Home Health

Beginning in 2022, the Centers for Medicare and Medicaid Services (CMS) required home health agencies to submit a one-time Notice of Admission (NOA), using Type of Bill (TOB) 32A. However, Highmark’s implementation of TOB 32A had been delayed.

Effective July 14, 2023, Highmark will require home health agencies that submit Medicare Advantage claims in the Provider Driven Grouper Model (PDGM) format to use TOB 32A on all admissions.

TOB 32A Payment Adjustments

The prompt submission of TOB 32A is necessary to determine whether payment adjustments should be applied (for timeliness), under CMS’ PDGM. Like CMS, Highmark will apply payment penalties to the final claim (TOB 329) when the associated NOA is submitted late.

The NOA must be submitted within the first five calendar days of the admission date, or a payment reduction will be incurred. While Highmark will not issue payment on the claims with TOB 32A, the claim is still required to prevent payment penalties on the associated TOB 329 claims.

As the July 14, 2023 implementation date approaches, additional communications will be provided. Please ensure you are checking the Provider Resource Center regularly, so you don’t miss important updates.