October 29,2026: Attention Nursing Facilities, Medicaid Managed Care Providers, MI Coordinated Health Providers: This notice serves as a reminder that Nursing Facility, Managed Care Providers, and MI Coordinated Health (MICH) providers must follow the Medicare day reporting requirements outlined in Section 8.17, Reporting Medicare on the Nursing Facility Claim, within the Billing and Reimbursement for Institutional Providers chapter of the Medicaid Provider Manual.
When Medicare days are included on claims or encounters, MDHHS policy may require additional informational details depending on the situation. This includes value codes, occurrence codes, claim reason and remark codes (CARC/RARC), and the applicable from/through dates. Providers should refer to the Medicaid Provider Manual for complete Medicare day reporting requirements.
- Value Code 80 – Covered Days :Reflects days for which Medicare has approved payment during the Medicare‑covered portion of a stay (typically days 1–100).
- Value Code 81 – Non‑covered Days: Reflects days beyond the covered Medicare benefit or when active care has ended (generally day 100 and after).
- Note: For MICH beneficiaries, the occurrence code related to the three‑day qualifying hospital stay is not required.
- Value Code 82 – Coinsurance Days: Reflects days within the coinsurance period of a Medicare or Medicare Advantage stay (typically days 21–100).
- Prior Stay Date: Used in situations where a skilled nursing facility or nursing facility stay ended within 60 days of the Nursing Facility admission.
- Nursing Facilities with Medicaid‑Only Certified Beds: Used in situations for beneficiaries who have Medicare coverage based on Medicaid’s TPL file.
For beneficiaries enrolled in a Medicaid Managed Health Plan (MHP) or Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP) as part of the MICH program, providers should contact the specific plan for questions related to prior authorization and billing requirements.