BSB 606 Traditional Waiver Provider Payment Requirements

							                                                                                                  BSB 606

TRADITIONAL WAIVER PROVIDER PAYMENT REQUIREMENTS

Payment for Services

Payment for Big Sky Bonanza (BSB) traditional waiver services is contingent on the following factors:

       1.        The consumer is financially eligible for Medicaid during the month in which the service is
                 rendered;

       2.        The consumer meets Level of Care requirements;

       3.        The provider is eligible for Medicaid participation on the day the service is rendered and has
                 agreed to accept the consumer and bill Medicaid;

       4.        Services are approved in the consumer's Support and Services Spending Plan (SSSP);

       5.        A third-party has not already paid in full for the service;

       6.        The consumer has not exceeded the limitations for his/her approved SSSP without
                 Department approval;

       7.        The BSB Financial Manager (FM) has prior authorized the service;

       8.        A clean claim is received by ACS within 365 days of the date of service;

       9.        Payment is unavailable for any days a consumer is hospitalized or in a nursing facility unless
                 the consumer and Independence Advisor (IA) have approved retainer reimbursement days.
                 Refer to BSB 410 for the policy on retainer days. Payment may be available on the date of
                 admission and the date of discharge for hospital and nursing facility placement; and

       10.       Payment may be approved for consumers in hospitals, nursing facilities, or community
                 settings who have not been admitted to BSB if such services are necessary to transition
                 them into the BSB waiver. However, the date of service, for billing purposes, cannot be
                 before the date of admission to BSB and prior authorization by the Community Services
                 Bureau is required.




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August 1, 2008                             Senior & Long Term Care                           Page 1 of 1