IN THESE CASES, THE ADMISSION DATE SHOULD BE THE DATE THE OUTPATIENT SERVICES WERE PROVIDED ADDITIONALLY, PSYCHIATRIC PATIENTS ADMITTED THROUGH THE EMERGENCY ROOM SHOULD HAVE THE ER CHARGES ROLLED INTO THE INPATIENT PSYCHIATRIC BILL (EVEN WHEN THE FACILITY HAS SEPARATE PROVIDER NUMBERS FOR ACUTE AND ...
Changes have since been made to Molina's system to prevent inappropriate payment of these claims. On the RA of 01/27/15, claims for reduced services that were approved by UHC and CHS will be reprocessed to ensure that providers receive the correct payment. On a future RA, Molina will ...
Data include demographic files; inpatient, other service, and long-term care claims and encounters; and pharmacy prescription claims. Data were purchased from the Centers for Medicare & Medicaid Services after application and approved data use agreement. More information about the data acquisition ...
Some clinicians perceived difficulties getting MCOs to reimburse inpatient stays, which created serious disruptions to clinical care: Utilization management says “this guy keeps going to rehab or to inpatient, something's wrong,” so we already determined that he needs a higher level of care, and...