Medi-Cal SNF Retro-Rates

From: WelbeHealth
To: Health Plan Providers
Type: Informational
Subject: Medi-Cal SNF Retro-Rates
Business: PACE
State(s): California

As a reminder Medi-Cal reimbursement rates for Freestanding Skilled Nursing Facilities (SNF) Level-B (FS/NF-B) and Adult Freestanding Subacute Facilities Level-B (FSSA/NF-B) are updated each calendar year (CY) using a cost-based facility-specific methodology pursuant to Supplement 4 of Attachment 4.19-D of the California Medicaid State Plan.

Facilities will receive the current published rates until new calendar year rates are published.

Once new rates are published, WelbeHealth runs reports on previously processed claims for possible adjustment to pay the difference if required based on new rates.

Claims previously processed and paid with a billed amount less than the newly published rates cannot be adjusted.

If your billed amount was less than the newly published rate, you will need to submit corrected claims using the proper corrected claims guidelines and with billed amounts at or higher than the newly published rates.

• CMS1500 claim form – Box 22 (Resubmission Code) must have a “7” followed by the original WelbeHealth claim number – do not add a leading 0
• UB-04 claim form – Field 4 (Bill Type) must have a “7” in the fourth digit placement and field 64 (Document Control Number) must list the original WelbeHealth claim number

If you have any questions, please contact your Provider Partnership Representative, or email the Provider Partnership team at providers@welbehealth.com. You may also visit https://welbehealth.com/partners. for online access to this document and all other WelbeHealth Provider Alerts.