Responsibility for Tracking 180-Day Benefit for MSC+ Sample Clauses

Responsibility for Tracking 180-Day Benefit for MSC+. ‌ The MCO shall be responsible for tracking accrual of days toward the 180-day SNF/NF benefit period for MSC+ Enrollees to whom the benefit applies. During the 180-day benefit period, reimbursement for NF services provided by a Nursing Facility Provider 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 the 180-day SNF/NF benefit, using the form DHS-4461A. The STATE will verify the information documented by the MCO.

Responsibility for Tracking 180-Day Benefit for MSC+. The MCO shall be responsible for tracking accrual of days toward the 180 day SNF/NF benefit period for MSC+ Enrollees to whom the benefit applies. During the 180 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 the 180 day SNF/NF benefit and the STATE will verify the information documented by the MCO. Acceptable notification shall include but is not limited to the following: (A) Provider claims submitted to the MCO for Nursing Facility services; (B) Documentation of Medicare covered days, including coinsurance claims for Medicare covered days; (C) Internal patient account summaries; (D) Service Authorizations if used by the MCO; (E) Claim denials for any days billed after the MCO’S 180-day Benefit Period has ended; or (F) Other documentation as agreed upon by the STATE, the MCO and the Nursing Facility.