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180-Day Claims Exception Requests Process During the COVID-19 Pandemic

Issued: June 4, 2020

To mitigate the spread of COVID-19 in Pennsylvania, Commonwealth employees who work in Dauphin County and the Capitol Complex were instructed to telework, beginning Monday, March 16, 2020. While teleworking, the Office of Long-Term Living (OLTL) has reduced access to the physical site where paper mail is delivered. Therefore, OLTL is implementing a temporary change in the processing of 180-Day Claims Exception Requests. OLTL is requesting that providers email their requests and supporting documentation to, until further notice. 

Please follow the below instructions 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: 

    • Nine-digit PROMISe™ Provider ID and four-digit service location code 
    • Recipient First and Last name 
    • From and To Dates of Service
      a. Example: 123456789-0001 John Smith 1/1/2019-6/30/2019

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

    1. MA 307 Signature Transmittal Form
      a) Please include an email address on the signature line in addition to a telephone number. 
    2. UB-04 Claim Form completed correctly according to the Billing Guide.
      a) UB-04 Billing Guide for PROMISe™ Nursing Facilities forCounty and Non-Public Nursing Facilities and State RestorationCenters 
    3. PA-162 Notice of Eligibility 
    4. PA 600L Application for Benefits, page 10; MA 51 Medical Evaluation; MA 103 Long Term Care Admission and Discharge Transmittal
      a) Please include the available documentation, only one is necessary. 
    5. 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.
      a. CMS-1500 Billing Guide for PROMISe ™ Home Health Agencies 
    2. Include documentation to support untimely billing.
      a. Include letter on company letterhead detailing the reason for untimely filing.
                  i. This can be communication between the Provider and Service Coordination Agency.
      b. Any updated service authorizations

If you have any questions about this  communication, contact the OLTL Provider Helpline at 1-800-932-0939, Option 2.