The date of admission to your facility This will help us and you to for each resident. List one admission Use mm/dd/yyyy format; for example, Admits Facility_Admission_Date determine eligibility for each per line; each resident can be listed 07/15/2017. Cannot be resident. multiple times. The date of discharge. Document discharges only. Transfers to the Use mm/dd/yyyy format; for example, hospital, or discharges with return 07/15/2017. This will help us and you to expected should only be included if the Facility_Discharge_Date Leave blank if listing the most recent determine eligibility for each resident did not return after 60 days. admit date for a resident still in the resident. If a resident dies in the facility, facility. document the date of death in this column. Use only one of the following: Death; Community; Another LTCF; This will help us and you to Specifies why the resident was Hospice (outside of facility); Facility_Discharge_Reason determine eligibility for each discharged Hospital; resident. Leave blank if listing the most recent admit date for a resident still in the facility. The category that describes the type of insurance that a resident as. If a Use only one of the following: resident has more than one insurance Medicare (Part A); type, list each type separately on a Medicare (Part B); new row. If a resident has both Medicaid; Insurance Insurance_Type Medicare Part A and Part B, list each Medicare Advantage (Part C); separately. For any Medicaid plan, VA; This will help us and you to including Managed Care, use Private; determine eligibility for each Use for any “Medicaid”. Other resident. insurance type not listed under values”. “Acceptable The plan number for each insurance Any insurance plan number. Leave Insurance Plan_Number listed. This should be Blank if one is blank if not applicable. (E.g. Private). “private”.
Admits Facility_Admission_Date The date of admission to your facility for each resident. List one admission per line; each resident can be listed multiple times. Use mm/dd/yyyy format; for example, 07/15/2017. Cannot be This will help us and you to determine eligibility for each resident. Facility_Discharge_Date The date of discharge. Document discharges only. Transfers to the hospital, or discharges with return expected should only be included if the resident did not return after 60 days. If a resident dies in the facility, document the date of death in this column. Use mm/dd/yyyy format; for example, 07/15/2017. Leave blank if listing the most recent admit date for a resident still in the facility. This will help us and you to determine eligibility for each resident. Facility_Discharge_Reason Specifies why the resident was discharged Use only one of the following: Death; Community; Another LTCF; Hospice (outside of facility); Hospital; Leave blank if listing the most recent admit date for a resident still in the facility. This will help us and you to determine eligibility for each resident. Insurance Insurance_Type The category that describes the type of insurance that a resident as. If a resident has more than one insurance type, list each type separately on a new row. If a resident has both Medicare Part A and Part B, list each separately. For any Medicaid plan, including Managed Care, use “Medicaid”. Use for any insurance type not listed under “Acceptable values”. Use only one of the following: Medicare (Part A); Medicare (Part B); Medicaid; Medicare Advantage (Part C); VA; Private; Other This will help us and you to determine eligibility for each resident. Insurance Plan_Number The plan number for each insurance listed. This should be Blank if one is “private”. Any insurance plan number. Leave blank if not applicable. (E.g. Private).