PDPM Claims Will Now Process

Carl J. Pucci in Finance & Reimbursement

CMS will begin processing PDPM claims, including (HIPPS) code claims. Members should submit all claims as soon as possible to start the 14-day floor claims process. 

Below is the AHCA bulletin: 

Yesterday, the Centers for Medicare and Medicaid Services (CMS) informed us that all Patient-Driven Payment Model (PDPM) claims, including multiple Health Insurance Prospective Payment System (HIPPS) code claims, will now process. Members should submit all claims as quickly as possible to start the 14-day floor claims process. 

Other highlights from our communications with CMS include:

  • The MACs installed the CMS claims processing fix on November 18, and all submitted PDPM claims are now being processed normally.  
  • All clean claims, including previously held claims, that have passed the 14-day payment floor period are being paid per normal processes.
  • There are no remaining outstanding claims processing issues at this time.

Sign up for AHCA's weekly webinar on Thursday, November 21 at 3pm ET. Register here for this week's webinar available to all AHCA members. This will focus on important PDPM updates and discuss the claims payment process in greater detail. 

If you have questions, suggestions or concerns, please contact pdpm@ahca.org

This is extremely positive news and we look forward to hearing how PDPM will be impacting the quality of care your facilities provide to residents and patients. Thank you for your patience and understanding while adjusting to a new payment system.  


Carl J. Pucci
Chief Financial Officer
518-462-4800 x36