DCH-i [Mar. 2015]

March 2015

Special Bulletin Follow Us!

Is Your Nursing Facility Ready?
In the last few years, the Department of Community Health, Division of Medicaid, Aging and Special Populations Section has worked diligently to establish prior authorization for nursing facility claims linked to the pre-admission screening process. The Department has provided significant education and technical assistance through webinars, provider workshops and Medicaid Fair breakouts to providers regarding compliance over the last three years.
With an official notice issued earlier in the year and after allowing time for facilities to rectify any lingering issues with prior authorization issues, DCH is set to begin enforcing the prior authorization requirement in alignment with state policies.This is scheduled to be effective beginning with the submission of claims for dates of service April 1, 2014 and after.
Many facilities are not aware of the issue because claims have been set to pay. Claims that are paying now may not pay any longer after April 1, 2015. Facilities are strongly encouraged to check their remittance advices for any of the following error codes, which may appear under the list ICN:
3001: PRIOR AUTHORIZATION/PRECERT NOT ON FILE. If a service requires prior authorization, and prior authorization is not found for the member and date of service, the error code will post. 3011: DOS NOT WITHIN PA/PRECERT EFFECTIVE DATES. If the first day of service of the claim and the effective date of the PA mismatch, the error code will post, or if the last day of service of the claim and the end date of the PA mismatch, the error code will post. 3024: CLAIM COS DOES NOT MATCH PA/PRECERT COS. If the COS associated with the provider submitting the claim does not match the COS associated with the PA, the error code will post.
Further guidance on this, including correction steps and a PowerPoint presentation, can be found on the DCH website at www.dch.georgia.gov/long-term-care/ (scroll to bottom of page).
If you have any questions, please do not hesitate to contact Wylean Thomas at wthomas1@dch.ga.gov or 404-657-9324, Pamela Madden at pmadden@dch.ga.gov or 404-657-9946, or Linda McCall at lmccall@dch.ga.gov or 404-657-5463.

About DCH
Through effective planning, purchasing and oversight, the
Department of Community Health (DCH) provides
access to affordable, quality health care to millions of
Georgians, including some of the state's most vulnerable and underserved populations.
DCH is responsible for Medicaid and PeachCare for
Kids, the State Health Benefit Plan, Healthcare Facility Regulation and
Health Information Technology in Georgia.
Clyde L. Reese III is the DCH Commissioner. We are dedicated to A Healthy Georgia.
www.dch.georgia.gov
Editor-in-Chief Jeremy Arieh Circulation Janice Abrams Director of
Communications and Legislative Affairs
Lisa Marie Shekell

DCH Mission
We will provide Georgians with access to affordable quality health care through effective planning, purchasing
and oversight.
We are dedicated to A Healthy Georgia.