Fiscal Year (FY) 2022 Skilled Nursing Facility (SNF) Claim Reprocessing

Palmetto GBA shall initiate reprocessing the SNF Prospective Payment System (PPS) claims that meet certain criteria after the successful implementation of the FY 2022 SNF Pricer into Production on February 22, 2022: 

The criteria for reprocessing claims are as follows: 

• TOB = 21X and 18X (subject to SNFPPS) 
• Claim Date of Service (DOS) = through date on or after October 1, 2021 
• QRP=FED PPS BLEND IND field in the PSF equals “1” to indicate the SNF did not meet the QRP standards 
• Date of Receipt = On or after October 4, 2021

Palmetto GBA shall reprocess the SNF claims that the above criteria within 60 days. The production deployment of the Java/Cloud SNF Pricer API (release version: v1.5.1, calculation version: 2022.1) was completed on February 22, 2022.  There is no provider action required.