[Provider] Requesting and Billing Prior Athorization

[Provider Notification]

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.

 

 

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