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Medicaid- Bed Reserve and Therapeutic Pass Reimbursement Update

WellCare of Kentucky has some important information to share with you regarding payments for bed reserve and therapeutic pass days.  

Bed Reserve Day Reimbursement

As a reminder, WellCare’s contract with you establishes that WellCare will pay 100% of the Department for Medicaid Services (DMS) amount for covered services. DMS pays either 75% of a provider’s per diem or 50% of the provider’s per diem for a bed reserve day that meets the coverage criteria (including limits) in 907 KAR 9:005, Non-outpatient Level I and II psychiatric residential treatment facility service and coverage policies.

Effective August 11, 2021, and in accordance with your provider agreement, WellCare will pay your facility the current DMS rate for your facility for a bed reserve day that meets the bed reserve coverage criteria in 907 KAR 9:005.

Additionally, if you have been overpaid for any bed reserve days, WellCare intends to recover any such overpayment in accordance with KRS 304.17A-714.

Bed Reserve Code

The revenue code for a bed reserve day is 180. WellCare will deny any claim for a bed reserve day if revenue code 180 is not listed on the claim.

Therapeutic Pass Day Reimbursement

As a reminder, WellCare’s contract with you establishes that WellCare will pay 100% of the Department for Medicaid Services amount for covered services. DMS pays either 100% of a provider’s per diem or 50% of the provider’s per diem for a therapeutic pass day that meets the coverage criteria (including limits) in 907 KAR 9:005.

Effective August 11, 2021, and in accordance with your provider agreement, WellCare will pay your facility the current DMS rate for your facility for a therapeutic pass day that meets the therapeutic pass day coverage criteria in 907 KAR 9:005.

Additionally, if you have been overpaid for any therapeutic pass days, WellCare intends to recover any such overpayment in accordance with KRS 304.17A-714.

Therapeutic Pass Code

The revenue code for a therapeutic pass day is 183. WellCare will deny any claim for a therapeutic pass day if revenue code 183 is not listed on the claim.

If you have any question regarding this notice, please contact your Provider Relations representative.