DMAS has requested all health plans suspend timely filing requirements for nursing facility crossover claims back to the beginning of the CCC Plus program until further notice. VHCA-VCAL has also been in touch with Virginia Premier on CCC Plus and D-SNP claims clean up; Virginia Premier has provided instructions on how to submit outstanding claims to the extent providers are able to give this matter attention during the COVID-19 emergency.

Waiving Timely Filing

On Tuesday, March 17 DMAS requested that all health plans suspend timely filing requirements for nursing facility Medicare Part A and Part B crossover claims for dates of service back to the beginning of CCC Plus (August 1, 2017) “until further notice”. This action came after repeated requests by VHCA-VCAL members dealing with crossover claims issues since the onset of the program. While DMAS recognized that “strides have been made by all the health plans in accurately processing crossover Medicare Part A and Part B claims for nursing facilities over the past two years” they also recognized that “there is still a considerable amount of activity on these claims, both current and historic”.

We appreciate DMAS’ recognition that providers should not be punished for claims languishing beyond timely filing deadlines when these issues were identified by providers almost immediately upon CCC Plus implementation. We would advise you to submit any outstanding Part A and Part B crossover claims for which proper adjudication has not occurred via spreadsheet (encrypted) to the relevant managed care plan, including any you had previously submitted but were denied for timely filing. 

Virginia Premier 2019 Claims Clean-Up – Soft Launch

Prior to the state of emergency related to COVID-19, VHCA-VCAL was working with Virginia Premier on the next “settlement” project, specifically for any and all (CCC Plus and D-SNP) claims with dates of service between January 1, 2019 and December 31, 2019 for which the provider believes proper adjudication has yet to occur. Because operations at nursing facilities and central offices across the state (and country, in some cases) are in a crisis mode for the next several weeks at least, both VHCA-VCAL and Virginia Premier have agreed that it does not make sense at this time to formally request that this process start with a specified due date.

However, understanding that both providers and Virginia Premier have an incentive to get these claims resolved, Virginia Premier has decided to make the process available for those companies that have the time to engage in this process now. To the extent you have the time and ability, the spreadsheet and following instructions are being provided. At some point in the future when the crisis averts, Virginia Premier will formally start this settlement project with a specified due date providing 60 days for the provider to submit the claims. 

Instructions from Virginia Premier

Virginia Premier is asking nursing home providers to submit all outstanding claims for which the provider believes proper adjudication has yet to occur. This might include overpayments (for example, patient pay issues or improper payments of Part A claims), underpayments, or even valid unprocessed/pended/denied claims. Any unresolved claims issues for which the provider is seeking resolution should be included for the D-SNP and CCC Plus programs for dates of service between January 1, 2019 and December 31, 2019.

Virginia Premier is seeking this information via the attached spreadsheet.  We are strongly encouraging that all fields in the template be provided.  These fields will ensure accurate and timely review of the claims in question.  Inclusion of the claim number that contains the contested payment to the nursing home provider is critical.  A lesson learned during the first iteration of this process is that there may be several claims submitted for a specific date of service, or the claim could have been adjusted several times, each with a separate claim number.  We ask that all best efforts are made to include this information. If a claim number is not available, it is vital that all other fields be populated with data. It is equally important that the following fields are included for each claim: Total Billed Charges, Total Expected Reimbursement and Balance Remaining.

This information is requested to be encrypted and returned to Virginia Premier at VPHPLTSSProviderServices@virginiapremier.com. Spreadsheets sent to other addresses will not be considered.  Multi-facility companies can report all facilities on the same spreadsheet, but it is imperative to distinguish those facilities by NPI. In any case, a facility or company primary contact (name, phone number and email address) should be identified for follow-up once the Virginia Premier project resolution team has the opportunity to research the various claims. Virginia Premier expects a single spreadsheet by SNF (or company if that is what the multi-facility company prefers), but not multiple iterations of the spreadsheet. 

Virginia Premier will send a receipt confirmation to the designated facility/company contact within two business days of your submittal.

Virginia Premier will conduct the claims reviews and update the submitters as quickly as updates are available. Upon completion of review, we will provide responses to each provider that has submitted a spreadsheet for review.

Please do not include claims for dates of service in 2020.  For disputed 2020 claims, Virginia Premier encourages nursing facility providers to submit a reconsideration within the contractual guidelines. Providers also have the ability to seek assistance on disputed claims by contacting our dedicated SNF call line at 1-877-719-7358 ext. 58217 or by emailing claims directly at vphpltssclaims@virginiapremier.com.

If you have questions and concerns regarding any of these CCC Plus updates, please contact Steve Ford.

Editor’s note: This article was updated May 21, 2020 to reflect changes in contact information from Virginia Premier.