The American Health Care Association (AHCA) has provided the following PDPM Claims Payment Update:
The Centers for Medicare and Medicaid Services (CMS) informed AHCA that all Patient-Driven Payment Model (PDPM) claims, including multiple Health Insurance Prospective Payment System (HIPPS) code claims, will now process. Members should submit all claims as quickly as possible to start the 14-day floor claims process.
Other highlights from our communications with CMS include:
- The MACs installed the CMS claims processing fix on November 18, and all submitted PDPM claims are now being processed normally.
- All clean claims, including previously held claims, that have passed the 14-day payment floor period are being paid per normal processes.
- There are no remaining outstanding claims processing issues at this time.