PACE/MLTC Cabinet to Focus on “Clean Claims” Submissions
At the most recent meeting of the LeadingAge NY PACE/MLTC (Program for All-Inclusive Care for the Elderly and Managed Long Term Care) Cabinet, members identified the submission of “clean claims” by providers to plans as a serious and ongoing problem. A clean claim may be thought of as one that is paid the first time the provider submits it to the plan. Neither the plans nor the providers want to have to deal with the burden of multiple submissions of the same claim or delays in payment. The Cabinet is therefore seeking to develop a reference document on how to successfully submit clean claims. With the transition of the nursing home population to managed care sometime in the near future, the PACE/MLTC Cabinet is also reaching out to the Nursing Home Cabinet to help address the situation.
This is a follow-up to recent LeadingAge NY educational outreach designed in conjunction with the PACE/MLTC Cabinet that included our clean claims billing seminars and the most recent round of CFO Council Meetings. The following reference materials are available from these sessions:
Achieving the Goal of “Clean Claims”
Managed Long Term Care (MLTC) - The Billing Perspective
Prior Authorization, Concurrent Review, Retrospective Review and Appeals
The Claim Submission and Adjudication Process and the Role of the Clearinghouse
Review of Critical Managed Care Contracting, Transition, and Operating Issues
The submission of a clean claim starts early on, during the contracting phase as both providers and plans need to have a clear understanding of the mutual relationship and how best to work together to ensure that the process works efficiently for both sides. Through our cabinet process, LeadingAge NY plan and provider members are committed to working together on this critical issue.
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827