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Date ArticleType
12/6/2016 Payment/Reimbursement
Indiana Medicaid Level of Care Delay

Many of you have noticed a delay in the processing of nursing facility level of care updates. We recently received an update from FSSA explaining the status of the current delays and the likelihood of a greater backlog in the near future.

FSSA is reporting that they are nearly up-to-date on the nursing facility level of care updates, and should be processing them within the seven day period that they were hitting prior to last spring’s launch of AssessmentPro. However, FSSA has recently identified another issue with the data extracts from AssessmentPro. The data extracts have not contained the continued stay requests and the level of care determinations done at Medicaid eligibility. The identification of this issue is likely to lead to a large data dump of possibly a few thousand entries requiring processing. This, undoubtedly, will case a new backlog in processing.

The current plan is for FSSA to devote staff to specifically handle the current incoming claims within the seven day turnaround period, and have staff in place specifically assigned to clearing the new backlog. Unfortunately, this plan is dependent upon the size of the new backlog, and that is unknown at this time. Until the size of the backlog is known, FSSA is unable to commit to the aforementioned bifurcation of staff resources which would provide for the timely processing of new claims. We remain in communication with the Division of Aging to understand what staff resources they will dedicate to clearing the backlog.

In the meantime, FSSA has asked that providers refrain from submitting inquiries related to the processing of level of care updates until after January 15, 2017 which is when the data dump is supposed to occur so that they can focus on being completely up-to-date on processing when the new backlog begins.

FSSA maintains that the ultimate goal of these changes is total automation of this process, and thus much quicker adjudication. Total automation will require accurate reporting from all providers. Total automation of this process will begin at some point after the implementation of CoreMMIS, the date of which is currently unknown.