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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules also say that certain data elements are required. Any claim with incomplete, missing, or invalid 
information for all of these elements may be returned as unprocessable. You can find this rule in the Centers 
for Medicare and Medicaid Services, Internet Only Manual, Publication 100-04, Medicare Claims Processing 
Manual, Chapter 1, Section 80.3.1. 
 
The rules say that home health agencies (HHAs) must send the notice of admission (NOA) to the A/B MAC by 
mail, electronic data interchange (EDI), or direct data entry (DDE). EDI submissions require additional data 
not required by the NOA itself, to satisfy transaction standards. This data is described in a companion guide 
available on the Centers for Medicare and Medicaid Services website. HHAs may voluntarily agree to adopt 
the companion guide and use it to submit EDI NOAs at any time. 
 
The rules say that the admission date on the NOA must always match the From date. 
 
You can find these rules in the Centers for Medicare and Medicaid Services, Internet Only Manual, Medicare 
Claims Processing Manual, Chapter 10, Section 40.1. 
 
The rules say that home health agencies (HHAs) shall no longer submit Requests for Anticipated Payment 
(RAPS) for any home health (HH) period of care with a From date on or after January 1, 2022. Instead, for 
each admission to home health, the HHA notifies Medicare systems via submission of an NOA.  
 
HHAs shall send the NOA to the A/B MAC (HHH) by mail, electronic data interchange (EDI), or direct data 
entry (DDE). EDI submissions require additional data not required by the NOA itself, to satisfy transaction 
standards. This data is described in a companion guide available on the CMS website. HHAs may voluntarily 
agree to adopt the companion guide and use it to submit EDI NOAs at any time.  
 For all beneficiaries receiving HH services in 2021 whose services will continue in 2022, the HHA shall submit 
an NOA with a one-time, artificial 'admission' date corresponding to the "From" date of the first period of 
continuing care in 2022. For example, if a period of care begins in 2021 and ends on January 10, 2022, the 
HHA submits and NOA with an admission date of January 11, 2022 and then submits a claim when the 30-day 
period of care is over. The HHA should submit the January 11, 2022 admission date on all subsequent claims 
until the beneficiary is discharged and another NOA is required. This is to ensure the claim is matched to the 
correct NOA and the correct receipt date is used for payment. 
 
You can find this rule in the Centers for Medicare and Medicaid Services, Internet Only Manual, Medicare 
Claims Processing Manual, Chapter 10, Section 10.1.10.3. 
 
The rules say that HHAs may not submit this claim until after all services are provided for the period and the 
physician has signed the plan of care and any subsequent verbal order. 
 
You can find this rule in the Centers for Medicare and Medicaid Services, Internet Only Manual, Medicare 
Claims Processing Manual, Chapter 10, Section 10.1.10.4. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.