OLTL Issues COVID-19 180-Day Claims Exception Requests Process

The Office of Long-Term Living (OLTL) has issued a notice regarding the implementation of a temporary change in the processing of 180-day claims exception requests. This change was made due to the Commonwealth employees who work in Dauphin County and the Capitol Complex that were instructed to telework as of March 16, 2020 to mitigate the spread of COVID-19. While these employees were teleworking, OLTL reduced access to the physical site where paper mail is delivered. Therefore, OLTL is requesting that providers email their requests and supporting documentation until further notice.

Providers should follow the instructions below when submitting 180-day claims exception requests via email:

When submitting claims for 180-Day review electronically, please be sure to only send one email per recipient.

Subject line must include:

• 9-digit PROMISe™ Provider ID and four-digit service location code
• Recipient First and Last name
• From and To Dates of Service

*Example: 123456789-0001 John Smith 1/1/2019–6/30/2019

 Nursing Facility claim requests must attach supporting documentation in the following order:

• MA 307 Signature Transmittal Form
  1. Please include an email address on the signature line in addition to a telephone number.
• UB-04 Claim Form completed correctly according to the Billing Guide.
  1. UB-04 Billing Guide for PROMISe™ Nursing Facilities for County and Non-Public Nursing Facilities and State Restoration Centers
• PA-162 Notice of Eligibility
• PA 600L Application for Benefits, page 10; MA 51 Medical Evaluation; MA 103 Long Term Care Admission and Discharge Transmittal
  1. Please include the available documentation, only one is necessary.
• Third Party denied Explanation of Benefits (EOB), if necessary.

Direct Care Provider claim requests must attach supporting documentation in the following order:

1. 1500 Claim form completed correctly according to the billing guide.
   1. CMS-1500 Billing Guide for PROMISe ™ Home Health Agencies
2. Include documentation to support untimely billing.
   – Include letter on company letterhead detailing the reason for untimely filing.
   *This can be communication between the Provider and Service Coordination Agency.
   – Any updated service authorizations.

Questions regarding these instructions should be directed to the OLTL Provider Helpline at 800-932-0939, Option 2.