[Provider] Reminder for Billing Co-Insurance and Deductibles after Medicare

[Provider Notification]

ATTENTION:  All Providers Who Bill for Co-Insurance and Deductibles
after Medicare

 

It has come to our attention that some providers have not yet finished
submitting their coinsurance and deductible claims.  This may be because
they are waiting for MaineCare to process "crossover" claims
electronically.  That functionality is not now available.  So providers
who want to be reimbursed for these types of claims MUST submit them on
paper.

 

Providers who have outstanding claims to file are asked to submit them
by September 12, 2008.  

 

Special Reminders:

 

*      Attach the Explanation of Medicare Benefits (EOMB), unless you
are billing for physician or APRN services.  Claims for these two
provider types only require an EOMB when billing for coinsurance and
deductibles that exceed $200.00, or when billing for services that have
been denied by Medicare and are covered by MaineCare.  

*      When billing on the new CMS1500 claim form, providers should not
combine coinsurance / deductible charges with Medicare denied charges.
Use one claim form for billing coinsurance / deductible charges, and a
separate claim for Medicare denied charges.

 

This message does not pertain to Maine hospital providers.  MaineCare is
pursuing a work-around solution that will not require these claims to be
processed through MeCMS.  Additional information will be shared as
details become available.  

 

Billing instructions can be found on the MaineCare website at:

http://www.maine.gov/bms/providerfiles/provider_billing_manuals.htm

 

Please contact MaineCare Customer Service at 1-800-321-5557, Option 8
with questions.

 

 

 

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

 

 

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