Nursing Facility Claims Billing Value Code 31 (Medicaid, MyCare)

Reminder: Nursing Facility Claims Billing Value Code 31

For Nursing facility claims, Value code 31 should only be used to indicate a Lump Sum amount, and not the individual’s monthly patient liability amount as indicated in OAC 5160-3-39.1. Buckeye Health Plan will separately apply any amount billed under value code 31, on nursing claims as a separate Lump sum payment.  The Lump Sum amount will be applied in addition to the member’s monthly liability indicated to Buckeye by ODM.

Value code 31 should not be used to indicate the member’s monthly liability.  For additional guidance on billing the appropriate member liability codes, please seeplease see Ohio Medicaid companion Guides