Personal Care Services and CDPAP UB04 Billing Guidelines

What this rule requires your agency to do

• 1For Medicaid HHA, Personal Care, and CDPAS claims, Direct Care Worker information must be included in the Medical Record Number loops (Home Care Registry IDs for HHA/Personal Care claims; SFI Personal Assistant IDs for CDPAS claims).(Personal Care Services and CDPAP UB04 Billing Guidelines)
• 2Claims must be submitted within 90 days of the date of service unless acceptable circumstances for the delay can be documented.(Personal Care Services and CDPAP UB04 Billing Guidelines)
• 3Service units must be reported as full units only, rounding partial hours to the nearest whole hour (a service under 30 minutes may be claimed as one hour); if fewer hours than prior-approved are rendered, report the actual hours.(Personal Care Services and CDPAP UB04 Billing Guidelines)
• 4All Personal Care and CDPAP services require Prior Approval, and the eleven-digit Prior Approval number must be entered in Form Locator 63.(Personal Care Services and CDPAP UB04 Billing Guidelines)
• 5Providers submitting Medicaid claims electronically are required to use the HIPAA 837 Institutional (837I) transaction; paper claims must use the NUBC UB-04 claim form.(Personal Care Services and CDPAP UB04 Billing Guidelines)