How To Use The Nursing Facility (Nf) Provider Id Number And National Provider Id (Npi) For A Nursing Facility

Transcription

1 March 2010 Administrator «DBA» «street_address1» «street_address2» «city» «state» «zip» Provider ID: «champs_provider_id» Subject: Nursing Facility Provider Identification (ID) Number and Disenrolling Residents from Medicaid Health Plans Dear Nursing Facility Administrator: The purpose of this letter is to inform you of your facility s seven-digit Medicaid Provider ID number in the Community Health Automated Medicaid Processing System (CHAMPS), which is located in the upper right-hand corner of this letter. It also reminds you of the need for this number on the Facility Admission Notice (MSA-2565-C) and the importance of providing this new Provider ID number and your facility s National Provider ID (NPI) number to hospices providing services in your facility. Finally, this letter reiterates the process for disenrolling residents from Medicaid Health Plans (MHPs) when they are enrolled due to an administrative error. Use of the Nursing Facility (NF) Provider Identification Number and National Provider ID (NPI) 1. Your facility s Provider ID number is necessary for completion of the MSA-2565-C, box 12.b. When admitting a Medicaid beneficiary to the facility, this form must be submitted to the Department of Human Services (DHS) where level of care (LOC) 02 will be added to the beneficiary file if the admission is approved. NOTE: Do not submit a MSA-2565-C for beneficiaries receiving hospice services in your facility. 2. Your facility s Provider ID number and your NPI number are also necessary for use by hospice providers when enrolling a beneficiary residing in your facility in hospice. Please provide the ID number in the upper right hand corner of this letter to each hospice providing services in your facility. Providing this number will help to ensure proper room and board payment to your facility by your contracted hospice providers. This Provider ID does not take the place of your NPI number, which is also required on the MSA-2565-C and is required on the institutional format when billing for Medicaid services. Disenrolling Residents from Medicaid Health Plans (MHPs) When a beneficiary residing in a NF is subsequently enrolled in a MHP, this is considered an administrative error. Disenrollment of NF residents enrolled in a MHP due to an administrative error may be requested by either the NF or the MHP. To request disenrollment, the NF must submit a Nursing Facility Request to Disenroll From Medicaid Health Plan (DCH-1185) form and a copy of the MSA-2565-C. The completed forms must be mailed or faxed to the Michigan Department of Community Health, Enrollment Services Section as indicated on the DCH CAPITOL COMMONS 400 SOUTH PINE LANSING, MICHIGAN L

2 L February 2010 Page 2 Any questions regarding this letter should be directed to Provider Inquiry, Department of Community Health, P.O. Box 30731, Lansing, Michigan , or at [email protected]. When you submit an , include your name, affiliation, and phone number so you may be contacted if necessary. Providers may phone toll-free Sincerely, Stephen Fitton, Director Medical Services Administration

3 Aberdeen Rehabilitation and Skilled Nursing Center Alamo Nursing Home Inc Allegan County Medical Care Facility Allendale Nursing and Rehabilitation Community Alpha Manor Nursing Home Altercare of Big Rapids Americare Convalescent Center Applewood Nursing Center Arbor Manor Care Center Argentine Care Center Inc Ashley Health Care Center Aspirus Ontonagon Hospital AuSable Valley Community Autumn Woods Autumnwood of Deckerville Autumnwood of Livonia Autumnwood of McBain Baraga County Memorial HLTCU Bay County Medical Care Facility Bay Shores Nursing Center Bayside Village Beacon Hill at Eastgate Beaconshire Nursing Centre Belle Fountain Nursing & Rehab Center Bishop Noa Home Bloomfield Orchard Villa Borgess Gardens Bortz Health Care of Rose City Bortz Health Care of Warren Bortz Health Care of West Bloomfield Bortz Health Care of Ypsilanti Inc Botsford Continuing Health Center Boulder Park Terrace Boulevard Health Center Brittany Manor Bronson Nursing and Rehabilitation Center Brookcrest Brookhaven Medical Care Facility Burcham Hills Retirement Center II Calhoun County Medical Care Facility Cambridge East Healthcare Center Cambridge North Healthcare Center Cambridge South Healthcare Center Camelot Hall Convalescent Center Canterbury on the Lake Carriage House of Bay City Cass County Medical Care Facility Cheboygan Memorial Hospital LTCU Chelsea Retirement Community Cherrywood Nursing and Living Center Chesaning Nursing Care Center Chippewa County War Memorial Hospital LTCU Christian Care Nursing Center Christian Park Health Care Center Christian Park Village Christian Rest Home CHRISTUS ST ELIZABETH HOSPITAL Church of Christ Care Center CLARK REGIONAL MEDICAL CENTER Distribution List for L / of 4 Clark Retirement Community Inc Clarkston Specialty Healthcare Center Clinton-Aire Healthcare Center Countryside Care Center Inc Countryside Nursing and Rehabilitation Community Courtney Manor Cranbrook Geriatric Village Inc Crestmont Nursing Healthcare Center Cypress Manor Health and Rehabilitation Center DeBoer Nursing Center Dimondale Nursing Care Center Durand Senior Care and Rehab Center East Grand Nursing Home Inc. East Lansing Health Care Center Eastwood Convalescent Center Eastwood Nursing Center Eaton County Medical Care Facility Elmwood Geriatric Village Inc Emmet County Medical Care Facility Evangelical Home Saline Evangelical Home Sterling Heights Evergreen Manor Senior Care Center Fairlane Senior Care and Rehab Center Fairview Nursing and Rehabilitation Community Faith Haven Senior Care and Rehab Centre Farmington Health Care Center Farmington Health Care Center - VDCU Father Murray Nursing Center Fenton Health Care Ferguson Convalescent Home Inc Fisher Convalescent Home Fountain View of Monroe Four Chaplains Convalescent Home Four Seasons Nursing Center of Westland Freeman Nursing and Rehabilitation Community Froh Community Genesys Convalescent Center Glacier Hills Gladwin Nursing and Rehabilitation Community Gogebic County Medical Care Facility Golden Living Center-Florence Golden Oaks Medical Care Facility Grace of Douglas Grand Blanc Rehab & Nursing Center - VDCU Grand Blanc Rehabilitation & Nursing Center Grand Oaks Nursing Center Grand Traverse Medical Care Facility Grandvue Medical Care Facility Grayling Nursing and Rehabilitation Community Greenfield Rehab and Nursing Center Hamilton Nursing Home Harborside Healthcare - Sylvania Rehab Harold & Grace Upjohn Community Care Center Hartford Nursing and Rehabilitation Center Hazel I Findlay Country Manor Health Source Saginaw - Skilled Heartland Health Care Center - Allen Park Heartland Health Care Center - Battle Creek Heartland Health Care Center - Briarwood

4 Heartland Health Care Center - Dearborn Heights Heartland Health Care Center - Dorvin Heartland Health Care Center - Fostrian Heartland Health Care Center - Grand Rapids Heartland Health Care Center - Greenview Heartland Health Care Center - Hampton Heartland Health Care Center - Holland Heartland Health Care Center - Ionia Heartland Health Care Center - Jackson Heartland Health Care Center - Kalamazoo Heartland Health Care Center - Knollview Heartland Health Care Center - Plymouth Court Heartland Health Care Center - Saginaw Heartland Health Care Center - Three Rivers Heartland Health Care Center - University Heartland Health Care Center - Whitehall Heather Hills Care Center Helen Newberry Joy Hospital Henry Ford Continuing Care Corporation - Belmont Henry Ford Continuing Care Corporation - Roseville Henry Ford Village Inc Heritage Manor Healthcare Center Heritage Nursing and Rehabilitation Community Herrick Memorial Hospital Manor Hickory Ridge of Temperance Highland Cottage Hillcrest Nursing and Rehabilitation Community Hillsdale Community Health Center LTCU Hillsdale County Medical Care Facility Hilltop Manor Health Care Center Hilton Convalescent Center Holland Home Breton Manor Holland Home Fulton Manor Holland Home Raybrook Manor Holly Convalescent Center Inc Holt Senior Care and Rehab Center LLC Hope Healthcare Center Houghton County Medical Care Facility Howell Health & Rehabilitation Center Howell Health & Rehabilitation Center - VDCU Hoyt Nursing & Rehab Centre Huron County Medical Care Facility Huron Woods Nursing Center Hyland Nursing Home Imperial Healthcare Centre Ingham County Medical Care Facility Iosco County Medical Care Facility Iron County Medical Care Facility Iron River Care Center IRONWOOD HEALTH & REHABILITATION CENTER Isabella County Medical Care Facility Jackson County Medical Care Facility Jamieson Nursing Home Jordans Nursing Home Inc Josephson Nursing Home Kalkaska Memorial Health Center King Nursing and Rehabilitation Community Kith Haven Distribution List for L / of 4 Lahser Hills Care Centre Lake Orion Nursing and Rehab Centre Lakeland Continuing Care Center St Joseph Lakeland Specialty Hospital at Berrien Center Lakepointe Senior Care and Rehab Center Lakeview Extended Care & Rehabilitation Facility Lakeview Lutheran Manor Lakeview Manor Healthcare Center Lapeer County Medical Care Facility Lapeer Regional LTCU Law-Den Nursing Home Lenawee County Medical Care Facility Life Care Center of Plainwell Lilian Kerr Nursing Care and Rehabiliation Center Lincoln Haven Nursing and Rehabilitation Community Little Rock Baptist Charity Care Center Inc Livonia Woods Nursing and Rehabilitation Lourdes Nursing Home Luther Haven Luther Manor Lutheran Home - Frankenmuth Lutheran Home - Livonia Lutheran Home - Monroe Lynwood Manor Healthcare Center Mackinac Straits Long Term Care Unit Manistee County Medical Care Facility Manor Care Nursing and Rehabilitation Manor of Battle Creek Skilled Nrsg & Rehab Center Manor of Wayne Skilled Nursing & Rehab Center Maple Lawn Medical Care Facility Maple Manor Rehab Center Maple Valley Nursing Home of Maple City Maple Wood Manor Marlette Community Memorial Marquette County Medical Care Facility Marshall Nursing and Rehabilitation Community Martha T Berry Memorial Medical Care Facility Marvin & Betty Danto Family Health Care Center Marwood Manor Nursing Home Marycrest Manor Maryhill Manor, Inc Marywood Nursing Care Center Masonic Healthcare Center Mather Nursing Center Meadow Brook Medical Care Facility Meadow Woods Nursing & Rehabilitation Center MediLodge of Hillman LLC Medilodge of Howell Medilodge of Monroe LLC MediLodge of Montrose Inc MediLodge of Plymouth Inc MediLodge of Port Huron LLC Medilodge of Richmond Inc MediLodge of Rochester Hills Inc Medilodge of Southfield Inc MediLodge of St Clair Inc MediLodge of Sterling Medilodge of Sterling Heights

5 MediLodge of Taylor Inc Medilodge of Yale Menominee Care Center Mercy Hospital Grayling LTCU Mercy Memorial Nursing Center Metron of Belding Metron of Big Rapids Metron of Cedar Springs Metron of Forest Hills Metron of Greenville Metron of Lamont MidMichigan Gladwin Pines MidMichigan Stratford Village New Light Nursing Home Newaygo County Medical Care Facility Norlite Nursing Centers Of Marquette Inc North Ottawa Care Center North Woods Nursing Center Northfield Place Northland Lutheran Services Oakland Geriatric Village Inc Oakland Nursing Center OakPointe Senior Care and Rehab Center Oakview Medical Care Facility Oakwood Healthcare Inc Oakwood Rehab & Skilled Nursing Center - Dearborn Oceana County Medical Care Facility Okemos Health and Rehabilitation Center Omni Continuing Care Omni Continuing Care VDCU Orchard Grove Extended Care Center Otsego County Memorial Hospital Our Lady of Mercy Health & Rehab Ovid Healthcare Center Park Geriatric Village Inc Petoskey Geriatric Village Inc Pilgrim Manor Inc Pine River Healthcare Center Pinecrest Medical Care Facility Plainwell Pines Nursing and Rehabilitation Comm Portage Point Porter Hills Presbyterian Village Providence Christian Healthcare & Rehab Ctr Provincial House of Adrian Qualicare Nursing Home Redford Geriatric Village Inc Regency Healthcare Centre Regency Heights Nursing and Rehab Center Regency on the Lake - Fort Gratiot Renaissance Gardens at Fox Run Rennes Health Center - East Rennes Health Center - West Resthaven Care Center Rivergate Health Care Center Rivergate Terrace Riveridge Manor Inc Riverside Nursing and Rehabilitation Community Riverview Manor Distribution List for L / of 4 Romeo Continuing Care Romeo Nursing Center Roosevelt Park Nursing and Rehabilitation Communit Roubal Care and Rehab Center Royalton Manor Saginaw Geriatrics Home Saginaw Senior Care and Rehab Center LLC Samaritan Manor Sanctuary at Alexander Sanctuary at Bellbrook Sanctuary at Fraser Villa Sanctuary at McAuley Sanctuary at Saint Marys Sanctuary at the Abbey Sanctuary at the Park Sanctuary at the Shore Sanford Hospital Webster Sanilac County Medical Care Facility Scheurer Hospital LTCU Schnepp Health Care Center Schoolcraft County Medical Care Facility Sheffield Manor Nursing & Rehab Center Shiawassee County Medical Care Facility Shore Pointe Nursing Center Silverbrook Manor Sisters, Servants Immaculate Heart of Mary Sky View Nursing Center Sorrento Care Center SOUTH CENTRAL REGIONAL MEDICAL CTR South Haven Nursing and Rehabilitation Community South Lyon Senior Care and Rehab Center LLC Spectrum Health Kelsey Spectrum Health Kent Community Campus Spectrum Health Reed City Campus Spectrum Health Rehab and Nursing Center Spectrum Health United Memorial St Anne's Convalescent Center St Anns Home St Anthony Healthcare Center St Francis Home St Francis Nursing Center St James Nursing Center St John Senior Community ST JOSEPH CARE CENTER - WEST St Josephs Healthcare Center St Jude Nursing Center St Mary's Rehab & Health Care Center Standish Community Hospital/SNF Star Manor of Northville Sunny Acres Nursing Center Superior Woods Healthcare Center Tendercare - Alpena Tendercare - Cass City Tendercare - Clare Tendercare - Gaylord Tendercare - Gaylord - VDCU Tendercare - Green View Tendercare - Hastings

6 Distribution List for L Tendercare - Kalamazoo Tendercare - Marshall Tendercare - Midland Tendercare - Mt Pleasant Tendercare - Portage Tendercare - Rogers City Tendercare - Saginaw Tendercare - Tawas City Tendercare - Traverse City Tendercare - West Tendercare Health & Rehabiliation Center of Taylor Tendercare Health and Rehab Center of Holland Tendercare Health Center - Birchwood Tendercare Health Center of Adrian Tendercare Health Center of Albion Tendercare Health Center of Cheboygan Tendercare Health Center of Frankenmuth Tendercare Health Center of Leelanau Tendercare Health Center of Wyoming Tendercare of Ludington Tendercare of Monroe Tendercare of Westwood Tendercare Sault - Ste Marie The Gilbert Residence The Lakeland Center The Laurels of Bedford The Laurels of Carson City The Laurels of Coldwater The Laurels of Fulton The Laurels of Galesburg The Laurels of Hudsonville The Laurels of Kent The Laurels of Mt Pleasant The Laurels of Sandy Creek The Lodge at Maplecreek The Manor of Farmington Hills The Manor of Northwest Detroit The Manor of Novi The Manor of Southgate Skilled Nrsg & Rehab Center The Manor of Wayne Continuing Care Center The Maples Benzie County MCF The Oaks at Northpointe Woods The Pines Healthcare Center The Springs at the Fountains The Village of East Harbor The Village of Redford The Village Rehabilitation and Care Center Thornapple Manor Medical Care Facility Transitional Health Services of Fremont Transitional Health Services of Wayne Traverse Geriatric Village Inc Trilogy Healthcare of Jackson Trilogy Healthcare of Oakland Tuscola County Medical Care Facility Valley Health Care Center Villa Maria Health and Rehabiliation Center Warren Woods Health and Rehabilitation Warwick Living Center West Bloomfield Nursing & Convalescent Center West Branch Geriatric Village Inc West Hickory Haven West Oaks Senior Care and Rehab Center West Toledo Healthcare & Rehabilitation West Woods of Niles Westgate Nursing and Rehabilitation Community Westland Nursing & Rehabiliation Centre Westwood Nursing Center WHISPERING OAKS CARE CENTER Whitehall Healthcare Center of Ann Arbor Whitehall Healthcare Center of Novi Whitehills Health Care Center Wil Mar Convalescent Home Willowbrook Manor Woodhaven Retirement Community Woodward Hills Nursing Center 3/ of 4