From provider at lists.maine.gov Fri May 2 16:13:00 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 2 May 2008 16:13:00 -0400 Subject: [Provider] Important Claims Information Regarding U1 Modifier Message-ID: ATTENTION: MaineCare Providers of Behavioral Health Services It has come to our attention that MaineCare is unable to process claims correctly in most cases when the U1 modifier is used on claim forms. We are asking that providers not use the U1 modifier except for the cases where procedure codes H0021 HU or H0023 HU are authorized with the additional U1 modifier under Section 65, Mental Health Services. The "Servicing Provider ID Number" must be included on the claim form. If you are using the CMS 1500 (12/90) version this number is written in Box 24K that is labeled "Reserved for Local Use". If using CMS 1500 (08/05) version, enter the servicing provider number in the shaded area of 24J that is labeled "Rendering Provider ID #". If the service is provided by one of the Grandfathered (BS-1) "Bachelor's Level staff" or other qualified staff, put the servicing provider number of the supervisor in Box 24K or 24J. Remember, except as indicated above; do not put the U1 modifier on the claim form. All billing questions should be directed to the MaineCare Billing and Information Unit at 1-800-321-5557, Option 8. This Unit will assist providers with billing resolution. If during the call, it is determined that the issue needs a higher level of intervention, the caller will be referred to the appropriate Provider Relations Specialist. 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/20080502/3e8a1471/attachment.html From provider at lists.maine.gov Mon May 5 09:34:23 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 5 May 2008 09:34:23 -0400 Subject: [Provider] Revision to MaineCare Billing Instructions for Medicare C (Medicare Advantage Plans) Message-ID: ATTENTION: All MaineCare Providers that bill Medicare C (Medicare Advantage Plans) This notice is to inform providers of an update to Medicare C co-payment billing instructions. Please utilize the following value codes when billing on the UB92 or UB04 claim form. A1 = Deductible A2 = Co-insurance and / or Co-pay If you are billing for a MaineCare member who has Medicare C (Medicare Advantage Plans) or Railroad Medicare please follow the revised billing instructions outlined below. UB92 UB04 CMS 1500 Field Locator 50A needs to contain the word Medicare. Field Locator 50B needs to contain the word MaineCare. Field Locator 50A needs to contain the word Medicare Field Locator 50B needs to contain the word MaineCare. Field Locator 9D needs to contain the word Medicare Replacement Field Locator 84 (remarks) needs to say Medicare Replacement or Medicare Railroad depending on which plan pertains to your billing. Field Locator 80 (remarks) needs to say Medicare Replacement or Medicare Railroad depending on which plan pertains to your billing. If you have questions regarding this message please contact 1-800-321-5557 Option # 8. 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/20080505/3fbe6734/attachment.html From provider at lists.maine.gov Mon May 5 16:25:14 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 5 May 2008 16:25:14 -0400 Subject: [Provider] Correction for Previous U1 Modifier Message Message-ID: ATTENTION: MaineCare Providers of Behavioral Health Services An earlier message on this topic stated one of the procedure codes incorrectly. It has come to our attention that MaineCare is unable to process claims correctly in most cases when the U1 modifier is used on claim forms. We are asking that providers not use the U1 modifier except for the cases where procedure codes H2021 HU or H0023 HU are authorized with the additional U1 modifier under Section 65, Mental Health Services. The "Servicing Provider ID Number" must be included on the claim form. If you are using the CMS 1500 (12/90) version this number is written in Box 24K that is labeled "Reserved for Local Use". If using CMS 1500 (08/05) version, enter the servicing provider number in the shaded area of 24J that is labeled "Rendering Provider ID #". If the service is provided by one of the Grandfathered (BS-1) "Bachelor's Level staff" or other qualified staff, put the servicing provider number of the supervisor in Box 24K or 24J. Remember, except as indicated above; do not put the U1 modifier on the claim form. All billing questions should be directed to the MaineCare Billing and Information Unit at 1-800-321-5557, Option 8. This Unit will assist providers with billing resolution. If during the call, it is determined that the issue needs a higher level of intervention, the caller will be referred to the appropriate Provider Relations Specialist. 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/20080505/fb8ec1b4/attachment.html From provider at lists.maine.gov Wed May 7 08:55:36 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 7 May 2008 08:55:36 -0400 Subject: [Provider] Revised Behavioral Health Service Grid Available Message-ID: ATTENTION: MaineCare Behavioral Health Providers There is a revised Service Grid posted on the APS Healthcare-Maine Website. The APS Healthcare-Maine website is: http://www.qualitycareforme.com/ The revised Service Grid dated 5/6/08 can be found at this link: http://www.qualitycareforme.com/documents/provider_providermanual_servic egrid.pdf The Service Grid has been revised so that it is consistent with recent changes in the MaineCare Benefits Manual. The following procedure codes have been eliminated from the MaineCare Benefits Manual, and so have been removed from the APS Service Grid: Codes Removed from the Service Grid: Section 100 Psychological Services Group Therapy-Psychologist 3/1/08 Z9063 60 min Group Therapy-Psychologist 3/1/08 Z6057 45 min Group Therapy-Psychologist 3/1/08 Z6058 30 min Group Therapy-Co-Therapist Pscyh. 3/1/08 Z6060 60 min Group Therapy-Co-Therapist Pscyh. 3/1/08 Z6061 45 min Group Therapy-Co-Therapist Pscyh. 3/1/08 Z6062 30 min Individual Psychotherapy-Psych. 3/1/08 Z9057 60 min Individual Psychotherapy-Psych. 3/1/08 Z9058 45 min Individual Psychotherapy-Psych. 3/1/08 Z9059 30 min Family Psychotherapy- Pscyhologist 3/1/08 Z9075 60 min Family Psychotherapy- Pscyhologist 3/1/08 Z9076 45 min Family Psychotherapy- Pscyhologist 3/1/08 Z9077 30 min Section 65 Children's Services Children's Day Treatment 3/1/08 Z4107 1 Day Infant Mental Health-Physician 3/1/08 Z4121 15 min Infant MH-Pscyhiatrist 3/1/08 Z4122 15 min Infant MH-Psychologist 3/1/08 Z4123 15 min Infant MH-LCSW,LMSW 3/1/08 Z4124 15 min Infant MH-LCPC,LMFT 3/1/08 Z4125 15 min Infant MH-Pscyhiatric Nurse 3/1/08 Z4126 15 min 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/20080507/6a3a179c/attachment.html From provider at lists.maine.gov Fri May 9 15:38:17 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 9 May 2008 15:38:17 -0400 Subject: [Provider] Resolution of Payment Problem for Crisis Support Services and the HB modifier Message-ID: ATTENTION: All MaineCare Providers who file claims for crisis support services or use the HB modifier For the past several weeks, MeCMS has not been processing claims for crisis support services or claims with an HB modifier correctly (H0018 HB). These claims have been paying $0 or denying incorrectly. This problem has been corrected in MeCMS and these claims can now be submitted with the expectation that they will be processed and paid correctly. For providers with these type claims that paid at $0 or denied incorrectly, a system initiated adjustment will be entered into MeCMS. This will be done over the next few weeks. Providers should see this reflected on their remittance statements after the adjustment has occurred. 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/20080509/531cbe92/attachment.html From provider at lists.maine.gov Mon May 19 10:05:41 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 19 May 2008 10:05:41 -0400 Subject: [Provider] HCFA 1500 Update Message-ID: ATTENTION: MaineCare Providers Filing Adjustment and Void Claims on HCFA 1500 Forms Providers that are submitting claims using the EMC HCFA 1500 format and are submitting adjustment/void claims are asked to remember: * MaineCare will only accept one "G" record in the file * The "G" record is the information contained in box 22 on the HCFA 1500 form (Medicaid Resubmission Code and Original TCN). Claims that are billed with multiple "G" records fail to load in MeCMS. Please reference the Appendix II: Electronic Claims FAQ's from the voids communication packet. These instructions can be found at http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#r epair 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/20080519/bc34bdcd/attachment.html From provider at lists.maine.gov Tue May 27 08:59:29 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 27 May 2008 08:59:29 -0400 Subject: [Provider] Demonstration Project for High-risk MaineCare Members 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 Schaller Anderson Medical Administrators, Inc. (SAMAI) is soliciting applications from clinical entities located and doing business in the State of Maine to contract with SAMAI for a period of not less than one (1) year in a community-based care management demonstration project for high-risk MaineCare members. Such clinical entities may include Physician Hospital Organizations (PHO), Federally Qualified Health Centers (FQHC), physician practices or other clinical enterprises not associated with a PHO or FQHC engaged and participating in the care of MaineCare members. Selected clinical entities will be expected to enter into a contract with SAMAI; the contract will be effective July 1, 2008. The purposes of the contract are to support the implementation of community-based care management for high-risk, chronically ill MaineCare members residing in the State of Maine. A power point presentation is attached that outlines the demonstration project expectations. An application for participation is also attached. Please note the time lines and application requirements as described in the application document. 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/20080527/1b222b7d/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: SA Care Management Demo Presentation May 23 2008.ppt Type: application/vnd.ms-powerpoint Size: 692224 bytes Desc: SA Care Management Demo Presentation May 23 2008.ppt Url : http://mailman.informe.org/pipermail/provider/attachments/20080527/1b222b7d/SACareManagementDemoPresentationMay232008.ppt -------------- next part -------------- A non-text attachment was scrubbed... Name: Application for Community Based Care Mgt Demo Proj May 23 2008 v2.doc Type: application/msword Size: 1205760 bytes Desc: Application for Community Based Care Mgt Demo Proj May 23 2008 v2.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080527/1b222b7d/ApplicationforCommunityBasedCareMgtDemoProjMay232008v2.doc From provider at lists.maine.gov Tue May 27 09:08:00 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 27 May 2008 09:08:00 -0400 Subject: [Provider] Targeted Case Management Training Message-ID: ATTENTION: All MaineCare Providers of Targeted Case Management Services Changes in MaineCare's coverage of Targeted Case Management (TCM) services are planned. A rule-making process is underway for Chapters II and III, Section 13, Targeted Case Management that reduces the TCM categories to three and that proposes major changes to provider reimbursement and billing. In addition, services intrinsic to another program will no longer be covered under Section 13. The complete proposed rule can be found at http://www.maine.gov/bms/rules/provider_proposed_mcare.shtml Training on the changes will be provided during the month of June. An attached training sheet lists dates, locations and times, and provides options for registration. Providers must first register before attending a training session. Providers offering case management services will need to file a provider agreement with MaineCare to specify the population(s) of members the provider will serve and the counties in which services will be provided. This agreement is also attached and should be returned to Provider Enrollment Office of MaineCare Services 442 Civic Center Drive Augusta, ME 04333-0011 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/20080527/76d329fa/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: OMS TCM Provider Agreement.doc Type: application/msword Size: 37888 bytes Desc: OMS TCM Provider Agreement.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20080527/76d329fa/OMSTCMProviderAgreement.doc -------------- next part -------------- A non-text attachment was scrubbed... Name: TCMproviderRegistrationFormfinal.xls Type: application/vnd.ms-excel Size: 17408 bytes Desc: TCMproviderRegistrationFormfinal.xls Url : http://mailman.informe.org/pipermail/provider/attachments/20080527/76d329fa/TCMproviderRegistrationFormfinal.xls From provider at lists.maine.gov Wed May 28 16:20:13 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 28 May 2008 16:20:13 -0400 Subject: [Provider] APS Healthcare Update Message-ID: Attention: MaineCare Providers Participating in the Behavioral Health Administrative Services Organization (ASO) Please note the following updates: 1. 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 service grid and the TCM Transition Process for the ASO is posted at this link: http://www.qualitycareforme.com/MaineProvider_Update052808.htm The revised service grid, dated 6/1/08 is posted at this link: http://www.qualitycareforme.com/documents/provider_providermanual_servic egrid.pdf 2. Conference Call to Discuss ASO Provider Billing Questions: Wednesday, June 4th at 11:00am -12:00pm Conference Line: 1-888-242-1836 Access code 8377033 This call is intended for provider staff that is responsible for or involved with billing claims for services that are included in the ASO. APS staff and OMS representatives will host the call. Please send questions/topics for discussion in advance to kbickmore at apshealthcare.com 3. Provider Data Questionnaire: In an effort to further refine our contact lists and increase efficiency in communication with you, we are sending each provider registered in our CareConnection System a brief directory questionnaire. This will help insure that we are contacting the correct people within your practice/agency or hospital. Please take a moment to complete and return this form and thanks in advance for your help. Thank you! 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/20080528/ff986bf9/attachment.html