CommercialReimbursementHigh impact
Mutual News October 2019 Bulletin
Medical Mutual of Ohio·Mutual News Bulletin
Effective date
Nov 1, 2019
We identified it
Jun 20, 2026
Summary
Medical Mutual is implementing a new Hospital Readmissions Reimbursement Policy effective November 1, 2019, that may deny payment for readmissions within 30 days if they are clinically related and could have been prevented. The insurer is also expanding HIPAA validation rules that may reject claims with incorrect formatting.
Action Required
By November 1, 2019: Billing team must contact clearinghouse/billing service to ensure they are using SNIP Level 6 and CMS SNIP Level 7 edits, specifically asking about dollar amount character limit 99,999,999.99 without commas. Hospital billing staff must ensure complete medical records are submitted for all readmissions within 30 days, including discharge planning documentation, clinical status at discharge, and discharge instructions. Review electronic response reports routinely to identify rejections and resubmit corrected claims promptly to avoid payment delays.