Interim Billing Guidelines

Interim Billing Guidelines for inpatient stays exceeding 100 consecutive days

AmeriHealth Caritas Florida has established a process for submission of interim billing for inpatient hospital stays that exceed one hundred (100) consecutive days.

Providers may not receive interim payments if any of the following apply:

  • Provider is not reimbursed through All Patient Refined Diagnosis Related Group (APR-DRG) or Diagnosis Related Group (DRG) payment methodology
  • AmeriHealth Caritas Florida is not the member’s primary insurer

In accordance with guidance issued by the Agency for Healthcare Administration (AHCA), for each subsequent inpatient hospital billing, the previous interim claim must be voided and replaced with a new claim.

Providers must submit interim claims utilizing the following bill types:

  • 0112: First Interim Claim
  • 0113: Continuing Interim Claim
  • 0117: Final Claim (Admit through Discharge)

Each claim must include the initial admission date, the dates of service and the amounts from previous claim(s) through the current billing. Submission of claims with bill types 0113 and 0117 will act as a void/replacement claim to the previous interim claim.

Claims submitted with bill type 0117 must reflect the dates of services for the entire stay, and must not contain a patient discharge status of 30 (Still a patient).

Providers opting to seek interim payments will be required to reconcile the final claim within 90 days from the date of discharge.