[Provider] Physician Fee Changes

[Provider Notification]

ATTENTION: Physicians who bill for MaineCare Services under Section 90 

 

RE:                  Some Physician Fees Increased December 24, 2008   

 

On December 24, 2008, MaineCare's physician fees on certain procedure codes increased from 53% to 56.94% of Medicare's 2008 rate.  A complete list of the codes receiving increases is available at http://www.maine.gov/dhhs/bms/member/innerthird/news_page.shtml <http://www.maine.gov/dhhs/bms/member/innerthird/news_page.shtml>  (Click "Physician Fee Revision.")  

 

The increase applies only to physicians billing for services under MaineCare Benefits Manual Section 90, Physician Services.  It does not apply to procedure codes billed under Section 55 Laboratory Services, Section 95 Podiatric Services, Section 101 Medical Imaging, or Section 75 Vision Services.  

 

Here is a summary of how the claims will be processed: 

 

*	The rate increase is retroactive to July 1, 2008.  

 

*	Claims billed for services provided December 24th and after will receive the new MaineCare rate.  

 

*	Claims yet to be filed for dates of service July 1, 2008 through December 23, 2008:  Please file them using your usual charges rate.  You will be paid the lower of your usual charges or the new MaineCare rate.  

 

*	Claims filed for dates of service July 1, 2008 through December 23, 2008:  If you filed using your usual charges rate, and that rate was higher than the old MaineCare rate, the claims system will automatically adjust the claim to the lower of your usual charges or the new MaineCare rate.  You will be paid the difference in one of your regular checks.  

 

*	We will issue another communication for claims for dates of service July 1, 2008 through December 23, 2008 that were billed using the old MaineCare rate or for services that required Prior Authorization. 

 

Feel free to contact Customer Service with questions at 1-800-321-5557 Option #8.  

 

Is your mailing address up to date with MaineCare?  Please keep MaineCare up to date so your Remittance Statements and checks arrive on time.  Call Provider Enrollment at 1-800-321-5557 Option #6.  

 

If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page <http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml%20>  to unsubscribe.
 
This is a one-way communication.  Do not reply to this e-mail.  Your e-mail will not receive response.  If you have questions, please call 1-800-321-5557.  

 

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