What are the appropriate TOB codes to be used for LTC claims?
Response: Nursing facilities will use the following TOB codes: • 260 – Non-payment/Zero Claim • 261 – Admit Through Discharge Claim • 262 – Interim – First Claim • 263 – Interim – Continuing Claim • 264 – Interim – Last Claim • 267 – Replacement of a Prior Claim • 268 – Void/Cancel of a Prior Claim ICFs/MR, ICFs/ORC and State ICFs/MR will use the following TOB codes: • 650 – Non-payment/Zero Claim • 651 – Admit Through Discharge Claim • 652 – Interim – First Claim • 653 – Interim – Continuing Claim • 654 – Interim – Last Claim • 657 – Replacement of a Prior Claim • 658 – Void/Cancel of a Prior Claim 30. If the resident has Medicare Part A commercial insurance that does not cover the service period and is not otherwise involved with payment calculations for Medical Assistance purposes, does it have to be listed as a resource and payer? Response: All third party resources that might apply should be entered even if they do not apply during the service month. If a resident has four or more
