The Indiana Office of Medicaid Policy and Planning (OMPP) continues to monitor Fee For Service payments made through Gainwell for SCU/Vent unit add-ons beginning July 1, 2023. As of this week, more than 79% of these payments have been made, but OMPP remains concerned about the slow payment of these claims. It appears that there are at least 17 facilities that still have not either billed or received any payments for their SCU add-ons.
To help more quickly resolve these payment issues, OMPP and Gainwell held a couple of office hours sessions in late August to discuss claims denials and proper billing techniques. As a part of those meetings, providers were instructed to reach out to Rebecca Young at Gainwell (rebeccay@gainwelltechnologies.com) to discuss a facility’s issues with processing of their SCU/Vent Unit Add-on claims. OMPP and Gainwell are suggesting again that providers reach out to Ms. Young to discuss their issues. You may e-mail her to request a TEAMS meeting (or a phone call) but you may also e-mail her your specific issues and questions.
You should be aware that there is a known issue that the Gainwell rate table may have a different suffix for your provider number than the one you are using. (E.g. – you may be using 100123456C and the Gainwell system may have a provider number 100123456D for the SCU Unit). If billing using the provider number with the “C” suffix, this situation would indicate in the Gainwell system that the facility does not have an approved SCU and claims would deny. This is just one example of a potential issue that could cause your claims to deny. Ms. Young should be able to help you to determine the causes of your claim denials for this or any other reason.
If you still have not billed for these claims for any reason, please do so as soon as possible. IHCP bulletin BT202499 issued on June 27, 2024, extended the timely filing limit for these claims by 180 days from the date of the bulletin. However, providers were instructed in this bulletin to “include a copy of this bulletin when submitting claims beyond the standard filing limit.” The attaching of the bulletin to the claim is what prompts Gainwell to extend the timely filing limit. Without the bulletin attached, the claim will be denied. If you are now re-submitting claims or submitting claims for the first time, you should probably attach the bulletin to any claims that exceed the timely filing limit.
OMPP and Gainwell would like to resolve these issues and pay these claims as quickly as possible. Therefore, we highly recommend that you take this opportunity to review your claims issues for SCU/Vent add-ons and reach out to Gainwell to resolve them. Please copy Derris Harrison – LTC Reimbursement Manager for OMPP (derris.harrison@fssa.in.gov) on any e-mails. OMPP would like to monitor these issues in case they identify any other systemic issues that can be resolved globally.