Name of Manual - Blue Cross and Blue Shield of Minnesota

SNF Billing for Blue
Plus Government
Program Products
(continued)
How to bill the room & board line:
Loop and Segment
on 837I
Coding Policies and Guidelines (Hospital / SNF Care)
Description of Data Content
Loop 2400, SV201 Revenue Code for room & board; for
example “0120.”
Loop 2400, SV202 The rate charged per day for the room and
board, for example “174.41.”
Loop 2400, DTP03 Can be left blank.
Loop 2400, SV205 The number of days that room and board
were provided.
Loop 2400, SV203 The total charge for the room and board.
Skilled Nursing Facility Services should be billed with claim
facility type of bill code 02XX.
Intensive Service Days (ISD)
Nursing facility providers should bill Intensive Service Days (ISD)
with revenue code 0230.
Providers may request prior authorization and, if approved, receive
reimbursement for Intensive Service Days for a resident who is in
skilled or custodial care. ISDs can be considered regardless of
whether Blue Plus or the Department of Human Services (DHS) is
responsible for the payment of the custodial stay.
If DHS is responsible for the custodial room and board, the
nursing facility should prior authorize the ISD and then bill to
Blue Plus only the revenue code 0230 for the ISD services
provided.
If Blue Plus is responsible for the custodial room and board, the
nursing facility should prior authorize the ISD and then bill the
revenue code 0230 for the ISD services along with normal billing
procedures for the custodial room and board.
Medicaid
Custodial days are billed at the Medicaid Case Mix rate as
determined by the MN Department of Human Services.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)
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