United Healthcare Billing Issue

There has been a report from United HealthCare that they are seeing some members billing from long-term care that are showing level of care for swing bed.  If a resident goes to the hospital and is put in a swing bed at the hospital for skilled nursing care, then that does not count as a hospital reserve day for billing. 

Nursing homes should submit MS-2126 to the KanCare Clearinghouse upon the members return, so that their level of care will reflect nursing home.

1. Remember, the MS-2126 only needs to be submitted for the following reasons.
   1. A medical recipient is admitted or discharged from the facility
   2. A resident files an application for medical assistance
   3. A resident has been absent from the facility for 30 days or longer
   4. A resident changes level of care (including swing bed)

United Healthcare is working with KMAP/KanCare to get these levels of care changed/corrected, but they need your help. If you receive an email from United regarding this issue, please send KanCare Clearinghouse a MS-2126 for the dates we send in the email, and then a copy to United for tracking purposes only. If these do not get these submitted to KanCare and the level of Care doesn’t get updated your claims are at risk of recoupment.

If you have any questions on this, please contact Mona Hull, Manager of Provider Services for Nursing Facilities for United Healthcare at (612) 642-7797 or email her.