Notice of fb88Care Reimbursement Methodology Change, fb88Care Benefits Manual, Sections 67, Nursing Facility Services and Section 97, Private Non-Medical Institution (PNMI) providers delivering services through Appendix C

Notice of fb88Care Reimbursement Methodology Change

´¡³Ò·¡±·°ä³Û:Ìý Department of Health and Human Services, Office of fb88Care Services

SERVICES INCLUDED:  Chapter 101, fb88Care Benefits Manual, Sections 67, Nursing Facility Services and Section 97, Private Non-Medical Institution (PNMI) providers delivering services through Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities

Notice of fb88Care Reimbursement Methodology Change, fb88Care Benefits Manual, Section 97, Private Non-Medical Institution (PNMI) Substance Use Treatment Facilities (Appendix B) and Children's Residential Care Facilities (Appendix D)

Notice of fb88Care Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of fb88Care Services

SERVICES INCLUDED:  Chapter 101, fb88Care Benefits Manual, Section 97, Private Non-Medical Institution (PNMI) Substance Use Treatment Facilities (Appendix B) and Children's Residential Care Facilities (Appendix D)

Notice of fb88Care Reimbursement Methodology Change, fb88Care Benefits Manual, Section 13, Targeted Case Management Services

Notice of fb88Care Reimbursement Methodology Change

´¡³Ò·¡±·°ä³Û:Ìý Department of Health and Human Services, Office of fb88Care Services

SERVICES INCLUDED:  Chapter 101, fb88Care Benefits Manual, Section 13, Targeted Case Management Services

Notice of fb88Care Reimbursement Methodology Change, fb88Care Benefits Manual, Family Planning Services

Notice of fb88Care Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of fb88Care Services

SERVICES INCLUDED:  Chapter 101, fb88Care Benefits Manual, Family Planning Services

NATURE OF PROPOSED CHANGES: The Department plans to amend reimbursement of certain family planning services, effective July 1, 2024. These changes are as follows:

Notice of fb88Care Reimbursement Methodology Change, fb88Care Benefits Manual, Section 25, Dental Services and Reimbursement

Notice of fb88Care Reimbursement Methodology Change

AGENCY:  Department of Health and Human Services, Office of fb88Care Services

SERVICES INCLUDED:  Chapter 101, fb88Care Benefits Manual, Section 25, Dental Services and Reimbursement

Non-Emergent - Emergency Department Claims Not Pricing Correctly

fb88Care discovered that some hospital non-emergency claims failed to price correctly and were overpaid. This occurred when there was more than one emergency room service on the claim, for claims submitted for Dates of Service from January 1, 2022, and March 31, 2024. fb88Care reimburses differently in cases where non emergent use of the emergency room is determined.

No provider action is required as fb88Care will re-process these claims.