From provider at lists.maine.gov Fri Nov 7 15:27:16 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 7 Nov 2008 15:27:16 -0500 Subject: [Provider] Update to Providers Not Receiving MaineCare Payment This Week Message-ID: ATTENTION: MaineCare providers who did not receive a check this week MaineCare claims volume was much higher than usual this past week. Even after four additional hours of processing, not all of the checks could be produced. If the processing had been allowed to continue, the timeframe for producing checks would have expired and no providers would have received payment. More than $38 million in checks was produced, but nearly $5 million in checks could not be completed. Providers who missed this week's cycle will have their check processed in next week's cycle. We apologize for the inconvenience. 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/20081107/76ee0dd1/attachment.html From provider at lists.maine.gov Thu Nov 13 14:18:24 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 13 Nov 2008 14:18:24 -0500 Subject: [Provider] MeCMS Claims Payment Update Message-ID: ATTENTION: MaineCare providers submitting claims to MeCMS This is an update to the listserv message sent previously about last week's claims cycle. The entire amount of $4.8 million that was not included in last week's cycle will be paid as a part of this week's regular cycle. As we worked to correct that problem, a second part of the problem was identified. This has resulted in additional claims from the current cycle that are delayed. However, rather than wait a full week for these payments, a special cycle will be run. As a result, some of this week's MaineCare payment checks and EFTs will be delayed by a day or two and happen early next week. We apologize for any inconvenience. For questions, please contact MaineCare billing and information at 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/20081113/6ac8de6e/attachment.html From provider at lists.maine.gov Thu Nov 13 15:29:46 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 13 Nov 2008 15:29:46 -0500 Subject: [Provider] Adopted Rules and Billing Codes for Hearing Aids and Services Message-ID: ATTENTION: All MaineCare Providers of Section 35 Services The adopted rules for Hearing Aids and Services, Section 35, are effective December 1, 2008 and reflect the current practice of only allowing members under age 21 to receive this service. In addition: * Prior Authorization has been eliminated for all but one code * Updated criteria for medical evaluation and testing were added * Audiologists were added as hearing aid dispensers to conform to a change in their scope of practice * Terminology, such as using MaineCare instead of Medicaid and member instead of recipient, is also updated * Chapter III establishes new billing codes based on HIPAA compliant coding as indicated in the attached file. Please contact the MaineCare Provider Relations office at 1-800-321-5557, Option 8 for further assistance. 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/20081113/0248a7a5/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: MaineCare Services Hearing Aids (35) Procedure Code Crosswalk.doc Type: application/msword Size: 178176 bytes Desc: MaineCare Services Hearing Aids (35) Procedure Code Crosswalk.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20081113/0248a7a5/MaineCareServicesHearingAids35ProcedureCodeCrosswalk.doc From provider at lists.maine.gov Fri Nov 14 14:21:35 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 14 Nov 2008 14:21:35 -0500 Subject: [Provider] Plavix for outpatient use Message-ID: ATTENTION: Providers who prescribe Plavix for outpatient use Plavix will NOT require Prior Authorization (PA) when it is prescribed for patients who * have a percutaneous angioplasty procedure (PCI) scheduled, or * have had percuntaneous angioplasty (PCI) procedure in the past 12 months. When you are prescribing Plavix for such a patient, please write on the prescription: "PCI procedure" scheduled for (date)" or ""PCI procedure occurred (date)". (Note: documentation may be requested for audit purposes.) This exception applies only for these patients and only for brand name Plavix. For all other patients prescribed Plavix and for all patients prescribed Clopidogrel (the generic of Plavix), the normal Prior Authorization criteria and process will apply. If you have any questions about Plavix or prior authorization requirements please contact GHS Prior Authorization at 888-445-0497 or Pharmacy Help Desk at 888-420-9711. 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/20081114/03e2811c/attachment.html From provider at lists.maine.gov Fri Nov 14 14:58:59 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 14 Nov 2008 14:58:59 -0500 Subject: [Provider] Billing Refractions and Comprehensive Eye Exams Message-ID: ATTENTION: All Section 75, Vision Providers We recently discovered that some providers have been billing for Refractions (92015) along with Comprehensive Eye Exams (92014 or 92004) on the same date of service. The Refraction is included in the Comprehensive Eye Exam for MaineCare and should not be billed separately from the Comprehensive Eye Exam (92014 or 92004). Included below is Section 75.03-1 of the MaineCare Benefits Manual, Section 75, Vision policy. The exception is when billing after Medicare. Medicare does not reimburse for the Refraction, therefore, the Refraction is separately billable to MaineCare when billing after Medicare. MaineCare has overpaid for Refractions provided on the same date of service as Comprehensive Eye Exams (92014 or 92004). Please void the MaineCare claim if you have been overpaid. In some cases, MaineCare paid the Refraction first, and denied the Comprehensive Eye Exam. In these cases, please submit a void for the Refraction. Once the void is listed on a Remittance Advice Statement, you can then bill for the Comprehensive Eye Exam. We apologize for any inconvenience this may have caused. Please contact Provider Relations at 1-800-321-5557, option 8 with any questions. 75.03-1 3. Eye Examination - Comprehensive A comprehensive eye examination is a level of service involving an in-depth evaluation of a member with a new or existing problem requiring the development or complete re-evaluation of data. Example: The examination of the eye and related structures to ascertain defects or abnormalities, to detect the presence of eye diseases, to determine the refractive and accommodative states of the eyes, and to evaluate the visual functions. The eye examination includes a diagnostic history, visual acuity determination, testing for refraction, muscle balance and accommodative function, ophthalmoscopy and biomicroscopy. Tonometry and gross visual field testing should be included when indicated. Other tests may be included as required as long as they fall within the scope of licensure for optometry. 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/20081114/b5aa9859/attachment.html From provider at lists.maine.gov Wed Nov 19 14:43:39 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 19 Nov 2008 14:43:39 -0500 Subject: [Provider] New Process for Prior Authorization on Out-of-State Services Message-ID: ATTENTION: MaineCare Providers that request prior authorization for Out-of-State Services The process for requesting out-of-state services for MaineCare members will change on December 1. Beginning on that day, requests for these services should be submitted to and will be processed by Schaller Anderson. The complete instructions are posted to the MaineCare web site and can be found at: http://www.maine.gov/bms/providerfiles/pacriteriasheets.htm#oos 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/20081119/3b878283/attachment.html From provider at lists.maine.gov Thu Nov 20 14:50:22 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 20 Nov 2008 14:50:22 -0500 Subject: [Provider] Thanksgiving Note for MaineCare Providers Message-ID: ATTENTION: All MaineCare Providers Submitting Claims to MeCMS Due to the Thanksgiving holiday, payments to providers may be delayed a day for the week of November 24th. Electronic Fund Transfers (EFTs) will begin on Friday, November 25th and paper Remittance Advices (RAs) may be delayed a day or two. 835's will be viewable over the weekend. The claims portal is updated everyday and this won't be impacted by the holiday. The Office of MaineCare Services will observe the state holiday and the office will be closed on Thursday and Friday, November 24th and 25th. Happy Thanksgiving! 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/20081120/dd666949/attachment.html From provider at lists.maine.gov Thu Nov 20 15:15:39 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 20 Nov 2008 15:15:39 -0500 Subject: [Provider] Thanksgiving Note for MaineCare Providers - Correction of Dates Message-ID: ATTENTION: All MaineCare Providers Submitting Claims to MeCMS The dates have been corrected in this message. Due to the Thanksgiving holiday, payments to providers may be delayed a day for the week of November 24th. Electronic Fund Transfers (EFTs) will begin on Friday, November 28th and paper Remittance Advices (RAs) may be delayed a day or two. 835's will be viewable over the weekend. The claims portal is updated everyday and this won't be impacted by the holiday. The Office of MaineCare Services will observe the state holiday and the office will be closed on Thursday and Friday, November 27th and 28th. Happy Thanksgiving! 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/20081120/20fde5ed/attachment.html From provider at lists.maine.gov Tue Nov 25 16:24:47 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 25 Nov 2008 16:24:47 -0500 Subject: [Provider] Repaying the Department Message-ID: ATTENTION: MaineCare Providers who need to return money to the Department To clarify how to repay money to the Department, MaineCare offers the summary below. Interim Payments The Department expects full repayment of all outstanding interim balances. * Providers can * submit checks, * offset paid claims or * apply outstanding cost settlements. * The Department will work with you to repay balances using any of the above methods. Claims Adjustments Providers may owe the Department money related to overpaid claims. You can repay the Department by submitting claim adjustments. * If you are currently submitting claims and receiving payments, the system will automatically recapture the money owed to the Department. * Please do not submit checks along with the claims to be adjusted (known by many providers as "pinks"). * If you do submit a check with the "pink" adjusted claims, the adjustment unit will make every effort to process the adjustments and remove the automatic offset. * If staff is able to remove the automatic offset for your adjustment, you will not see the payment and the adjustment on your Remittance Advice (RA). This data will appear on your RA when that function is added to the system. Claim Voids Providers can submit a void to a claim that was overpaid through the system and MeCMS will recapture the overpayment from current paid claims. If you cannot void claims in the system, i.e., you no longer bill MaineCare, or if the number of voids you need to process would cause a severe cash flow issue, you can submit a check. * Before you submit a check, please contact the Adjustment Unit. * The Adjustment Unit will then process the voids as "non-offset" voids. These show up on the RA with an "N" in the offset column. A "non-offset" receivable -- a receivable that WILL NOT recoup money from current claims -- is created in the amount of the voided claims. * The non-offset receivable will appear on your RA in the far right section of the summary page. After the receivable shows up on the RA, the Adjustment Unit will apply your check to the receivable. * After the check is applied, your RA will show the amount owed and the amount applied, leaving a zero balance. Questions about repaying money? Call Customer Service at 1-800-321-5557 Option #8. If you need the Adjustments Unit staff to help you with a specific problem, please refer to the attached staff directory. Stay up to date on MaineCare's latest news and changes. Just visit OMS's list serve subscription page to get updates by e-mail! -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20081125/10bce911/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... 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