[Provider] MaineCare Matters No. 5

[Provider Notification]

ATTENTION:  All MaineCare Providers


The content of MaineCare Matters No. 5 is within this listserv message.
This newsletter will be mailed this week to all providers.

 


Billing News & Tips


MeCMS Adjustment functionality

Adjustment functionality will be implemented in MeCMS during the month
of April.  Training on the functionality for providers is scheduled to
take place in locations throughout the state between March 31st and
April 18th.  Providers who have not registered or this training can call
(207) 287-9345 Ext. 335. 

What Providers Can Do with Adjustment Functionality. . .

*   Adjust an original paid claim document or paid claim line for which
an adjustment was not previously submitted and approved

*   Adjust the Adjustment (replacement) claim line/document once the
Adjustment line/document appears as paid on the Remittance Advice (RA). 

*   Adjust a document with a status of Adjudicated/RA generated (i.e.,
mix of Paid and Denied lines) at the document level.  MeCMS will adjust
the paid lines and ignore the denied lines during this process.  Denied
lines cannot be adjusted.   

*   Adjust paid lines from a claim document one line at a time.  Any
subsequent line from that same document can be adjusted once the
Adjustment claim appears as paid on the RA.  

What the State Can Do with Adjustment Functionality. . . 

*   Process Adjustments that were previously submitted in MeCMS

*   Process Adjustments previously submitted on a pink or green form 

*   Process Adjustments previously submitted with a check so that funds
are not offset, since payment has already been received

What Providers Cannot Do:

*   Adjust a claim line if there is a different line of the SAME
original claim currently being adjusted (i.e. has not processed through
to the RA)

*   Adjust LEGACY (pre-MeCMS) claim document or claim line (until
further notice)

*   Adjust a DENIED claim document or claim line

*   Adjust a VOID claim document or claim line

*   Adjust a SUSPENDED claim

*   Adjust a claim held for Interim Payment Recovery (IPR)

*   Adjust a claim held in Edits Processing Failure

*   Adjust a claim held in Fund Allocation Failure 

*   Resolve a current outstanding billing issue by submitting an
Adjustment, e.g. limits issues that have not yet been resolved in MeCMS.

Additional information, including the implementation schedule, can be
found on the MaineCare web site at 
http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#r
epair

 

Bill leave days correctly so that other providers get paid

When a MaineCare member leaves a Private Non-Medical Institution (PNMI),
or 

Cost Reimbursed Boarding Home to go to the hospital or another facility,
the provider must send a movement card to Elder Services and must bill
MaineCare for leave days.   If the provider bills for a regular day,
then the hospital's claim for that day will be denied.  Other providers
are counting on you to bill correctly, so that they can also get paid
for their services.  

For example, Member A leaves Cost Reimbursed Boarding Home and is
admitted to the hospital on 2/14/2008 and returns to the Boarding Home
on 2/21/08.

The Boarding Home should bill the month of February as follows:

Revenue Code / Procedure Code / Units

0169                                        BH
13

0940                                        BP
13

0242                                        BQ
13

0189                                        BL
7

0183                                        PL
7

0183                                        BQL
7

0169                                        BH
9

0940                                        BP
9

0242                                        BQ
9

When a MaineCare member leaves a Nursing Home to go to the hospital or
another facility, the provider must send a movement card to Elder
Services.  Elder Services enters a leave classification code.  The
provider bills using Revenue Code (0167) and the member's classification
must be updated for the leave days.

If you have billed a leave day incorrectly, please void and re-bill the
claim using the appropriate codes.

HIPAA code set update

Effective April 1st, the quarterly HIPAA Code Sets update will be
implemented into MeCMS. Please note however, that although A2 has been
discontinued as a Claims Adjustment Reason Code for Contractual
Adjustment, this will not be part of the MeCMS update on April 1st.

MeCMS will continue to use A2 for "Contractual Adjustment" until July 1,
2008.  At that time, Adjustment Reason Code 45, "Charge exceeds fee
schedule/maximum allowable or contracted/legislated fee arrangement"
will be substituted for Adjustment Reason Code A2.  

HIPAA compliant submission of claims

When sending claims in window envelopes, please be sure to insert claims
so that member information does not show, or to wrap the claims in a
blank sheet paper.  It is one way we can all help protect the privacy of
the individuals we serve.

Oxygen co-payments will not be taken

For a limited period of time, copayments on claims for oxygen and
oxygen-related equipment will not be processed by MeCMS.  Until this
problem is corrected sometime in April, providers have the option to
hold claims or to submit adjustments for claims at a later time.
Copayments should continue to be collected from members.

 


Contact Us


Call: Toll free: 1-800-321-5557

         TTY: 1-800-423-4331
Augusta area: 207-624-7539

On the web: http://www.maine.gov/dhhs/bms/

Write: 

MaineCare Billing and Information Unit

Office of MaineCare Services

11 State House Station 

Augusta, ME 04333-0011 

 

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://mailman.informe.org/pipermail/provider/attachments/20080331/f7050d31/attachment.html