Split-Year Claim Submission

General
Policy Number: GP-X-093

Last Updated: March 12, 2024 

Non-Nebraska Outpatient and Professional Claims

For outpatient and professional claims with charges incurred during different years, the charges must be submitted on separate claims. This requirement will be the same each year end for split-year claims.  

Claims for non-Nebraska members that are not split will reject back to the provider upon submission. 

For example:
If dates of service are from Dec. 15, 2022, to Jan. 15, 2023:

  • Submit charges incurred from Dec. 15, 2022, to Dec. 31, 2022, on one claim 
  • Submit charges incurred from Jan. 1, 2023, to Jan. 15, 2023, on a separate claim 

Claims submitted with charges incurred during both years on the same claim will be rejected back to the provider to split the claim.  

Institutional Inpatient Claims 

For inpatient* institutional claims, it is no longer required to split the entire claim for non-Nebraska members; however, it will be required to split the R&B charges per calendar year. 

Claims for non-Nebraska members where the R&B charges are not split per line by calendar year will reject back to the provider upon submission. 

For example
If dates of service are from Dec. 15, 2022, to Jan. 1, 2023: 

  • Submit R&B line for 2022 dates of service on another line 
  • Submit R&B line for 2023 dates of service on another line 

Claims that are submitted with the R&B on one line for multiple years will be rejected back to the provider to split the R&B lines. 

*Inpatient includes acute care hospital, psychiatric hospital, rehabilitation hospital, skilled nursing and swing-bed