IL 10-67: Alternative to Inactivating Processed Forms 3618/3619 Submitted in Error
Information Letter No. 10-67
June 3, 2010
Page 2
June 3, 2010
To: Nursing Facilities (NF)
Hospice Providers
Subject: Information Letter No. 10-67
Alternative to Inactivating Processed Forms 3618/3619 Submitted in Error
This letter provides the procedures and examples as an alternative to inactivation for Forms 3618/3619 which are in a "Processed/Complete" status or which have a GN-9400 Response Code in the LTC Online Portal. In these situations, the inactivation process is not allowed. Instead, an alternative process must be used. A counteracting form may need to be submitted unless a retroactive form is involved; retroactive forms may be able to be handled with a correction.
Current transaction date
The most common scenario requiring a counteracting form occurs when the form with the most recent transaction date was completed in error – the submission should never have occurred.
If the form submitted in error has the most recent transaction date, the appropriate counteracting form must be submitted. A counteracting form is defined as a form which has the same form type, but the opposite transaction, for the same Date of Above Transaction.
Examples of counteractions to inactivate Forms 3618/3619:
· A discharge to the hospital was submitted in error and, because the admission to the hospital was “observation only,” no discharge form should have been submitted.
To correct this: Submit an admission from the hospital for the same Date of Above Transaction. This will counteract the discharge that was submitted in error, reestablishing the service authorization for the client.
· A 3618 admission was submitted, but the client is classified as Medicare.
To correct this: Submit a 3618 discharge for the same Date of Above Transaction in order to counteract the 3618 admission.
· An NF admission was submitted under the wrong contract number and processed onto the file.
To correct this: A discharge must be submitted for the incorrect contract number, using the same Date of Above Transaction. Once both forms are processed, the provider must contact DADS Provider Claims Services at 512-438-2200, option 1, so the forms can be changed to “Invalid/Complete” status. When the incorrect forms are marked Invalid/Complete, the provider can then submit the admission with the correct contract number.
Note that if an admission or discharge was submitted for the wrong Date of Above Transaction (e.g., the 5th instead of the 8th of the month), the form should be corrected, not inactivated.
Retroactive transaction dates
If the form submitted in error is retroactive (because subsequent forms have processed), it may be possible to submit a correction to fix the error.
Examples of corrections to Forms 3618/3619:
· A discharge to the hospital was submitted in error and subsequent form(s) have processed
To resolve this: Correct the Date of Above Transaction on the admission to match the discharge date, closing the gap. This basically creates a counteracting form for the discharge.
· A 3618 admission was submitted but the client should have been classified as Medicare, and subsequent form(s) have processed.
To resolve this: Correct the Date of Above Transaction on the Form 3618 to the date the client admitted from Medicare to Medicaid and submit the Form 3619 admission and discharge prior to the new Medicaid admission date.
REMINDER: When submitting a counteracting form or a correction that reduces or eliminates a service authorization when payment already has been made, recoupment will occur unless additional forms are processed at the same time (to reestablish the service authorization).
If assistance is needed in the determination process, please contact TMHP at 1-800-626-4117 Option 1. Occasionally, TMHP may refer the provider to DADS Provider Claims Services (PCS) Hotline for further assistance.
Sincerely,
[signature on file]
Gordon Taylor
DADS Chief Financial Officer
GT:pa