[Provider] Important Update on Claim Hold from MaineCare Services

[Provider Notification]

ATTENTION:  MaineCare Providers with Interim Payment Balances

 

Important Update on Claim Hold


Since April 2007, MaineCare Services (MaineCare) has been holding
certain claim payments to help providers repay interim payments issued
during the MeCMS implementation.  Thank you for your cooperation and
patience with this process.

 

Beginning the week of November 12th, 2007, MaineCare Services will be
releasing some claims from the interim payment recovery claim hold.
MaineCare is implementing this claim hold release process for several
reasons.  First, we know that it will benefit you.  We understand that
providers want to record the claim payments in their accounts receivable
systems and close their books.  Likewise, the State needs to recover the
interim payments issued to providers.

 

Here's how the process will work:

 

*        Each week, a group of providers and associated provider numbers
will be designated for the claim hold release process.  Not all of your
provider numbers may be released in a given week.

 

*        If you are one of the designated providers, your claims will be
released from the claim hold.

 

*        MaineCare will run its customary claim payment cycle, including
any "non-held" claims that are set to pay.

 

*        Paper and 835 electronic remittance advices will be generated.

 

-       On paper remittance advices, the previously held claims will be
listed individually in the claims payment section.  The actual amount
paid for each claim will be indicated.  The amount of the claim hold
will be subtracted in the remittance advice section labeled "Provider
Adjustments" with a source of "State Initiated-Adjustment Unit" or
"State Initiated-Finance."

 

-       For 835 electronic remittance advices, the actual amount paid
for the claim will be reflected in the customary field.  The claim hold
deduction will appear in the "PLB" section of the 835.  You will see an
"FB" code that reflects the forwarding interim balance and a "CS" code
that identifies the actual deduction that adjusts the payment.

 

-       Any "non-held" claims included in the payment cycle will be
reflected in paper remittance advices and 835 transactions in their
customary manner.  If you have asked MaineCare to offset your claim
payments at a specified percentage to reduce interim payments, that
offset will be applied to any "non-held" claims paid during the payment
cycle.

 

*        Once the claim payment cycle is complete:

 

-       The previously held claims will no longer be listed in the "Held
for IPR" report that is available on the claims status portal.  Your
interim payment balance will be reduced by the dollar value of the
claims released from the claim hold.  Please note that the reduction in
the interim payment balance will not be immediately reflected in the
portal since the claim hold release is a multi-step process.

 

-       Your claim hold will be reinstated to continue accumulating
payments towards your outstanding interim payment balance.  Or, if you
prefer, you can remit a check repayment for the balance to MaineCare.
Your check should be issued to Treasurer, State of Maine and sent to:

 

Interim Payments Recovery Team

Office of MaineCare Services

11 State House Station

442 Civic Center Drive

Augusta, ME   04333-0011

 

 

Please note that you will not be notified in advance if you are one of
the providers designated for the weekly claim hold release process.  You
will need to review your paper and 835 remittance advices to determine
if claims have been released from the claim hold.

 

 

For questions regarding the claim hold release process, please call the
MaineCare Billing & Information Unit at 1-800-321-5557, Option 8.

 

 

This is a one-way communication.  Please do not respond to this message.

 

 

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