From provider at lists.maine.gov Mon Jun 2 16:20:06 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 2 Jun 2008 16:20:06 -0400 Subject: [Provider] Community Providers and DHHS Staff Message-ID: Attention: Community Providers and DHHS Staff From: Brenda M. Harvey, Commissioner RE: Targeted Case Management Rules Federal Update We have learned recently that there may be changes in the Interim Targeted Case Management Rule when the final rule is published. Based on a very large number of comments, CMS is rethinking the requirement to bill in 15-minute increments. While CMS will not allow monthly billing, indications are that daily or weekly billing may be acceptable and may be reflected in the final rules, due to be published in August. CMS has also determined that the case management component of ACT programs does not meet the strict definition of case management articulated in the new rule. Therefore, the integrity of this evidence-based program will be maintained. It is also important to note that case management provided as part of a waiver program does not have to comply with any part of the new rule until renewal date of the waiver, though new waiver applications must demonstrate compliance with the new rule. All of this assumes that there will not be a moratorium on these and other new rules. Even if such a moratorium becomes a reality, we will continue the work of revising our case management rule and reorganizing the services we provide under the rehabilitation rule. State Update We will be submitting a State Plan Amendment regarding case management services prior to June 30, 2008. We will finalize our new State TCM rule after the federal rule is finalized. Until that time, providers should plan to continue to bill as they have in the past. Groups that have been prohibited from billing by the terms of the Interim Final TCM Rule will be allowed to continue to bill until such time as that rule is final, most likely at the end of August. This includes education and corrections, as well as state employees who provide case management services for children and adults in protective services. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080602/d0dea669/attachment.html From provider at lists.maine.gov Tue Jun 3 09:08:32 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 3 Jun 2008 09:08:32 -0400 Subject: [Provider] Targeted Case Management Update fro APS Healthcare Message-ID: ATTENTION: MaineCare Targeted Case Management Providers Due to changes in Federal Rulemaking for Targeted Case Management, Targeted Case Management Transition process with APS Healthcare is "on hold" until further notice. The Commissioner's update about the status of rule changes is at this link: http://mailman.informe.org/pipermail/provider/2008-June/000334.html What does this mean for Targeted Case Management Providers, in terms of the review process with APS Healthcare? * The regular, established review process continues uninterrupted at this time. * The TCM Transition process that was posted on the APS Healthcare website is not in effect at this time. * If an existing authorization is expiring, submit Continued Stay Requests for members who are already in service, as outlined in the Maine Behavioral Health ASO Provider Manual * DO NOT Register existing members who are already in service. Please contact APS Healthcare Provider Relations staff at 1-866-521-0027 if you have questions about this change. This is a one way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080603/b3510682/attachment.html From provider at lists.maine.gov Wed Jun 4 10:49:26 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 4 Jun 2008 10:49:26 -0400 Subject: [Provider] Provider Training for Targeted Case Management Is Cancelled Message-ID: ATTENTION: All MaineCare Providers of Targeted Case Management Services This past Monday, DHHS Commissioner Brenda Harvey informed providers of a delay in implementation of rule changes for targeted case management services. That message stated in part, that "we have learned recently that there may be changes in the Interim Targeted Case Management Rule when the final rule is published. Based on a very large number of comments, CMS is rethinking the requirement to bill in 15-minute increments. While CMS will not allow monthly billing, indications are that daily or weekly billing may be acceptable and may be reflected in the final rules, due to be published in August." For this reason, the MaineCare training for providers on TCM rule changes that was scheduled for June, has been cancelled and will be rescheduled once the final rule is in place. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080604/48170dcb/attachment.html From provider at lists.maine.gov Thu Jun 5 09:42:49 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 5 Jun 2008 09:42:49 -0400 Subject: [Provider] Work to Implement New Medicaid Claims Processing System Has Begun Message-ID: ATTENTION: All Active MaineCare Providers The following information is from an issue of MaineCare Matters that has been mailed to all active billing providers. As you may know, the State of Maine, the Department of Health and Human Services and MaineCare Services have begun work to implement a new Medicaid claims processing system. Over the past year, the Centers for Medicare and Medicaid Services (CMS) approved the State's plan for transitioning MaineCare to a fiscal agent model of operation. This includes contracting with a fiscal agent vendor for some MaineCare operations, including a new HIPAA compliant, CMS certified claims processing system. Unisys was selected to be the fiscal vendor in December 2007. Unisys brings to MaineCare its transfer claims processing system known as "HealthPAS." The new system is scheduled to begin processing claims in early 2010. Between now and then, the team will fully design and test the system. The first phase of the new system's implementation, provider re-enrollment, will take place during 2009. Re-enrollment is vital to the overall project because it will ensure that the most up-to-date provider information is in the new system. The re-enrollment process is being designed to minimize any short-term negative impact on providers. MaineCare is working to make the process of collecting all the required information as easy as possible. Once a provider re-enrolls in MaineCare and also enrolls as an Electronic Data Interchange (EDI) Trading Partner, they will be able to submit electronic claims, as well as batch claims, to MaineCare. Electronic claims will be submitted through the Unisys HealthPAS OnLine (the new claims processing provider web portal). Providers that re-enroll will also be able to add their National Provider Identification (NPI) number(s) to claims. Even providers who won't be using NPI can re-enroll and submit electronic claims beginning in 2009. Prior to the new system starting in 2010, the current MeCMS system will continue to process claims and generate paper Remittance Advice statements as well as Electronic Remittance Advice statements. With the re-enrollment, MaineCare plans to kick-off some of the HealthPAS OnLine functions. In 2009, once providers re-enroll they will be able to go to the web site and: * Enroll, re-enroll and change their enrollment information * Get Electronic Data Interchange (EDI) claim submission companion guides * Submit HIPAA compliant 837 Professional, Institutional and Dental claim transaction files (batch upload) or onto a claims entry screen for transfer to submission in MeCMS for processing (anticipated in mid-2009). Once the new claims system is fully implemented in 2010, the provider portal web site will provide: * Member eligibility * Prior authorization * Claim status and history * Payment status and history * Member rosters At all levels there will be look-up tables, pull down menus, tools to drill down to detailed information and help screens. MaineCare will send additional re-enrollment information in the coming months. Watch for the MaineCare Matters newsletter, other updates like this and listserv announcements. Please visit http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml to sign up for the MaineCare listserv. The MaineCare Providers' Advisory and Technical Advisory groups will also be discussing this and other fiscal agent activities in their future meetings. In the meantime, if you have questions, please send them to MaineCare2010.DHHS at maine.gov or contact 1-800-321-5557, option 8. Thank you! -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080605/5f5a527b/attachment.html From provider at lists.maine.gov Thu Jun 5 10:06:42 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 5 Jun 2008 10:06:42 -0400 Subject: [Provider] Follow-up to Announcement of Communithy Based Care Management Demonstration Project Message-ID: ATTENTION: MaineCare Physician Hospital Organizations (PHO), Federally Qualified Health Centers (FQHC), Physician Practices and other Clinical Enterprises not associated with a PHO or FQHC caring for MaineCare members The following questions have been received from potential applicants for the Community Based Care Management Demonstration Project. If additional questions are received prior to June 6th an updated Q&A will be released. 1. What is the financial reimbursement for the high-risk care management program from Schaller Anderson? Financial reimbursement will be negotiated with each of the three selected demonstration sites relative to methodology of payment. For example, one group could choose to be paid a PMPM (per member per month) rate, another a flat monthly fee, or a demonstration site could choose to subcontract with Schaller Anderson for their staffing needs which would impact the amount of dollars paid. Using Schaller Anderson's work drivers and staffing models for a community based care management program, consideration for reimbursement will be based on the number of members assigned to the demonstration site as well as their risk stratification. Payment discussion will occur with each selected demonstration site during the contracting phase. 2. Will the sites reimbursed similar to the North Carolina Model? No. The powerpoint slides provided to potential applicants contained information on the North Carolina model. This was for the purposes of understanding how North Carolina implemented their model of community based care management. Providers will continue to be reimbursed according to MaineCare payment methodology, and in addition, they will receive a payment from Schaller Anderson for the high risk care management (as described in the answer to question 1). This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080605/87a745a7/attachment.html From provider at lists.maine.gov Thu Jun 5 13:45:48 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 5 Jun 2008 13:45:48 -0400 Subject: [Provider] Letter Sent to MaineCare Members dated June 2008 Message-ID: ATTENTION: All MaineCare Primary Care Providers and Providers of Targeted Case Management, Durable Medical Equipment, Children's Behavioral Health and Podiatric Services Federal law requires MaineCare Services to notify members 30 days in advance when services are being reduced or eliminated. For this reason, a letter dated June 1, 2008 has been mailed to all MaineCare members related to potential and planned changes for targeted case management, durable medical equipment, children's behavioral health and podiatric services. This letter and a frequently asked question document has been posted to the MaineCare Services web site in the Provider Meeting and News section at http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#m ember It can also be found on the Member section opening page. All MaineCare rule-making documents can be found at http://www.maine.gov/dhhs/bms/rules/provider_mcare_benefit.htm This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080605/ba7b026f/attachment.html From provider at lists.maine.gov Fri Jun 6 09:26:35 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 6 Jun 2008 09:26:35 -0400 Subject: [Provider] APS Healthcare-Maine Updates Message-ID: ATTENTION: MaineCare Behavioral Health Providers There are some new materials posted on the APS Healthcare-Maine Website. The APS Healthcare-Maine website is: http://www.qualitycareforme.com/ A provider update describing revisions in the Level of Care Criteria is posted at this link: http://www.qualitycareforme.com/MaineProvider_Update060608b.htm The revised Level of Care Criteria, dated 6/6/08 is posted at this link: http://www.qualitycareforme.com/documents/provider_levelofcarecriteria.p df Important Change for Children's PNMI Providers: A provider update describing the Children's CBHS-Approved PNMI Room & Board Authorization Transition Process is posted at this link: http://www.qualitycareforme.com/MaineProvider_Update060608a.htm Clarification of the 5 Calendar Day Grace Period and Limit for Request Submissions to the Maine ASO: 1- Registration Requests and Prior Authorization Requests are due to APS on the day that service provision begins. For all providers (except for PNMI providers), there is a 5 calendar day Grace Period, so that the Registration may be submitted up to 5 calendar days after service begins. Registration Requests may not be submitted beyond the 5 calendar day Grace Period for a particular service start date. PLEASE NOTE: This Grace Period does not apply to PNMI Providers. PNMI Providers must submit Registration Requests within 24 hours of Admission for purposes of the PNMI Bed Tracking System. 2- Providers may submit a Continued Stay Request at any time during an existing authorized period. The 5 calendar day Grace Period means that the start date for the Continued Stay Request must be within 5 calendar days of the date that the Continued Stay Request is submitted. For example: A CI Registration authorization expires July 1. The provider may choose to submit the Continued Stay Request a month early, on June 1. The start date of the CI authorization must be within 5 calendar days of when the request is submitted (up to June 6). Can I Spread Out or "Stagger" Continued Stay Requests so they don't all Come Due at Once? Providers may choose to submit Continued Stay Requests before they are due (as noted above), in order to spread them out (or "stagger" ), and then reduce the impact of having many due in a short period of time. Many providers have chosen to align Continued Stay Requests with ISP due dates, in order to further simplify record keeping. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080606/690b2446/attachment.html From provider at lists.maine.gov Wed Jun 11 14:12:00 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 11 Jun 2008 14:12:00 -0400 Subject: [Provider] MaineCare System Initiated Retro-rate Adjustments Message-ID: ATTENTION: All MaineCare providers billing provider or member rates System initiated retro-rate adjustments will be done for claims where a provider or member rate adjustment was initiated on or after 1/1/2008. Providers do not need to submit adjustments or "green forms" in these instances. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080611/1577b3bc/attachment.html From provider at lists.maine.gov Wed Jun 11 16:32:14 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 11 Jun 2008 16:32:14 -0400 Subject: [Provider] Final Questions and Answers on Community Based Care Management Demonstration Project Message-ID: ATTENTION: MaineCare Physician Hospital Organizations (PHO), Federally Qualified Health Centers (FQHC), Physician Practices and other Clinical Enterprises not associated with a PHO or FQHC caring for MaineCare members The attached document contains the final set of questions submitted by providers, with the answers, regarding the Community Based Care Management Demonstration Project managed by Schaller Anderson. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080611/f508d715/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: Q and A - June 9, 2008.doc Type: application/msword Size: 560640 bytes Desc: Q and A - June 9, 2008.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080611/f508d715/QandA-June92008.doc From provider at lists.maine.gov Thu Jun 19 13:24:45 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 19 Jun 2008 13:24:45 -0400 Subject: [Provider] Processing of Week 52 MeCMS Payments Message-ID: ATTENTION: All MaineCare Providers Paid Through MeCMS In the last two weeks we have experienced an unanticipated volume of claims submitted to MaineCare for MeCMS processing. Due to improved MeCMS functionality we have been able to process those claims, resulting in $25 million more in paid claims above the anticipated $39.6 million weekly average. We will process the last cycle payment (Week 52) for this state fiscal year on July 1st. This will mean that payments by Electronic Fund Transfer (EFT) will be delivered to provider accounts on July 3rd and paper checks on July 7th. The first payment for the new state fiscal year will process normally on July 2nd; however due to the 4th of July holiday, EFT payments will arrive on July 7th and paper checks on July 8th. 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. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080619/23d2ec5e/attachment.html From provider at lists.maine.gov Fri Jun 20 15:41:56 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Jun 2008 15:41:56 -0400 Subject: [Provider] Improvements for MaineCare Primary Care Providers Message-ID: ATTENTION: All MaineCare Primary Care Providers The following message is a letter from Tony Marple, Director of the Office of MaineCare Services. It is being mailed to all primary care providers. Dear Primary Care Provider, Several improvements for MaineCare - including higher fees for certain services - were funded in the 2007 State budget. Rulemaking for these changes is underway now. The proposed rules: * increase the MaineCare reimbursement rate for certain services from 53 percent to 61.7 percent of Medicare's January 2008 rate (Services that are billed with CPT codes as fee-for-service will get the increase. Providers who get cost settlements, bill with local codes, radiologists , FQHCs and RHCs will not be affected); * add coverage for fluoride varnish for patients under age 21; * increase the primary care case management (PCCM) fee from $2.50 to $3.50 per member per month; * expand PCCM membership by around 25,000 members; that's a 15% increase in the PCCM membership. The expansion will happen in phases over a few months one county at a time; * add a requirement for a care plan overseen by the physician for members who have chronic conditions to help keep members as healthy as possible. Care Plans are for members who have chronic obstructive pulmonary disease, asthma, cardiovascular disease, depression and/or diabetes. and * drop the requirement that PCP's manage audiology, speech and hearing services. All of these changes take effect on July 1, 2008. We will give you more specifics on these changes in separate communications. (Note: some changes will be finalized later this year, and then made retroactive to July 1.) Rules and rulemaking documents are available on the MaineCare website (http://www.maine.gov/dhhs/bms/) . Questions about policies? Call 1-800-321-5557. Thank you for your commitment to providing quality care for MaineCare members. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080620/31551489/attachment.html From provider at lists.maine.gov Fri Jun 20 15:47:28 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Jun 2008 15:47:28 -0400 Subject: [Provider] Increase in Payments for MaineCare Primary Care Provider Payments Message-ID: ATTENTION: MaineCare Primary Care Providers The following message is a letter from Tony Marple, Director of the Office of MaineCare Services. It is being mailed to all primary care providers. Dear MaineCare Provider, The Fiscal Year 08-09 State budget includes an $8.3 million (state and federal) increase in physician payments. The 2007 budget approved by the Maine Legislature and signed into law by Governor Baldacci increased MaineCare physician rates from 53% to 61.7% of Medicare's January 2008 rates. The rate increase will affect professional physician services, including cognitive and physician-performed procedure services that are billed with CPT codes as fee-for-service. Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) will not see a rate change. Radiology services, which are already paid at a higher percentage of Medicare rates than we are proposing, will also not see a rate change. Hospital employed primary care physicians will be paid on an interim basis on the new fee table, but settled to 89.7% of cost. There will be two rulemakings to make the necessary changes to Section 90 of the MaineCare Benefits Manual. An emergency rule is expected to be adopted by mid-August and will be retroactive to July 1. Payment of the new rates will not occur until the rule-making process is complete. When the rule is adopted, the claims system will use adjustment functionality to capture the new rates for claims filed on or after July 1. Providers will get a check for the difference between the new and old rates for these claims. For the adjustment feature to work, providers need to submit claims using their usual charges (not the MaineCare rate), unless specifically instructed by policy. Please refer to the MaineCare HCFA1500 and CMS1500 billing instructions on the web at http://www.maine.gov/bms/providerfiles/provider_billing_manuals.htm The new rates by procedure code are posted on the MaineCare website. These can be viewed by selecting the News and Provider Meetings tab from the home page and then the Primary Care Physician Rates headline under "News You Can Use." The direct link to these is http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#p rim Thank you for serving MaineCare members. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080620/fcf6e99d/attachment.html From provider at lists.maine.gov Wed Jun 25 12:49:04 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 25 Jun 2008 12:49:04 -0400 Subject: [Provider] Clarification for Denied and Suspended Adjustments Message-ID: ATTENTION: All MaineCare Providers Submitting Adjustments to MeCMS Clarification of the MeCMS adjustment functionality for denied and suspended adjustments follows. Clarification of Adjustment Functionality within MeCMS for Denied Adjustment If an adjustment claim is denied for an adjustment edit (an error that will cause the adjustment action to fail or be denied), the credit portion of the adjustment will not be created in the system. The status of the original claim will revert back to its original status of "Paid/RA Generated", "Paid/CDI", or "Adjudicated/RA Generated" in MeCMS. Adjustment edits are: * Missing Claim Detail * Line Level Adjustment or Void To Room & Board, Cost of Care, Spend Down Bill Prov Type=31 * Former TCN Missing or Not on File * Former TCN Status Invalid * Former TCN Billing Provider Mismatch * Former TCN Member ID Mismatch How this will appear on the Remittance Advice (RA): An adjustment denied for one of the above edits will appear on the Remittance Advice (RA) and the RA will reflect ONLY the denied adjustment, i.e., there will be a denied adjustment entry under "Category: Adj-Deny" with no associated "Credit" on the RA. What the affect is: The original claim (the claim you are trying to adjust) will not be affected and the status in MeCMS for the original claim will revert back to "Paid/RA Generated". This claim remains in its original state and the original claim can be adjusted or voided in the future. Provider action: Provider can submit a new adjustment to adjust the original claim or void the original claim and re-bill. However, if an adjustment claim is denied for edits OTHER than those mentioned above, a credit claim will be created in the system for both header and line level adjustments. How this will appear on the Remittance Advice (RA): An adjustment denied for any other edit (that would have caused the original claim to deny had it been submitted today) will appear on the RA under "Category: Adj-Deny" and the RA will reflect BOTH the denied adjustment AND an associated "Credit" entry under "Category: Adjustment". What the affect is: The original claim (the claim you are trying to adjust) payment will be taken back and the status in MeCMS will change to "Adjusted/RA Generated". This claim has effectively been "voided" and is available for re-bill to correct whatever billing error caused the claim to deny during the "adjustment". Provider action: Provider can re-bill the claim. Clarification of Adjustment Functionality within MeCMS for Suspended Adjustment If an adjustment claim is suspended (in MeCMS) for any edit (an error that will cause the adjustment action to suspend for review), the credit portion and the payment portion of the adjustment will not process until the suspension is resolved by a claims evaluator. Once the suspension is resolved, the adjustment will both process and adjust the claim (at which time the credit and payment portion of the adjustment will appear on the RA together under "Category: Adjustment"), OR the adjustment will deny and the process flow will be as described above for a denied adjustment. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080625/8b262b7a/attachment.html From provider at lists.maine.gov Wed Jun 25 15:00:04 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 25 Jun 2008 15:00:04 -0400 Subject: [Provider] National Code Set Updates Message-ID: ATTENTION: All MaineCare Providers The attached document outlines national code set changes related to the UB-92 & UB-04 forms, as well as updates to remittance advice codes. New codes will be added in MeCMS with an effective date of July 1, 2008. Old codes will be end dated June 30, 2008. Special Reminder: As previously communicated, Claims Adjustment Reason Code A2 "Contractual Adjustment" will be replaced with Adjustment Reason Code 45 "Charge exceeds fee schedule/maximum allowance or contracted/legislated fee arrangement". This will also be effective on July 1, 2008. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080625/c02e2572/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: EDIFECS Code Updates 07-01-08.doc Type: application/msword Size: 45568 bytes Desc: EDIFECS Code Updates 07-01-08.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080625/c02e2572/EDIFECSCodeUpdates07-01-08.doc From provider at lists.maine.gov Thu Jun 26 13:25:55 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 26 Jun 2008 13:25:55 -0400 Subject: [Provider] Rule-Making Related to PNMI Bedhold Days Message-ID: ATTENTION: MaineCare Providers Currently Billing Bedhold Days Emergency rule-making will be published later today and effective on July 1, 2008 related to private non-medical institutions. In order to implement budget initiatives adopted during the last legislative session and to comply with federal Medicaid rules that prohibit separate reimbursement for bedhold days under the MaineCare program, the Department is adopting rule changes and rate changes to accomplish the following: 1. MaineCare codes for bedhold days are being eliminated. 2. Per diem rates will be increased to include allowable costs which include fixed operational costs not related to occupancy levels. The methodology used to calculate these increases varies by types of facility. Further information will be provided by your contract administrator. 3. Where applicable, cost caps are being adjusted to ensure that budgeted savings are realized. 4. These rules will be permanently adopted in the proposed rulemaking, and a public hearing will be held as part of that separate rulemaking. The proposed rules will be posted to the MaineCare Services web site later today and can be found at http://www.maine.gov/dhhs/bms/rules/prov_emergency.html once they are posted. State funding for bedhold days through Chapter 21 (children's facilities), Chapter 115 (adult residential care facilities) and specified grant funding (adult mental health and substance abuse treatment facilities) will not be affected by these changes. Providers impacted by these changes should contact their contract administrator with questions. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080626/ef6c2e46/attachment.html From provider at lists.maine.gov Thu Jun 26 13:56:03 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 26 Jun 2008 13:56:03 -0400 Subject: [Provider] Hospital Roster Billing / NDC Code Submissoins Message-ID: ATTENTION: Maine Hospital Providers MaineCare will be hosting a roundtable discussion with regards to Roster Billing / NDC Code submissions. Billing and pharmacy representatives from all Maine hospitals are encouraged to join and share information about what solutions or methods are being used to submit roster billing. We have scheduled a conference call on July 9th from 1:00 - 2:00 p.m. The conference number is 1-888-727-6732, Passcode 810486. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080626/a53508d9/attachment.html From provider at lists.maine.gov Thu Jun 26 15:21:57 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 26 Jun 2008 15:21:57 -0400 Subject: [Provider] New MaineCare ID Cards for Non-Categorical Members Message-ID: ATTENTION: All MaineCare Providers During the first week of July members with non-categorical coverage will be receiving their new identification cards which contain the letters "LTD". The letters LTD are used to identify members who receive MaineCare non-categorical benefits. It is important that all providers verify eligibility each time a member presents for service. This will ensure that the services you are providing are covered by this program. Please contact 1-800-321-5753 Option 8 or 9 to verify eligibility. Thank you for serving MaineCare members. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080626/d0b5331d/attachment.html From provider at lists.maine.gov Thu Jun 26 16:06:58 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 26 Jun 2008 16:06:58 -0400 Subject: [Provider] Identification Cards for Non-Categorical MaineCare Members Message-ID: This message is sent as a correction to the phone number on the previous message. ATTENTION: All MaineCare Providers During the first week of July members with non-categorical coverage will be receiving their new identification cards which contain the letters "LTD". The letters LTD are used to identify members who receive MaineCare non-categorical benefits. It is important that all providers verify eligibility each time a member presents for service. This will ensure that the services you are providing are covered by this program. Please contact 1-800-321-5557 Option 8 or 9 to verify eligibility. Thank you for serving MaineCare members. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080626/1f543eb5/attachment.html From provider at lists.maine.gov Mon Jun 30 11:08:30 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 30 Jun 2008 11:08:30 -0400 Subject: [Provider] Behavioral Health Services Policy Changes Message-ID: ATTENTION: All MaineCare Providers of Services within Sections 111, 100, 58 and 65 of the MaineCare Benefits Manual As a result of the supplemental budget law (PL 545) the Department is consolidating mental health and substance abuse outpatient services into one section of the MaineCare Benefits Manual. Sections 111 (Substance Abuse Treatment Services), 100 (Psychological Services), 58 (Licensed Clinical Social Worker, Licensed Clinical Professional Counselor and Licensed Marriage and Family Therapist Services) and 65 (Mental Health Services) will be repealed and replaced with a new Section 65 which will be titled Behavioral Health Services. Several initiatives are being rolled into this consolidation including local code reduction, service re-design and rate standardization. Timeframe for Implementation We plan to file an emergency rule in early July with an effective date of August 1. The emergency rule can only be in effect for 90 days. So, on a parallel track, we will propose a permanent rule. You will receive a notice of rulemaking process as you usually do for the rulemakings. When the emergency rule is adopted it will be posted at http://www.maine.gov/bms/rules/provider_mcare_benefit.htm in the emergency section. Training Schedule Information about provider training dates, locations and registration is enclosed with this memorandum. To register for training by e-mail, submit the completed form to Mainecaretng.DHHS at maine.gov This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080630/4c85123f/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: Behavioral Health Services Policy Changes.doc Type: application/msword Size: 67584 bytes Desc: Behavioral Health Services Policy Changes.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080630/4c85123f/BehavioralHealthServicesPolicyChanges.doc -------------- next part -------------- A non-text attachment was scrubbed... Name: Super 65 Registration Form.xls Type: application/vnd.ms-excel Size: 24576 bytes Desc: Super 65 Registration Form.xls Url : http://mailman.informe.org/pipermail/provider/attachments/20080630/4c85123f/Super65RegistrationForm.xls From provider at lists.maine.gov Mon Jun 30 11:10:09 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 30 Jun 2008 11:10:09 -0400 Subject: [Provider] Recall: Behavioral Health Services Policy Changes Message-ID: Negron, Patricia would like to recall the message, "Behavioral Health Services Policy Changes". -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080630/612e190b/attachment.html From provider at lists.maine.gov Mon Jun 30 12:01:49 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 30 Jun 2008 12:01:49 -0400 Subject: [Provider] Update: New Effective Date for PNMI Bedhold Days Changes Message-ID: ATTENTION: MaineCare Providers Currently Billing Bedhold Days Following the listserv message sent last week on emergency rule-making for PNMI Bedhold Days, the implementation date has changed. This rule-making is now planned with an effective date of August 1, 2008. Updated emergency rules will be posted soon and can be found at http://www.maine.gov/bms/rules/provider_mcare_benefit.htm Once again, the changes are being made to implement budget initiatives adopted during the last legislative session and to comply with federal Medicaid rules that prohibit separate reimbursement for bedhold days under the MaineCare program. The Department is adopting rule changes and rate changes to accomplish the following: 1. MaineCare codes for bedhold days are being eliminated. 2. Per diem rates will be increased to include allowable costs which include fixed operational costs not related to occupancy levels. The methodology used to calculate these increases varies by types of facility. Further information will be provided by your contract administrator. 3. Where applicable, cost caps are being adjusted to ensure that budgeted savings are realized. 4. These rules will be permanently adopted in the proposed rulemaking, and a public hearing will be held as part of that separate rulemaking. State funding for bedhold days through Chapter 21 (children's facilities), Chapter 115 (adult residential care facilities) and specified grant funding (adult mental health and substance abuse treatment facilities) will not be affected by these changes. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080630/60ece116/attachment.html From provider at lists.maine.gov Mon Jun 30 12:11:10 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 30 Jun 2008 12:11:10 -0400 Subject: [Provider] Update: Behavioral Health Services Policy Changes Message-ID: ATTENTION: All MaineCare Providers of Services within Sections 111, 100, 58 and 65 of the MaineCare Benefits Manual The memorandum on these changes has been updated since the previous message on Behavioral Health Services Policy Changes. Impacted providers should check for provider types that do not need contracts, but only provider agreements. These changes are in bold type. This is a one-way communication. Please do not respond to this message. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20080630/ce6994d5/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: Super 65 Registration Form.xls Type: application/vnd.ms-excel Size: 24576 bytes Desc: Super 65 Registration Form.xls Url : http://mailman.informe.org/pipermail/provider/attachments/20080630/ce6994d5/Super65RegistrationForm.xls -------------- next part -------------- A non-text attachment was scrubbed... Name: Behavioral Health Services Policy Changes.doc Type: application/msword Size: 69120 bytes Desc: Behavioral Health Services Policy Changes.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080630/ce6994d5/BehavioralHealthServicesPolicyChanges.doc