Common use of Responsibility for Tracking 100-Day Benefit Clause in Contracts

Responsibility for Tracking 100-Day Benefit. Non-SNP.‌ The MCO shall be responsible for tracking accrual of days toward the 100-day SNF/NF benefit period for SNBC Enrollees to whom the benefit applies. During the 100-day benefit period, reimbursement for NF services provided by a Nursing Facility Subcontractor can only be made through the MCO and not through the Medical Assistance fee-for-service claims system. Before Medicaid NF claims can be paid by the STATE, the MCO shall be required to provide documentation to the STATE demonstrating that it has paid for 100 days of SNF/NF services and the STATE will verify the information documented by the MCO. Acceptable documentation shall include a claims record that contains the number of days paid to the Nursing Facility by the MCO. Acceptable documentation shall include a claims record that contains the number of days paid to the Nursing Facility by the MCO. Acceptable documentation shall include but is not limited to the following: • Provider claims submitted to the MCO for Nursing Facility services; • Documentation of Medicare covered services, including coinsurance claims for Medicare covered days; • Internal patient account summaries; • Service Authorizations if used by the MCO; • Claim denials for any days billed after the MCO’S 100-day benefit period has ended; or • Other documentation as agreed upon by the STATE, the MCO and the Nursing Facility.

Responsibility for Tracking 100-Day Benefit. Non-SNP.‌ The MCO shall be responsible for tracking accrual of days toward the 100-day SNF/NF benefit period for SNBC Enrollees to whom the benefit applies. During the 100-day benefit period, reimbursement for NF services provided by a Nursing Facility Subcontractor can only be made through the MCO and not through the Medical Assistance fee-for-service claims system. Before Medicaid NF claims can be paid by the STATE, the MCO shall be required to provide documentation to the STATE demonstrating that it has paid for 100 days of SNF/NF services and the STATE will verify the information documented by the MCO. Acceptable documentation shall include a claims record that contains the number of days paid to the Nursing Facility by the MCO. Acceptable documentation shall include a claims record that contains the number of days paid to the Nursing Facility by the MCO. Acceptable documentation shall include but is not limited to the following: •  Provider claims submitted to the MCO for Nursing Facility services; •  Documentation of Medicare covered services, including coinsurance claims for Medicare covered days; •  Internal patient account summaries; •  Service Authorizations if used by the MCO; •  Claim denials for any days billed after the MCO’S 100-day benefit period has ended; or •  Other documentation as agreed upon by the STATE, the MCO and the Nursing Facility.