[Provider] Classification Reminder for MaineCare Day Health Service Providers

[Provider Notification]

ATTENTION:  Day Health Providers are required to obtain correct
classification

 

This is a reminder to Day Health Service providers that a correct
classification is required for members receiving services under Section
26 of the MaineCare Benefits Manual.  Classification is required to
ensure claims payment by MaineCare.  Classifications should be obtained
from the Office of Elder and Adult Services.  Obtaining a classification
includes an assessment by Goold Health Systems (GHS).  

 

MeCMS claims edit logic was updated on June 6, 2008 to enable the claims
processing system to look for these classifications on submitted claims.
Claims submitted without the correct classification will be denied.

 

Policy surrounding the classification requirement has not changed.
Chapter II, Section 26 of the MaineCare Benefits Manual states 

"26.02-2 Specific Day Health Services Eligibility Requirements
(8/05/2005): The member must be assessed by the Department or the
Department's authorized agent, using the Department's approved medical
eligibility assessment form.  A member must require assistance with a
combination of activities of daily living and nursing at specific levels
in order to meet eligibility for specific levels of care."

 

 

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/20080905/b5020d82/attachment.html