From provider at lists.maine.gov Thu Oct 2 15:42:04 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 2 Oct 2008 15:42:04 -0400 Subject: [Provider] ICD9 Codes Updated in MeCMS Message-ID: ATTENTION: MaineCare Providers using ICD9 Codes The 2009 ICD9 diagnosis and procedure code file has been updated in MECMS for dates of service starting October 1, 2008. A list of additions and deletions can be found on the MaineCare web site at (link) http://www.maine.gov/dhhs/bms/providerfiles/provider_billing_manuals.htm There are numerous changes to descriptions for both the ICD9 diagnosis and procedure codes. Diagnosis codes that have been discontinued September 30th, 2008 are listed here: 0461, 0510, 1362, 2595, 3370, 5118, 5997, 6118, 6951, 7299, 7606, 7775, 7806, 7889, 7951, 9973, 9998, V135, V152, V155. V288, V451, V51, V610, V622 Some ICD9 procedure codes have been discontinued as of September 30, 2008. They are: 458, 485, 537, 857 New ICD9 procedure codes to be used by institutional providers are also on the MaineCare web site. The final addendum which describes all ICD-9-CM changes is posted on CMS' webpage at: http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/ 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/20081002/7bda2be7/attachment.html From provider at lists.maine.gov Fri Oct 3 10:22:31 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 3 Oct 2008 10:22:31 -0400 Subject: [Provider] Revised Day Habilitation Cost Report and Cost Report Instructions Message-ID: ATTENTION: MaineCare Providers of Day Habilitation The Audit Program within DHHS Financial Services asks that you review the attached memorandum concerning revised Day Habilitation Cost Reports and their Instructions. 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/20081003/f49942f2/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: Day Hab Cost Report.doc Type: application/msword Size: 69632 bytes Desc: Day Hab Cost Report.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20081003/f49942f2/DayHabCostReport.doc From provider at lists.maine.gov Tue Oct 7 08:13:32 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 7 Oct 2008 08:13:32 -0400 Subject: [Provider] Planned MeCMS Downtime Message-ID: ATTENTION: All MaineCare Providers Utilizing MeCMS for Claims Payment Starting Friday evening October 10th, MeCMS will be unavailable until 6:00 am Tuesday morning, Oct 14. This is due to an upgrade to Oracle 10g. Providers will be able to transmit files to the state during this time, but will not receive acknowledgements until MeCMS becomes available on Tuesday. The IVR and Claims Portal will also not be available until MeCMS is back online. 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/20081007/1ab4a13c/attachment.html From provider at lists.maine.gov Tue Oct 7 12:44:07 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 7 Oct 2008 12:44:07 -0400 Subject: [Provider] Filing MaineCare Claims for LCPC, LMFT, CRN and RN Services Message-ID: ATTENTION: MaineCare Providers who are Licensed Clinical Professional Counselors, Licensed Marriage and Family Therapists, Registered Nurses - Certified and Registered Nurses Services provided by LCPCs, LMFTs, CRNs and RNs can be billed to MaineCare without the Medicare Explanation of Benefits (EOB) for procedure codes H0004, H2000 and H2010. These claims must be submitted to MaineCare on paper claim forms. Any claims submitted electronically will deny. Prior to the revisions of Section 65, providers were able to bill specific or local codes for these servicing provider services. New Section 65 policy uses general, HIPAA compliant codes that cover multiple licensure types. This requires MaineCare to review these types of claims manually, in order for them to process correctly. 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/20081007/d95f3d26/attachment.html From provider at lists.maine.gov Tue Oct 7 16:00:33 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 7 Oct 2008 16:00:33 -0400 Subject: [Provider] Billing Reminder for LCPCs and LMFTs Message-ID: PLEASE NOTE CORRECTION: The message (below) sent earlier today was also addressed to Registered Nurses - Certified and Registered Nurses. This was in error. The message here has been corrected. We apologize for any confusion. ATTENTION: MaineCare Providers who are Licensed Clinical Professional Counselors and Licensed Marriage and Family Therapists Services provided by LCPCs and LMFTs can be billed to MaineCare without the Medicare Explanation of Benefits (EOB) for procedure codes H0004, H2000 and H2010. These claims must be submitted to MaineCare on paper claim forms. Any claims submitted electronically will deny. Prior to the revisions of Section 65, providers were able to bill specific or local codes for these servicing provider services. New Section 65 policy uses general, HIPAA compliant codes that cover multiple licensure types. This requires MaineCare to review these types of claims manually, in order for them to process correctly. 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/20081007/f618d488/attachment.html From provider at lists.maine.gov Tue Oct 14 10:01:21 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 14 Oct 2008 10:01:21 -0400 Subject: [Provider] Reminder for MaineCare Hospitals that bill for Outpatient Drugs Message-ID: ATTENTION: All Hospitals Billing for Outpatient Drugs The Deficit Reduction Act (DRA) of 2005 required State Medicaid agencies to provide for the collection of National Drug Codes (NDC). This relates to all claims for certain physician-administered drugs and is for the purpose of billing manufacturers for Medicaid drug rebates. Specifically, this relates to outpatient claims submitted to MaineCare by hospitals for certain outpatient drugs, the "top 20" list of most commonly prescribed outpatient drugs. This requirement went into effect for services provided on or after July 1, 2008. This message serves as a reminder for Maine Hospitals to begin submitting this information via a Roster file method. Roster billing files for 3rd quarter (07/01/08 - 09-30-08) should be submitted to the State no later than December 31, 2008. Additionally, it is necessary to bill for drugs on the list of Top-20 outpatient drugs at the CPT/HCPCS code level. For each drug billed to MaineCare on the Top-20 list, the UB claim form must contain a separate charge showing the appropriate HCPCS code. To access the "top 20" list please refer to the following link. This list may be subject to change annually. http://www.cms.hhs.gov/DeficitReductionAct/40_PhysicianAdministeredDrugs .asp Previously CMS issued a change request (5950) informing hospitals they have made modifications that would allow the capture of drug rebate data on Medicare-Medicaid crossover claims on the UB 04 billing form. MaineCare cannot currently accommodate the UB 04 billing method. Until further notice, MaineCare is requesting hospitals to bill for the Top-20 drugs at the CPT/HCPCS code level on their Medicare/Medicaid claims and to include NDC code data for these crossover claims on their quarterly rosters. MaineCare will be ready to accept production rosters beginning Monday, November 17. In subsequent quarters, hospitals may submit rosters at any point in the quarter. Roster billing instructions are attached. To request your hospital's login name and password please call 1-800-321-5557, option 9. For all other inquires please contact 1-800-321-5557, option 8. We appreciate your cooperation, and your service to 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/20081014/168d7496/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: Roster Billing Instruction for Maine Hospitals-Final Version.doc Type: application/msword Size: 65024 bytes Desc: Roster Billing Instruction for Maine Hospitals-Final Version.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20081014/168d7496/RosterBillingInstructionforMaineHospitals-FinalVersion.doc From provider at lists.maine.gov Wed Oct 22 15:11:03 2008 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 22 Oct 2008 15:11:03 -0400 Subject: [Provider] Implementing File Transfer (FTP) of claims to MaineCare Message-ID: ATTENTION: MaineCare Providers currently sending claims by modem Very recently, providers sending claims to MaineCare by modem may have experienced delays or other problems in the transfer of those claims. The technology used for this process is older and problems like this may continue to occur over time. For this reason, we are asking that providers using modem change to sending their claims by file transfer (FTP). This is a relatively easy process and only requires the installation of software (at no charge). Complete instructions for the installation of this software are attached. Please make this change by Friday, December 5th. This is the last day that modem submission of claims will be supported by MaineCare. Once the software is installed, providers will find that sending claims by FTP is faster and more reliable. If you have questions about this, please call 800-321-5557, option 9. 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/20081022/f931fbe1/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: Core FTP Setup For Providers 10-22-08.doc Type: application/msword Size: 897536 bytes Desc: Core FTP Setup For Providers 10-22-08.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20081022/f931fbe1/CoreFTPSetupForProviders10-22-08.doc From provider at lists.maine.gov Fri Oct 24 15:27:29 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 24 Oct 2008 15:27:29 -0400 Subject: [Provider] Conference Call for Roster Billing / NDC Codes Message-ID: ATTENTION: Maine Hospital Providers MaineCare will be hosting a roundtable discussion with information about 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 Tuesday, November 4th from 10:00 to 11:00 a.m. The conference call number is 1-888-727-6732, pass code 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/20081024/44a9ac4d/attachment.html From provider at lists.maine.gov Mon Oct 27 13:50:49 2008 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 27 Oct 2008 13:50:49 -0400 Subject: [Provider] Requesting and Billing Prior Athorization Message-ID: ATTENTION: All MaineCare Providers That Request Prior Authorization for Services It has come to our attention that when billing for services that require Prior Authorization (PA), MaineCare is unable to process claims correctly when the modifier(s) on the claim form does not match exactly to the modifier(s) on the PA. For this reason, we are asking providers to include all modifiers that will be used in billing when submitting PA requests, including descriptive modifiers. When billing claims with PA's, only bill the procedure codes and modifiers authorized on the PA. Submitting claims with procedure code(s) or modifier(s) not authorized will cause the claims to deny. 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/20081027/78d679eb/attachment.html From provider at lists.maine.gov Tue Oct 28 22:01:20 2008 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 28 Oct 2008 22:01:20 -0400 Subject: [Provider] Cost of Care Issue Message-ID: ATTENTION: MaineCare Nursing Home and Boarding Home Providers On October 14th a correction was implemented in MeCMS to correct a cost of care issue for Boarding Home claims. This action corrected the issue for Claim Type 5 but inadvertently caused a new problem for claim type 12 (Nursing Homes). As a result, NO cost of care amounts are now being deducted from claim type 12. A correction for this new problem is in testing. It is expected that the cost of care issue for claim type 12 will be corrected by November 15th. 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/20081028/362a0674/attachment.html From provider at lists.maine.gov Thu Oct 30 11:43:06 2008 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 30 Oct 2008 11:43:06 -0400 Subject: [Provider] Questions and Answers for Filing Adjustments Message-ID: ATTENTION: All MaineCare Providers Filing Adjustments The attached document contains further information and tips for using the MeCMS adjustment functionality which was introduced earlier this year. It is recommended that provider staff planning to file adjustments review the document to avoid additional problems. This document will be posted to the MaineCare web site on the Billing Instruction page and under "Void and Adjustment Instructions". 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/20081030/3a89ec66/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: Billing and Adjustment QA Final.doc Type: application/msword Size: 356864 bytes Desc: Billing and Adjustment QA Final.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20081030/3a89ec66/BillingandAdjustmentQAFinal.doc From provider at lists.maine.gov Fri Oct 31 10:18:06 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 31 Oct 2008 10:18:06 -0400 Subject: [Provider] Proposed Rule for Chapter III, Section 21 Message-ID: ATTENTION: MaineCare Providers of Section 21 Services This is notice of a proposed rule for Chapter III, Section 21 of the MaineCare Benefits Manual. This is a major substantive rule for home and community benefits for members with mental retardation and autistic disorder. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. Concise Summary: This rulemaking will provisionally adopt the rule pending approval by the Legislature. The rule is currently in effect, having been adopted previously as an emergency rule, effective 10/1/08. See http://www.maine.gov/bms/rules/provider_rules_policies.htm for rules and related rulemaking documents. Public Hearing Information: A public hearing for this rulemaking will take place: November 24, 2008, 1:00-3:00 PM Conference Room # 1A Department of Health and Human Services, Office of MaineCare Services 442 Civic Center Drive Augusta, ME 04333-0111 Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before November 10, 2008. Deadline for Comments: Comments must be received by midnight, Thursday December 4, 2008 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Office of MaineCare Services Mailing Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) 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/20081031/749498ca/attachment.html From provider at lists.maine.gov Fri Oct 31 10:23:34 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 31 Oct 2008 10:23:34 -0400 Subject: [Provider] Adopted Rule for Chapter 115 Message-ID: ATTENTION: All MaineCare Providers of Residential Care Facilities This message is to give notice that a rule has been adopted for Chapter 115 of the MaineCare Benefits Manual. This is for Principles of Reimbursement for Residential Care Facilities - Road and Board Costs. Adopted rules are final and no changes can be made at this point. Concise Summary: This final rule permanently adopts an emergency rule eliminating a restriction on reimbursement for bedhold days in those instances where an associated PNMI treatment cost has not been billed under MaineCare. The rule change removes language in Chapter 115, Principles of Reimbursement for Residential Care Facilities. In a separate rulemaking, the Department has eliminated reimbursement for Private Non-Medical Institution (PNMI) bedhold days for those days reimbursed by the MaineCare program. Providers billing for PNMI services under Appendices C and F will still be able to bill up to thirty (30) bedhold days per calendar year when a member is absent from the facility. The codes used for this billing continue to be reimbursed with the billing codes "BL" and "MRBL." This will allow for continued reimbursement of some routine fixed costs that are not eliminated when the member is temporarily absent from the facility. These funds are reimbursed by all state dollars, and are not matched with reimbursement from the federal Medicaid program. Compliance with this rule change is not anticipated to impose additional administrative costs on small businesses. Effective Date: October 30, 2008 Agency Contact Person: Patricia Dushuttle Agency Name: Office of MaineCare Services Mailing Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9362 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) 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/20081031/14622d8d/attachment.html From provider at lists.maine.gov Fri Oct 31 10:28:06 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 31 Oct 2008 10:28:06 -0400 Subject: [Provider] Adopted Rule for Chapter 11, Section 97 Message-ID: ATTENTION: All MaineCare Providers of Private Non-Medical Institutions (PNMI) This message gives notice of an adopted rule for Chapter II, Section 97 of the MaineCare Benefits Manual. It is for private non-medical institutions. Adopted rules are final and no changes can be made at this point. Concise Summary: In this rulemaking, the Department is eliminating reimbursement for bedhold days. The Department has permanently adopted these changes currently in effect by emergency rule. These rules are intended to achieve a savings of $2,000,000.00 in the general fund for SFY 08-09. Compliance with this rule change is not anticipated to impose additional administrative costs on small businesses. Effective Date: October 30, 2008 Agency Contact Person: Patricia Dushuttle Agency Name: Office of MaineCare Services Mailing Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9362 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) 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/20081031/be8e366a/attachment.html From provider at lists.maine.gov Fri Oct 31 11:24:26 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 31 Oct 2008 11:24:26 -0400 Subject: [Provider] Adopted Rule for Chapters II and III, Section 65 - Behavioral Health Services Message-ID: ATTENTION: MaineCare Providers of Behavioral Health Services This is notice of an adopted rule for the MaineCare Benefits Manual, Chapters II and III, Section 65. Adopted rules are final and no changes can be made at this point. Concise Summary: The adopted rules consolidate four Sections of the MaineCare Benefits Manual into one Section. Sections 58, Licensed Clinical Social Worker, Licensed Clinical Professional Counselor and Licensed Marriage and Family Therapist Services, Section 65, Mental Health Services, Section 100, Psychological Services and Section 111, Substance Abuse Treatment Services Chapters II & III, were consolidated into one Section of the MaineCare Benefits Manual, now known as Section 65, Behavioral Health Services. The final rule incorporates two Emergency rules that were filed effective 8/1/08, Section 65, Chapters II & III, 2008-319 and Chapter III, 2008-332. The final rule consolidates Outpatient Services under one Section of the MaineCare Benefits Manual, ensuring better coordination of services. Emergency Services, which used to be covered as a stand alone service, has been incorporated into Outpatient services. Comprehensive Assessment, which was incorporated into Outpatient Services, is covered as a stand alone service and coded for reimbursement in Chapter III. This rulemaking also added proration language for partial months of Children's Assertive Community Treatment (ACT) in Chapter II. Crisis Services were renamed and redefined for reimbursement to better reflect current services being provided. Child and Family Behavioral Health Treatment and Community Based Treatment for Children without Permanency were merged into one service and renamed Children's Home and Community Support Services for better coordination. Collateral contacts were also added as a stand alone service for children who receive Children's Home and Community Support Services. Independent providers not employed by a Mental Health Agency are able to provide services within the scope of their licensure and be reimbursed for services provided to MaineCare members. Additionally, the Chapter III of this new Section contains HIPAA compliant coding. The Department also made some routine technical changes to the rule. This rule is not anticipated to increase administrative costs of compliance for small businesses and is not expected to impose new costs upon municipal or county governments. Effective Date: October 29, 2008 Agency Contact Person: Ginger Roberts-Scott, Comprehensive Health Planner Agency Name: Office of MaineCare Services Mailing Address: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: 207-287-9365 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf or Hard of Hearing) Adopted and Proposed Rules can be found online at: http://www.maine.gov/bms/rules/provider_rules_policies.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/20081031/82e00b37/attachment.html From provider at lists.maine.gov Fri Oct 31 11:30:28 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 31 Oct 2008 11:30:28 -0400 Subject: [Provider] Billing Note for MaineCare Providers of Section 65 Services Message-ID: ATTENTION: MaineCare Providers of Section 65, Behavioral Health Services It has come to our attention at MaineCare that providers billing their usual and customary charges for Section 65 services may be exceeding the maximum allowance listed in the policy. The maximum allowance for provider charges can be found in Chapter III, Section 65 of the MaineCare Benefits Manual. Please contact Provider Relations at 1-800-321-5557, option 8 with any 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/20081031/0e8f104a/attachment.html From provider at lists.maine.gov Fri Oct 31 12:55:22 2008 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 31 Oct 2008 12:55:22 -0400 Subject: [Provider] Updated Billing Note for Section 65 Providers Message-ID: ATTENTION: MaineCare Providers of Section 65, Behavioral Health Services A message on this topic sent earlier today did not contain the underlined information. Please note this information. It has come to our attention at MaineCare that providers billing their usual and customary charges for Section 65 services may be exceeding the maximum allowance listed in the policy. Billed charges must not exceed the maximum allowance. The maximum allowance for provider charges can be found in Chapter III, Section 65 of the MaineCare Benefits Manual. Please contact Provider Relations at 1-800-321-5557, option 8 with any 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/20081031/17a4f167/attachment.html