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Frequently Asked Questions

 
Q:

Graduate Medical Education (GME)– How do I bill this type of claim?

A:

Graduate Medical Education (GME) payments are made to cover the GME expenses related to an Inpatient stay on behalf of a Medicaid recipient enrolled in a Managed Care plan on the Date of Admission. GME claims are billed with all the information required on an Inpatient claim with a few modifications: The discharge date is required and the discharge date is repeated as the From-Thru date of service. The discharge status code is the final discharge code of the stay. The Medicaid days entry is 1 day and the payment is determined by the GME rate code entered. GME rate codes range from 3130 thru 3137.

Important elements:
837 Institutional

Loop 2300, CLM (Claim Information)

From and Through dates:

DTP*434*RD8* = Discharged Date –and- Discharged Date
(Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD)
From and Through Dates are always the same.

Admission date and Time:
DTP*435*DT* = Admission Date
(Date & Time Expressed in Format CCYYMMDDHHMM)

Occurrence Code:
HI*BH:42:D8:Discharged Date repeated here~
Date Expressed in Format CCYYMMDD

Patient Status Code:
CL103 needs to equal the final discharged code

Medicaid Covered Days:
QTY*CA*1*DA~

Rate Code:
HI*BE:24:::Rate Code~ (GME rate codes range from 3130 thru 3137)

 
Notes and Comments

Created:

July 7, 2006           

Last Modified:

October 12, 2006    

 
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