[Provider] Work to Implement New Medicaid Claims Processing System Has Begun

[Provider Notification]

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!

 

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