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Community HealthChoices: SNF's Recap of the First Month

February 27, 2018
Reimbursement By Jennifer Matoushek, Senior Consultant

During the last Third Thursday Webinar, held February 15, 2018, The Department of Human Services (DHS) stated that the first launch of Community HealthChoices (CHC) was a success. But what are skilled nursing facilities really feeling about the implementation?


From what we're seeing, Southwest nursing facilities are experiencing some issues. For starters, all three MCOs (AmeriHealth Caritas, PA Health and Wellness and UPMC) require nursing facilities (NFs) to submit claims through their own clearinghouse. This has required NFs to spend a considerable amount of time ensuring proper set up in their systems.

When submitting claims under the old system, NFs could submit batches. However, under the new process, some NFs are unable to submit batches and are required to hand-key claims into the system. Some facilities are having to hire help to assist with this process. By not being able to submit batches, NFs must go through each individual claim to see if an adjustment needs to be made. Additionally, if an adjustment does need to be made to a claim, the NF must submit a new claim; they are unable to perform an adjustment like they did under the old system.

NFs are also struggling with claim denials and are unclear of the reason for the denial. Under the old system PROMISe, NFs were informed immediately if claims were rejected. Now, it's a waiting game.

Another area of struggle is contacting MCOs with billing questions. We're hearing that MCOs are inadequately equipped to assist NFs with answering all their questions and are referring NFs to contact someone in their billing department.

As with all new implementations, it takes time to iron out the kinks. However, one good thing we’re seeing is that facilities are receiving payment earlier than anticipated. While some are having to wait on payments, reports are coming in that many NFs are receiving payment as soon as 5 days after claim submission.

So, what do Southwest NFs wish they had? They're wishing they received billing training from the MCOs to help better prepare for the implementation of CHC. What can other NFs learn from the Southwest implementation of CHC?

Contact LW Consulting, Inc. to see how we can help before your region's implementation of CHC.
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