted no later than 180 days after the date of service or admission transaction is completed.
- Note: Retroactive reductions of customer credit amounts, some level of care changes, and backdating of admit dates may all be considered claims for payment.
- LTC providers must report all Medicare coverage, bed reserves, and temporary absences by the 13th of the month following the service month affected.
- LTC providers must electronically report and update resident income for the current month or the next month. Changes for past months must be made by submitting a hard copy of Form 1156 to the DHS FCRC.
- An admission or a decrease to a resident's customer credit entered through MEDI or REV is not automatically updated. It is assigned a transaction number for tracking purposes. The transaction number, along with the admit information, is passed through to the DHS FCRC daily for processing via Mobius report #A2735KA1, LTC EDI Notifications. Income verification documentation for any customer credit for admissions or changes must continue to be submitted to the DHS FCRC. FCRC staff cannot use the transaction information until verification documents are received.
- Submitted admit and customer credit update transactions not acted upon or logged out within 30 days are reported weekly via Mobius report #A2735KK1, LTC EDI Transaction Aged Report. If the transaction number is entered when processing the LTC admit, the transaction will be automatically logged as completed in the tracking system. The appropriate status code should be entered in the tracking database for transactions that do not require completion due to pending actions (PF10 - Tracking Database on LTC Processing Selection Menu).
- LTC discharge transactions entered by providers through MEDI or REV are reported to FCRCs via the daily Mobius report #1BPCR331, LTC REV Night Trans Log (LTC EDI Discharge Transactions Log).
- To comply with federal internet standards and the Health Insurance Portability and Accountability Act (HIPAA), a person must register in the MEDI system and receive authorization (link provided above). Individuals who register will have access to applications depending on the specific authorizations granted. This is based on rules that apply to specific business types.
- Information about REV vendors may be found at the REV web site (link provided above).
Questions may be directed to the Bureau of Long Term Care at 217-782-0545.
[signed copy on file]
Michelle R.B. Saddler
Secretary, Illinois Department of Human Services
Julie Hamos
Director, Illinois Department of Healthcare and Family Services
