The Maryland DHMH 257 Long Term Care Activity Report is the form a nursing facility uses to tell Maryland Medicaid when a resident’s payment status changes: a new admission, a shift between Medicare and full Medicaid, a bed hold, a hospice revocation, a discharge, or a death. Completed forms go to Telligen, the state’s utilization control agent, either through the MarylandBenefits.gov portal or by fax to 1-888-297-4276, and every submission must be accompanied by a signed physician’s order.1Maryland Department of Health. Clarification of 257 Submission Processes The current PDF is the January 2016 revision, still labeled DHMH 257 even though the agency is now the Maryland Department of Health.2Maryland Department of Health. UCA Transition
What You Need Before You Start
Gather the facility and resident identifiers first. The header asks for two facility numbers: the Medicaid Provider ID and the CARES Vendor ID, both assigned by Maryland Medicaid at enrollment.3Maryland Department of Health. DHMH 257 Long Term Care Activity Report If billing doesn’t have the CARES Vendor ID on hand, pull it from the facility’s original enrollment paperwork.
For the resident, you need the full legal name, the Medicare Claim Number, and the Maryland Medicaid number (shown on the form as “MD Medicaid No.”).3Maryland Department of Health. DHMH 257 Long Term Care Activity Report There is no Social Security Number field. Check the Medicaid number against the resident’s Medical Assistance card; a single wrong digit will hold up payment.
You also need a physician’s order signed before you submit. Telligen will not accept a 257 without one. The order is the physician certification that the resident needs nursing facility-level care.4Telligen. Physician Certification Requirements for Nursing Facility Services
Section A: Reporting the Start of Payment
Section A has four checkboxes for events that begin or restart Medicaid payment.3Maryland Department of Health. DHMH 257 Long Term Care Activity Report
New Admission on Full Medicaid
Check box 1, Full MA coverage, and enter the begin pay date. If the resident is transitioning from Medicare Part A coinsurance to full Medicaid during the same stay, also check box 2, Medicare A co-payment, and enter both begin and end pay dates. The end pay date for the Medicare co-payment should equal the begin pay date for full MA coverage.5Maryland Department of Health. DHMH 257 Questions and Answers
Bed Reservation During Medicare Coverage
Check box 3 to hold a bed during a period of full Medicare coverage, and enter the begin and end pay dates.3Maryland Department of Health. DHMH 257 Long Term Care Activity Report More on Medicaid bed holds below.
Return From Hospice
When a resident revokes the hospice benefit and comes back to regular nursing facility care, check box 4 and enter the effective date. That date should match both the hospice discharge date and the nursing facility readmission date.5Maryland Department of Health. DHMH 257 Questions and Answers
Section B: Reporting the End of Payment
Section B captures discharges and deaths.3Maryland Department of Health. DHMH 257 Long Term Care Activity Report
Discharge or Transfer
Check “Discharged to” and the sub-box that matches the destination: another provider, community, or hospice. Enter the discharge date. For a transfer to another facility, the discharge date you report should match the admission date at the receiving facility.5Maryland Department of Health. DHMH 257 Questions and Answers Do not complete Section B if the resident is still in your facility and is only changing coverage types.
Death
Check the Death box and enter the date of death as the cancel pay date.3Maryland Department of Health. DHMH 257 Long Term Care Activity Report
Bed Holds for Hospital Stays and Therapeutic Leave
Maryland Medicaid reimburses up to 18 bed hold days per calendar year when a resident is transferred to a hospital or goes on therapeutic leave.6Maryland Department of Health. Maryland Medicaid Nursing Facility Reimbursement Manual To report the hold, check box 3 under Section A and enter the begin and end pay dates.
If the hospital stay runs past the bed hold maximum, switch to Section B. Check “Discharged to,” enter the discharge date, and note under the other-provider field that the hospital leave exceeded the maximum.5Maryland Department of Health. DHMH 257 Questions and Answers The resident keeps the right to be readmitted to the first available semiprivate bed once they are ready to return, as long as they still need nursing facility care and remain Medicaid-eligible.7Legal Information Institute. Maryland Code Regulations 10.07.09.12 – Resident Relocation and Bed Hold
Separate from the 257, the facility must give the resident or their representative written notice of the bed hold policy at admission and again at the time of transfer or therapeutic leave.7Legal Information Institute. Maryland Code Regulations 10.07.09.12 – Resident Relocation and Bed Hold
Where to Send the Completed Form
Everything goes to Telligen, not directly to the Maryland Department of Health. You have two paths.1Maryland Department of Health. Clarification of 257 Submission Processes
Online, submit long-term stay 257s through MarylandBenefits.gov. If the nursing facility requested the level of care review, upload the physician’s order as an attachment in Qualitrac. If the hospital requested the level of care, fax the physician’s order separately to Telligen.
By fax, send the completed 257 and the signed physician’s order to Telligen at 1-888-297-4276. If the nursing facility initiated the level of care request, also upload the physician’s order to Qualitrac. Short-term stays follow the same pattern: the 257 is faxed to Telligen, and the physician’s order goes to Qualitrac if the nursing facility requested the review, or to Telligen by fax if the hospital did.1Maryland Department of Health. Clarification of 257 Submission Processes
Keep a copy of every submitted form. The form carries an “Agency/UCA/Provider Copy” designation for exactly that purpose.3Maryland Department of Health. DHMH 257 Long Term Care Activity Report
After You Submit
Telligen reviews the submission and processes the reported activity into Maryland’s Medicaid records. An admission opens payment authorization; a discharge or death stops it as of the reported date. The adjustments show up on the facility’s Remittance Advice statements, which are the official confirmation that the activity was processed. Review each Remittance Advice against what you reported, and if dates or amounts don’t line up after a reasonable processing window, contact Telligen or the Maryland Department of Health’s long-term care division.
What Late or Incorrect Reporting Costs
If the facility keeps receiving Medicaid payments for a resident who has been discharged or has died, those payments are overpayments that have to be returned. Under federal rules, once a provider identifies or should have identified an overpayment, it has 60 days to report and return the funds. Missing that window can expose the facility to liability under the federal False Claims Act, with damages of up to three times the overpayment amount plus per-claim penalties.8eCFR. Requirements for States and Long Term Care Facilities
Inaccurate reporting can also hit residents directly. Federal regulations at 42 CFR 483.15 give nursing facility residents transfer and discharge rights, including proper notice and the right to appeal a facility-initiated discharge.8eCFR. Requirements for States and Long Term Care Facilities Reporting a discharge on the 257 before the resident has actually left, or before proper notice has been given, can trigger compliance violations that go well beyond a billing correction.