From provider at lists.maine.gov Tue Feb 3 16:36:27 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 3 Feb 2009 16:36:27 -0500 Subject: [Provider] Interpreter Services Fact Sheet Posted to MaineCare Services Web Site Message-ID: ATTENTION: All MaineCare Providers Billing Interpreter Services A new fact sheet is available on the MaineCare Services web site regarding Interpreter Services. This fact sheet defines the services and provides detailed information for billing the services to MaineCare. The sheet can be found at: http://www.maine.gov/dhhs/bms/providerfiles/billing_instructions.html Under the Paper Billing Instructions header, look for the title "Interpreter Services." This is a one-way communication and replies to this message will not be answered. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090203/23cd29ef/attachment.html From provider at lists.maine.gov Wed Feb 4 12:42:28 2009 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 4 Feb 2009 12:42:28 -0500 Subject: [Provider] Update on Emergency Hospital Rule Regarding Physician Reimbursement Message-ID: ATTENTION: Hospitals that receive Prospective Interim Payments from MaineCare Last week, the Office of MaineCare Services posted via this listserv, an emergency rule regarding reimbursements to hospital-based physicians. The proposed rule that was posted is inaccurate - the change in reimbursement should apply only to non-emergency, hospital-based outpatient physician services. Soon, an emergency rule will be drafted to correct what was proposed. We apologize for any confusion this may have caused. This is a one-way communication and replies to this message will not be answered. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090204/44d763ac/attachment.html From provider at lists.maine.gov Wed Feb 4 15:54:07 2009 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 4 Feb 2009 15:54:07 -0500 Subject: [Provider] New Issue of MaineCare Matters Message-ID: ATTENTION: All MaineCare Providers A new issue of MaineCare Matters has been posted to the MaineCare web site. This can be found at http://www.maine.gov/dhhs/bms/member/innerthird/mainecare_matters.html This is a one-way communication and responses to this message will not receive an answer. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090204/6f3fd063/attachment.html From provider at lists.maine.gov Thu Feb 5 10:14:33 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 5 Feb 2009 10:14:33 -0500 Subject: [Provider] MIHMS Provider Forum Posted Message-ID: ATTENTION: All MaineCare Providers The PowerPoint presentation from this morning's MIHMS Provider Forum has been posted to the MaineCare web site. This can be found at http://www.maine.gov/dhhs/bms/fiscal_agent_project_index.html The March Forum is scheduled for Monday, March 9th at 1:00 in Florian Hall, Central Maine Commerce Center in Augusta. This is a one-way communication and replies to this message will not receive a response. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090205/43a6c6f2/attachment.html From provider at lists.maine.gov Mon Feb 9 16:05:55 2009 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 9 Feb 2009 16:05:55 -0500 Subject: [Provider] DME Rate Changes and Suppler Resources Message-ID: ATTENTION: MaineCare Providers who offer certain Ostomy, Wound Care, and Durable Medical Equipment MaineCare has awarded Gulf South Medical, Inc. a contract to offer lower prices for some Ostomy and wound care supplies as well as certain durable medical equipment. (See list at http://www.maine.gov/dhhs/bms/member/innerthird/mecms_portal_news.html#d me ). The contract is not exclusive. Dealers may purchase these items elsewhere. However, the rates offered by Gulf South will be MaineCare's maximum allowed amount starting March 1, 2009. Nursing Facilities please note that procedure codes beginning with "E" are not billable as they are included in the daily rate. Procedure codes that begin with "A" are billable. There are no additional shipping charges for shipments to dealers from Gulf South, for items included in the contract. Gulf South charges $6.95 for shipment to a patient's home, no matter what size the package. MaineCare does not pay separate shipping charges. Frequently Asked Questions have also been published on the MaineCare web site, at the link above. In the meantime, if you have questions, feel free to contact Jennifer Cook Pharmacy Unit Manager (207)287-2705 or by email Jennifer.Cook at Maine.gov. Your Gulf South representative is Jen Rancourt. She may be reached by email: JRancourt at gsms.com, Voicemail: 1-800-532-4035 ext 1995 or Cell: 207-754-7165. This is a one-way communication and replies to this message will not be answered. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090209/1a9767c3/attachment.html From provider at lists.maine.gov Mon Feb 9 16:57:27 2009 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 9 Feb 2009 16:57:27 -0500 Subject: [Provider] Nursing Facility Cost of Care Adjustments Message-ID: ATTENTION: All MaineCare Nursing Facility Providers On November 17, 2008 MaineCare deployed a patch to MeCMS to correct the problem of Cost of Care amounts not being properly assessed on type 12 (Nursing Home) claims. This patch corrected the faulty edit logic, and Cost of Care is now being processed correctly for both PNMI and Nursing Facility claims. 16,700 type 12 claims have been identified, which were processed without applying cost of care. MaineCare processed these claims between October 14th and November 17th 2008. These claims will now be re-processed beginning February 23rd, 2009. These claims will be manually re-processed as adjustments. Providers will see the cost of care taken out that was not taken out on the original claim. The Remittance Advice (RA) will reflect an adjustment with an adjustment source of "State Initiated". MaineCare will not manually re-process any claims that have already been submitted for adjustment by the provider. 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/20090209/d786f375/attachment.html From provider at lists.maine.gov Fri Feb 13 13:38:37 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 13 Feb 2009 13:38:37 -0500 Subject: [Provider] Out of State Care Message-ID: ATTENTION: MaineCare Providers who refer patients out-of-state and Out of State MaineCare Providers Starting December 1, 2008, Schaller Anderson began to handle certain Prior Authorizations (PA) for MaineCare members receiving out-of-state medical care. MaineCare members should be sent out of state only if the care they need is not available in Maine. Keeping care in Maine helps the patient stay closer to family and friends. It also is good for our in-state economy. Listed below are types of care and the process for out-of-state care. Adults' and Children's Medical Care Unless it is a medical emergency, all out-of-state medical care needs MaineCare's Prior Authorization. Schaller Anderson, MaineCare's agent for out-of-state prior authorization, handles * outpatient services, and * inpatient admissions, including acute and rehabilitation facilities. You may contact Schaller Anderson Medical Administrators, Inc, Prior Authorization Unit, toll free at 1-866-543-2387. You may FAX Prior Authorization requests to 1-877-861-2615. Provider instructions are available online at Prior Authorization web page Emergency Medical Care Emergency medical care does not require a Prior Authorization. If a MaineCare member has a medical emergency and is admitted as an inpatient to a hospital, we ask that the hospital notify Schaller Anderson within 1 business day. Schaller Anderson will then work with the hospital and patient to manage the stay and ensure a smooth transition to the patient's Maine-based care providers. You may FAX notification to 1-877-861-2615. Children's Behavioral Health Services When you want to refer a child to an out-of-state hospital for behavioral health services, call the statewide crisis line at 1-888-568-1112. This will connect you to a Crisis Resolution Provider, and start the Prior Authorization process. All out-of-state hospital care needs CBHS's approval. Adult Emergency Behavioral Health Services For adults who have MaineCare and are admitted for emergency behavioral health services out-of-state, contact MaineCare's Prior Authorization Unit at 1-800-321-5557 Option #5 and by FAX at 207-287-7643. Other Services For other medically necessary out-of-state services not described above, please contact MaineCare's Prior Authorization Unit at 1-800-321-5557 Option #5. Reminder: There is no change for New Hampshire providers within 15 miles of the ME/NH border or Canadian providers within 5 miles of the ME/Canadian border (also known as REID providers). These providers are not treated as out-of-state providers. Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090213/a5408a9a/attachment.html From provider at lists.maine.gov Fri Feb 13 16:30:34 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 13 Feb 2009 16:30:34 -0500 Subject: [Provider] Corrected link for Out Of State Care list serve Message-ID: Earlier this afternoon, an e-mail was sent regarding out of state care. The message included a hyperlink that is not correct. Here is the correct link to the Prior Authorization Web Page . We apologize for any inconvenience. Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. 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/20090213/1251a6b4/attachment.html From provider at lists.maine.gov Fri Feb 20 12:36:41 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Feb 2009 12:36:41 -0500 Subject: [Provider] OES Central Office move Message-ID: ATTENTION: MaineCare Providers who use the Office of Elder Services The Office of Elder Services' Central Office will be moving to a new location Monday, February 23. Telephones and fax machines will not be working from Friday, February 20 at 5:00 pm until Tuesday, February 24 at 8:00 am. Please note: The PNMI Portal and NF Portals can still be accessed during that time. _______________________________________________________________ Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090220/2e022c89/attachment.html From provider at lists.maine.gov Fri Feb 20 12:46:18 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Feb 2009 12:46:18 -0500 Subject: [Provider] Billing for Hospital-Based Physicians Message-ID: To: Hospital CEOs, CFOs and Patient Account Managers From: Tony Marple, Director of MaineCare, DHHS Re: Billing for Hospital-Based Physicians MaineCare rules have changed in response to the Maine supplemental budget, PL1 (2009). The supplemental budget states: Sec. V-1. Hospital-based physician reimbursement; rules. Effective February 1, 2009, the Department of Health and Human Services shall amend the rules regarding reimbursement under the MaineCare program for hospital-based physician services to provide for reimbursement at a rate as close to 70% of the Medicare reimbursement rate as the department determines can be funded with the resources used for physician reimbursement in the Medical Care - Payments to Providers General Fund account, as adjusted by this Act. Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A. Certain hospital outpatient services are now required to be paid on a fee schedule rather than on a cost basis. Outpatient services include office and clinic-based services, ambulatory surgery, and ambulatory procedures. Services in the emergency room are not outpatient for this purpose. The rule affects all physicians, physician assistants, nurse practitioners, and nurse anesthetists providing services billed by the hospital. It applies whether those professionals are hospital employees or contract workers. To comply with the rule, you must proceed with the following steps. 1. Enroll as MaineCare servicing providers all physicians, physician assistants, nurse practitioners, and nurse anesthetists who provide any outpatient services. Emergency room physicians are excluded from this requirement. 2. Bill MaineCare for the outpatient services of those professionals on professional (CMS1500) rather than institutional (UB92/UB04) claim forms. 3. Enroll these professionals as soon as possible and no later than July 1, 2009. You may begin to submit professional CMS1500 claims as soon as the professionals have been enrolled. 4. You must bill for outpatient services for the professions listed above via professional claims. Inpatient and emergency department services of those professionals can be billed on either type of claim form. Professional claims, inpatient or outpatient, will be paid via check or funds transfer at the time of claim adjudication. Institutional claims will continue to be paid via PIP payments. The amount included in the PIP payments for outpatient physician costs will be decreased to 46.21% during the last five months of the fiscal year. This is to convert the fee table to a percentage of cost for this time period, while allowing hospitals time to enroll their physicians. All inpatient and emergency department claims for professional services will continue to be cost settled, whether submitted via institutional or professional claims. Any payments for non-outpatient 1500 bills will be subtracted from cost settlements. We recognize the complexity of this change. If you have questions, please contact Cheryl Rood at Cheryl.Rood at maine.gov or 287-5735. ________________________________________________________________ Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090220/49098c6a/attachment.html From provider at lists.maine.gov Fri Feb 20 13:08:43 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Feb 2009 13:08:43 -0500 Subject: [Provider] Recall: Billing for Hospital-Based Physicians Message-ID: Riddell, Linda would like to recall the message, "Billing for Hospital-Based Physicians ". -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090220/444e0978/attachment.html From provider at lists.maine.gov Fri Feb 20 14:17:55 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Feb 2009 14:17:55 -0500 Subject: [Provider] Corrected Version: Billing for Hospital-Based Physicians Message-ID: (You may discard the earlier e-mail. We apologize for any confusion.) To: Hospital CEOs, CFOs and Patient Account Managers From: Tony Marple, Director of MaineCare, DHHS Re: Billing for Hospital-Based Physicians MaineCare rules have changed in response to the Maine supplemental budget, PL1 (2009). The supplemental budget states: Sec. V-1. Hospital-based physician reimbursement; rules. Effective February 1, 2009, the Department of Health and Human Services shall amend the rules regarding reimbursement under the MaineCare program for hospital-based physician services to provide for reimbursement at a rate as close to 70% of the Medicare reimbursement rate as the department determines can be funded with the resources used for physician reimbursement in the Medical Care - Payments to Providers General Fund account, as adjusted by this Act. Rules adopted pursuant to this section are routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A. Accordingly, certain hospital outpatient services are now required to be paid on a fee schedule rather than on a cost basis. Outpatient services include office and clinic-based services, ambulatory surgery, ambulatory procedures and diagnostic readings. Services in the emergency room are not outpatient for this purpose. The rule affects all physicians, physician assistants, nurse practitioners, and nurse anesthetists providing services billed by the hospital. It applies whether those professionals are hospital employees or contract workers. To comply with the rule, you must proceed with the following steps. 1. Enroll as MaineCare servicing providers all physicians, physician assistants, nurse practitioners, and nurse anesthetists who provide any outpatient services. Emergency room physicians are excluded from this requirement. 2. Bill MaineCare for the outpatient services of those professionals on professional (CMS1500) rather than institutional (UB92/UB04) claim forms. 3. Enroll these professionals as soon as possible and no later than July 1, 2009. You may begin to submit professional CMS1500 claims as soon as the professionals have been enrolled. 4. You must bill for outpatient services for the professions listed above via professional claims. Inpatient and emergency department services of those professionals can be billed on either type of claim form. Professional claims, inpatient or outpatient, will be paid via check or funds transfer at the time of claim adjudication. Institutional claims will continue to be paid via PIP payments. The amount included in the PIP payments for outpatient physician costs will be decreased to 46.21% during the last five months of the fiscal year. This is to convert the fee table to a percentage of cost for this time period, while allowing hospitals time to enroll their physicians. All inpatient and emergency department claims for professional services will continue to be cost settled, whether submitted via institutional or professional claims. Any payments for non-outpatient 1500 bills will be subtracted from cost settlements. We recognize the complexity of this change. If you have questions, please contact Cheryl Rood at Cheryl.Rood at maine.gov or 287-5735. ________________________________________________________________ Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090220/40dc67df/attachment.html From provider at lists.maine.gov Fri Feb 27 11:46:55 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 27 Feb 2009 11:46:55 -0500 Subject: [Provider] Emergency Rule Proposal: Section 45, Hospital Services Message-ID: An emergency rule, MaineCare Benefits Manual, Chapter III Section 45 Hospital Services, was adopted February 1, 2009 and was repealed on February 21, 2009. A new emergency rule replaced it effective February 21, 2009. This is notice of the new emergency rule. The U.S. Centers for Medicare and Medicaid Services' (CMS) approval is required before this rule can be permanently adopted. AGENCY: Department of Health and Human Services, Office of MaineCare Services CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 45, Hospital Service ADOPTED RULE NUMBER: CONCISE SUMMARY: The Fiscal Year 2009 Emergency Supplemental Budget, deappropriated funds to reduce MaineCare reimbursement for hospital-based physician services to provide for a rate as close to 70% of the Medicare reimbursement rate as the Department determines can be funded with the resources used for physician reimbursement, as adjusted by the Supplemental Budget, which reduced the reimbursement by $1,947,490 state dollars, effective February 1, 2009. P.L. 2009, ch. 1. On February 1, 2009, the Department adopted emergency rules which reduced reimbursement for both hospital-based inpatient and outpatient physicians. Since February 1, 2009, the Department has determined that the February 1st emergency rule must be repealed because upon further review, the Department determined that it would be less administratively burdensome on hospitals to limit the impact to non-emergency hospital-based outpatient physician services only, rather than to all hospital-based physicians, within the required savings of $1,947,490 state dollars. Accordingly, the Department is repealing the February 1, 2009 emergency rules and will be adopting, simultaneously, these emergency rules, which are being adopted effective February 21, 2009. Hence, in accordance with P.L. 2009, ch. 1, the Department is adopting these emergency regulations, with an effective date of February 21, 2009, which will reduce reimbursement for hospital-based physician services as follows: non-emergency hospital-based outpatient physician rates at acute care non-critical access hospitals, acute care critical access hospitals and hospitals reclassified to a wage area outside Maine, will be reduced to 46.21% of non-emergency hospital-based outpatient physician costs. The rate of 46.21% is the closest to 70% of the Medicare reimbursement rate that the Department could fund with the resources used for physician reimbursement, as adjusted by the Supplemental Budget, which reduced the reimbursement by $1,947,490 of state dollars. Prospective Interim Payments (PIPs) will be lowered in an amount corresponding to the anticipated non-emergency hospital-based outpatient physician payment reductions. See http://www.maine.gov/bms/rules/provider_rules_policies.htm for rules and related rulemaking documents. EFFECTIVE DATE: February 21, 2009 AGENCY CONTACT PERSON: Bob Kohl, Health Planner AGENCY NAME: Division of Policy and Performance ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-6124 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) _______________________________________________________________________ Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription Page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090227/9e6f4f18/attachment.html From provider at lists.maine.gov Fri Feb 27 11:55:11 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 27 Feb 2009 11:55:11 -0500 Subject: [Provider] MaineCare Matters Message-ID: ATTENTION: All MaineCare Providers A new edition of MaineCare Matters is attached for your use. In addition to routine billing news and tips, this issue also carries information related to the PERM Audit and the proposed monthly billing for nursing facilities. This issue will be posted to the MaineCare Services website on Monday. Is your mailing address up to date with MaineCare? Please keep MaineCare up to date so your Remittance Statements and checks arrive on time. Call Provider Enrollment at 1-800-321-5557 Option #6. If you would rather not get these e-mails, visit MaineCare's List Serve Subscription < http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml> page to unsubscribe. This is a one-way communication. Do not reply to this e-mail. Your e-mail will not receive response. If you have questions, please call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090227/21c6feb8/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: MaineCare Matters February 2009.doc Type: application/msword Size: 104448 bytes Desc: MaineCare Matters February 2009.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20090227/21c6feb8/MaineCareMattersFebruary2009.doc