To add information, select Add, enter required information, and use the Effective Date from the certification and Transmittal form from OIG date of the survey.

 To change information, select Edit within the grid on the line item you wish to change. To End Date the selection, enter the date prior to the Effective Date of the Certification and  Transmittal form from OIG.

• The following information is required for Provider Type 12 (Nursing Facility):  Bed Type, Beds Per Room, Prefix, First Room Number, Last Room Number, Bed Suffix, Total Number of Rooms, Total Certified Beds, and Certified for Either Medicare or Medicaid. The Effective Date defaults from Requested Effective Date and End Date defaults as Open Ended (12/31/2299)

• For Provider Type 12 (Nursing Facility) with specialty of ”Brain Injury”: Total Certified Beds, and Certified for Either Medicare or Medicaid. The Effective Date is default from Requested Effective Date and End Date defaults as Open Ended (12/31/2299)

• For Provider Type 12 (Nursing Facility), with specialty of “Hospital Swing”: Total Certified Beds and Certified for Either Medicare or Medicaid. The Effective Date is default from Requested Effective Date and End Date defaults as Open Ended (12/31/2299)

• For all other Provider Types (01, 02, 11, 92 & 93), regardless of specialty, the following information is required: Bed Type, Total Certified Beds, and Certified for Either Medicare or Medicaid. The Effective Date is default from Requested Effective Date and End Date defaults as Open Ended (12/31/2299)

Bed Data

Bed Data information is required for these Provider Types:

• (01) General Hospital

• (02) Psychiatric Hospital

• (04) PRTF-Psychiatric Residential Treatment Facilities

• (11) ICF(Intermediate Care Facility)/MR/DD

• (12) Nursing Facility

• (92) Psychiatric Distinct Part Unit

• (93) Rehabilitation Distinct Part Unit

Bed Type

• Bed Type is required for all the above listed provider types

• Select Bed Type from the Dropdown box

• Additional Bed Type details are required for Provider Type 12

• If “Other” is chosen, provide a description in the comment box as this is required

Beds Per Room

• Enter the number of beds per room

Certified Beds

• Enter the number of Certified beds from your approved Certification and Transmittal with Bed Listing from OIG (Office of Inspector General)

Bed Effective Date

• Bed Effective Date will default to enrollment requested effective date

Bed End Date

• Bed end date should be open ended and is not a required field

First Room Number

• Enter the first room number

Last Room Number

• Enter the last room number

Total Rooms

• Enter the total number of rooms

Rooms Suffix

• Enter all Room Suffixes

Number Medicare Rooms

• Enter the total number of Medicare Rooms

Number Medicaid Rooms

• Enter the total number of Medicaid Rooms

Both

• Enter the total number of beds that can be used for both Medicare AND Medicaid

Substance Use Disorder (SUD) PT 03 Behavioral Health Service Organization (BHSO) Tier Selections and PT 66 Behavioral Health Multi-Specialty Group:  

There are three tiers available for selection:  Tier 1 Mental Health, Tier 2 Outpatient SUD, and Tier 3 Residential SUD.  PT 66:  No tier selections.  Bed data only required for Tier 3 PT 03 Residential SUD.

• At least one bed data record is required.

• Bed data must be entered for each Residential Facility.  Residential Facility will be selected from drop down menu based on addresses entered on screen 1.7 Address Information

• Enter Bed Type (select Residential).  No overlapping bed records for the same Bed Type.

• Enter Bed Effective/End Dates

• Enter Total Beds.  Total beds cannot exceed 999.  

Special Characters:

• The following Special Characters cannot be used in the situations below. Field properties will not allow the following characters in the box:

 For First Name, Business Name, Other name (if any):    | + \ '

 For Last Name field:    | + \ ', and numbers are not allowed

 For Comment Boxes:     <  >  ^  ~ ` + | \ / ¬ £

 For Address fields:    | + ! @ # $ ^ * ( ) ? / \ " < > & : ; _

• If you copy and paste an excluded special character, an error message will display after clicking Save & Next

• Remove excluded characters from pasted information or uploaded text in the document

Save & Next:

• When finished, click Save & Next to save the information and proceed to the next page

• Click Back to go to the previous screen without saving

• Click Exit to return to the dashboard without saving

• Note that if the information is not saved, you will lose the data on the current page