From provider at lists.maine.gov Tue Jan 6 13:43:15 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 6 Jan 2009 13:43:15 -0500 Subject: [Provider] Proposed Rules Sections 21 and 29 Message-ID: ATTENTION: MaineCare Providers of Section 21 and Section 29 services This is notice of a proposed rule for Chapters II and III of Section 21, and Chapters II and II of Section 29 of the MaineCare Benefits Manual. This is a major substantive rule for home and community support benefits for members with mental retardation or autistic disorder. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapter II, Section 21, Home and Community Support Benefits for Members with Mental Retardation or Autistic Disorder CONCISE SUMMARY: The proposed rule reduces rates for Home Support. Also, rates for the Medical Add On for Community Support, Employment Specialist Services and Work Support are being reduced. Additionally, this rule creates an additional level of support for Home Support Shared Living, and Home Support Family Centered Support Model. Also, the Behavioral Add On is being removed from all services. Lastly, Intensive Family Centered Support is being eliminated as a type of Home Support. PUBLIC HEARING: Date: January 26, 2009, 1:00-3:00 PM Location: Conference Room # 1A Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME DEADLINE FOR COMMENTS: Comments must be received by midnight, February 5, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner AGENCY NAME: Office of MaineCare Services 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) ________________________________________________________________________ _____ _ RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapter III, Section 21, Home and Community Support Benefits for Members with Mental Retardation or Autistic Disorder CONCISE SUMMARY: The proposed rule reduces rates for Home Support. Also, rates for the Medical Add On for Community Support, Employment Specialist Services and Work Support are being reduced. Additionally, this rule creates an additional level of support for Home Support Shared Living, and Home Support Family Centered Support Model. Also, the Behavioral Add On is being removed from all services. Lastly, Intensive Family Centered Support is being eliminated as a type of Home Support. PUBLIC HEARING: Date: January 26, 2009, 1:00-3:00 PM Location: Conference Room # 1A Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME Any interested party requiring special arrangements to attend the hearing must contact the agency person listed below before January 19, 2008. DEADLINE FOR COMMENTS: Comments must be received by midnight, February 5, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner AGENCY NAME: Office of MaineCare Services 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) ________________________________________________________________________ _____ _ RULE TITLE OR SUBJECT: MaineCare Benefits Manual, Chapters II & III, Section 29, Community Support Benefits for Members with Mental Retardation and Autistic Disorders CONCISE SUMMARY: The proposed rule eliminates the Behavioral Add On and reduces the rate of the Medical Add On. PUBLIC HEARING: Date: January 26, 2009, 1:00 -3:00 PM Location: Conference Room # 1A Department of Health and Human Services Office of MaineCare Services 442 Civic Center Drive Augusta, ME DEADLINE FOR COMMENTS: Comments must be received by midnight February 5, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner AGENCY NAME: Office of MaineCare Services 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) 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 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/20090106/8c0c958d/attachment.html From provider at lists.maine.gov Tue Jan 6 13:56:52 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 6 Jan 2009 13:56:52 -0500 Subject: [Provider] Adopted Rules: Sections 21 and 29 Home and Community Support Benefits for Members with MR or Autistic Disorder Message-ID: ATTENTION: MaineCare Providers of Sections 21 and 29 services This message is to give notice that rules have been adopted for Chapters II and III Section 21, Chapters II and III of Section 29. Adopted rules are final and no changes can be made at this point. CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter II, Section 21, Home and Community Benefits for members with Mental Retardation or Autistic Disorder CONCISE SUMMARY: The adopted emergency rules reduce rates for Home Support. Also, rates for the Medical Add On for Community Support, Employment Specialist Services and Work Support are being reduced. Additionally, this rule creates an additional level of support for Home Support Shared Living, and Home Support Family Centered Support Model. Also, the Behavioral Add On has been removed from all services. Lastly, Intensive Family Centered Support has been eliminated as a type of Home Support. EFFECTIVE DATE: January 1, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner AGENCY NAME: Division of Policy and Performance Services 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/Hard of Hearing) CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 21, Home and Community Benefits for members with Mental Retardation or Autistic Disorder CONCISE SUMMARY: The adopted emergency rules reduce rates for Home Support. Also, rates for the Medical Add On for Community Support, Employment Specialist Services and Work Support are being reduced. Additionally, this rule creates an additional level of support for Home Support Shared Living, and Home Support Family Centered Support Model. Also, the Behavioral Add On has been removed from all services. Lastly, Intensive Family Centered Support has been eliminated as a type of Home Support. Members currently receiving Intensive Family Centered Support will continue to receive increased Family Centered Support with the new regulations until the Department makes a determination under the criteria set forth in Section 21, Chapter II, 21.14 Appendix I. EFFECTIVE DATE: January 1, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner AGENCY NAME: Division of Policy and Performance Services 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/Hard of Hearing) CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapters II & III, Section 29, Community Support Benefits for members with Mental Retardation and Autistic Disorder CONCISE SUMMARY: The adopted rule eliminates the Behavioral Add On and reduces the rate of the Medical Add On. EFFECTIVE DATE: January 1, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner AGENCY NAME: Division of Policy and Performance Services 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/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 call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090106/cfb51dad/attachment.html From provider at lists.maine.gov Tue Jan 6 14:06:00 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 6 Jan 2009 14:06:00 -0500 Subject: [Provider] Adopted Rule: Section 90, Physician Services Message-ID: ATTENTION: MaineCare Providers of Section 90 services This message is to give notice that rules have been adopted for Chapter II Section 90, Physician's Services. Adopted rules are final and no changes can be made at this point. CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter 101, Ch II, Section 90, Physician's Services CONCISE SUMMARY: Pursuant to 5 M.R.S.A. Sec 8054, effective December 29, 2008, the Department is increasing the MaineCare reimbursement rate for non-hospital based physician services from 53% to 56.94% retroactive to July 1, 2008. This increase will not include reimbursement for procedures performed by radiologists, radiation oncologists, and pathologists, who currently receive a higher rate of reimbursement. No procedure codes are decreased as a result of this rulemaking. Furthermore, this increase does not apply to other sections of policy within the MaineCare Benefits Manual, Chapter 101. This emergency rule will remain in effect for 90 days while the Department promulgates rules to permanently adopt this rate change. EFFECTIVE DATE: December 29, 2008 AGENCY CONTACT PERSON: Nicole Rooney, Health Planner AGENCY NAME: Division of Policy ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-4460 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 call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090106/7aeccdcd/attachment.html From provider at lists.maine.gov Tue Jan 6 14:02:02 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 6 Jan 2009 14:02:02 -0500 Subject: [Provider] Adopted Rule: Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities Message-ID: ATTENTION: MaineCare Providers of Section 19 services This message is to give notice that rules have been adopted for Chapter III, Section 19 Home and Community Benefits for the Elderly and Adults with Disabilities. Adopted rules are final and no changes can be made at this point. CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 19, Home and Community Benefits for the Elderly and Adults with Disabilities CONCISE SUMMARY: This emergency rule adopts a rate reduction for the comprehensive care management service listed under this section. Specifically, the rate is being reduced to $126.50 per month from $139.00 per month. This is written in the approved budget curtailment which expects to save $62,600 in the General Fund in SFY 09 as a result of this rate change. This rule making is not expected to impose administrative costs on small businesses, counties or municipalities. EFFECTIVE DATE: January 1, 2009 - March 31, 2009 AGENCY CONTACT PERSON: Alyssa Morrison, Health Planner AGENCY NAME: Division of Policy ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-9368 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 call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090106/abcf6891/attachment.html From provider at lists.maine.gov Tue Jan 6 14:20:52 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 6 Jan 2009 14:20:52 -0500 Subject: [Provider] Adopted Rule for Section 67, Nursing Facilities Message-ID: ATTENTION: MaineCare Providers of Section 67 services This message is to give notice that rules have been adopted for Chapter III Section 67, Principles of Reimbursement for Nursing Facilities. Adopted rules are final and no changes can be made at this point. CHAPTER NUMBER AND TITLE: MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities CONCISE SUMMARY: In this emergency rule making, the Department is implementing changes in the rate methodology as well as providing an additional one time payment for the quarter between October 1, 2008 and December 31, 2008. Specifically, the rate methodology alters the base year from 1998 to 2005. The rule also establishes a new prospective per diem rate by adding a direct care regional cost component and a hold harmless provision to the rule. Other changes are made in this rulemaking that include changes in medical director costs and waiver of administrator costs that are included under the management ceiling. The Department has budgeted $9,388,889 (federal and state funds) for FY '09 for this rate methodology change. This amount is derived out of the original $16,353,230 appropriated by the State Legislature, Public Law 2007, Ch. 240, Pt. A., after other budgetary changes were made. EFFECTIVE DATE: December 16, 2008 - March 15, 2009 AGENCY CONTACT PERSON: Alyssa Morrison, Health Planner AGENCY NAME: Division of Policy and Performance ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-9368 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 call 1-800-321-5557. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090106/5c93d3d0/attachment.html From provider at lists.maine.gov Wed Jan 7 16:21:39 2009 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 7 Jan 2009 16:21:39 -0500 Subject: [Provider] Reminder for MIHMS Provider Forum #3 Message-ID: ATTENTION: MaineCare Providers Planning to Attend the MIHMS Provider Forum #3 Please note that the MIHMS Provider Forum previously scheduled for Thursday, January 8 has been moved to Monday, January 12th. This Forum will be held from 1:00 to 4:00 pm in Florian Hall at the Central Maine Commerce Center in Augusta. The agenda for this forum will include: * Current Status - Provider Re-enrollment * Provider Re-enrollment schedule, including a Training overview * Trading Partner Agreement (includes clearinghouses and billing services) * National Provider Identification * Provider questions You may also participate in this Forum via Live Meeting. The connection information for this is here: Click to Join Live Meeting Charmaine Hodge has invited you to attend an online meeting using Microsoft Office Live Meeting. https://www.livemeeting.com/cc/unisys/join?id=6DMJQ3&role=attend&pw=K%3F %5Dk.4k Call-in Information: 1-800-394-6604, Passcode 934057 FIRST-TIME USERS To save time before the meeting, check your system to make sure it is ready to use Microsoft Office Live Meeting. http://go.microsoft.com/fwlink/?LinkId=90703 TROUBLESHOOTING Unable to join the meeting? Follow these steps: 1. Copy this address and paste it into your web browser: https://www.livemeeting.com/cc/unisys/join 2. Copy and paste the required information: Meeting ID: 6DMJQ3 Entry Code: K?]k.4k Location: https://www.livemeeting.com/cc/unisys If you still cannot enter the meeting, contact support: http://r.office.microsoft.com/r/rlidLiveMeeting?p1=12&p2=en_US&p3=LMInfo &p4=support NOTICE Microsoft Office Live Meeting can be used to record meetings. By participating in this meeting, you agree that your communications may be monitored or recorded at any time during the meeting. -------------- next part -------------- An HTML attachment was scrubbed... URL: http://mailman.informe.org/pipermail/provider/attachments/20090107/af692aa5/attachment.html From provider at lists.maine.gov Mon Jan 12 12:21:54 2009 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 12 Jan 2009 12:21:54 -0500 Subject: [Provider] Ostomy supplies and certain durable medical equipment References: Message-ID: ATTENTION: MaineCare Providers who handle Ostomy Supplies and Certain Medical Equipment After a competitive bid, MaineCare has awarded Gulf South Medical Inc. an exclusive contract to supply the codes listed below. Any of the below-listed supplies must be ordered through Gulf South starting March 1, 2009. A representative from Gulf South will contact you to set up your MaineCare account. If you have questions you may contact Jennifer Cook, Pharmacy Unit Manager, Office of MaineCare Services by phone (207)287-2705 or by email Jennifer.Cook at Maine.gov. Thank you for helping to deliver cost effective medical supplies and equipment to Maine Care members. Procedure Code Short Description Old Rate New Rate w/ 40% mark-up w/ 40% mark-up A4365 Adhesive remover wipes $ 9.62 $ 4.00 A4385 Ost skn barrier sld ext wear $ 63.00 $ 62.21 A4389 Drainable pch w st wear barr $ 52.90 $ 51.28 A4413 2 pc drainable ost pouch $ 46.80 $ 34.45 A5061 Pouch drainable w barrier at $ 46.90 $ 46.38 A5120 SKIN BARRIER, WIPE OR SWAB $ 26.82 $ 12.21 A6021 Collagen dressing <=16 sq in $ 178.70 $ 110.03 A6196 Alginate dressing <=16 sq in $ 62.50 $ 52.57 A6210 Foam drg >16<=48 sq in w/o b $ 169.30 $ 102.73 A6212 Foam drg <=16 sq in w/border $ 82.50 $ 73.02 A6235 Hydrocolld drg >16<=48 w/o b $ 143.00 $ 124.57 A6238 Hydrocolld drg >16<=48 w/bdr $ 96.85 $ 50.72 A6240 Hydrocolld drg filler paste $ 10.40 $ 7.97 A6244 Hydrogel drg >48 in w/o bdr $ 333.90 $ 323.67 A6245 Hydrogel drg <= 16 in w/bdr $ 30.90 $ 29.20 A6246 Hydrogel drg >16<=48 in w/b $ 84.30 $ 63.33 A6247 Hydrogel drg > 48 sq in w/b $ 20.21 $ 10.53 E0100 Cane adjust/fixed with tip $ 20.19 $ 7.64 E0135 Walker folding adjust/fixed $ 83.43 $ 40.93 E0163 Commode chair stationry fxd $ 93.28 $ 36.17 E0240 BATH/SHOWER CHAIR W/WO WHEELS ANY SIZE $ 77.45 $ 19.22 E0244 Toilet seat raised $ 53.11 $ 32.19 E0245 Tub stool or bench $ 119.56 $ 55.78 A4368 Filter Replacement $ N/A $ 58.95 The ?New Rates w/40% mark-up? are MaineCare?s new maximum allowed amount for these codes effective March 1 2009. 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/20090112/235c7765/attachment.html From provider at lists.maine.gov Mon Jan 26 15:42:23 2009 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 26 Jan 2009 15:42:23 -0500 Subject: [Provider] Nursing Facility Mid-Month Rate change Message-ID: ATTENTION: MaineCare Nursing Facilities The emergency rules for the Nursing Facility rebasing went into effect on 12/16/2008. As a result, Nursing Facility rates also changed on that date. Nursing Facilities that bill monthly will have to split bill for the month of December 2008, using one rate through 12/15 and another from 12/16 forward. Nursing Facilities that billed for the entire month of December 2008 may see their claims deny. The Remittance Advice will show under the "Adjustment" column, code "147-Provider contracted/negotiated rate expired or not on file". If this happens, please re-bill separate clams for December 1st through the 15th and December 16th through the 31st. If you have questions, feel free to contact MaineCare Billing and Information at 1-800-321-5557 Option #8. Is your mailing address up-to-date with MaineCare Services? 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/20090126/bdda832a/attachment.html From provider at lists.maine.gov Tue Jan 27 11:52:15 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 27 Jan 2009 11:52:15 -0500 Subject: [Provider] Who DHSTech1 Message-ID: Who DHSTech1 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/20090127/f9159eae/attachment.html From provider at lists.maine.gov Tue Jan 27 15:50:29 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 27 Jan 2009 15:50:29 -0500 Subject: [Provider] Technical Error Message-ID: We apologize for the list serve message sent in error earlier today. In working on the subscription list, this message got sent to the wrong address. Thank you for your patience. ________________________________________________________________________ _____________________ 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/20090127/944792a3/attachment.html From provider at lists.maine.gov Fri Jan 30 12:46:19 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 30 Jan 2009 12:46:19 -0500 Subject: [Provider] Payment Method for Hospital-Based Physicians Message-ID: ATTENTION: Hospitals that receive Prospective Interim Payments (PIPs) from MaineCare The recently enacted State Supplemental Budget (for fiscal year ending June 30, 2009), changes MaineCare's payment method for hospital-based physicians. Effective February 1, 2009 MaineCare will pay hospital-based physicians a percentage of cost that equates to 70% of the 2008 Medicare fee. Beginning July 1, the CMS1500 claim form will be required for hospital-based physicians and other professionals. A new CMS rule requires this change. These professionals (see list below) will need to enroll as MaineCare Servicing/Rendering providers, and to bill for services on the CMS1500 claim form. To accomplish these changes an emergency rule will be effective February 1, 2009. A new rule will then be proposed to require the use of the CMS 1500 form effective July 1, 2009. Enrolling Servicing Providers Enrolling your Servicing Providers is a big project for you and your staff, as it is for MaineCare. MaineCare encourages you to get a head start. You can start enrolling Servicing Providers now and avoid holding back claims or re-doing claims later. (Note: This enrollment will be for the current claims management system; enrollment for the new system will occur later in 2009.) If you would like to start enrolling your professionals or have questions, please contact Cheryl Rood at 287-5735. List of hospital-based professionals who will need to enroll as MaineCare Servicing Providers * All hospital-based physicians who are MDs or DOs, including hospitalists, emergency department physicians, locum tenens physicians, radiologists, pathologists, anesthesiologists, etc. * psychiatrists * advance practice registered nurses, * certified registered nurse anesthetists, * licensed certified midwives, * physician assistants. Implementation of the Payment Change To pay for physician services on a fee schedule, your hospital-based professionals need to enroll as MaineCare Servicing Providers and bill claims for those services on a CMS1500 form. To allow time for these changes to occur, an interim approach will be followed: February 1, 2009 through June 30, 2009 During these five months, MaineCare's cost settlement will recognize a percentage of costs for physician services. Instead of using 100% of allowable costs for inpatient and emergency department physician services, MaineCare will recognize 78.51%. For outpatient services, the percentage will go from 89.7% to 70.42% of allowable costs. These percentages equate to reimbursing at 70% of Medicare rates. Your PIP will be adjusted for the change from cost-based to fee schedule reimbursement for physician services. The settlement's handling of claims paid from 1500 forms will not change. Starting July 1, 2009 MaineCare will reimburse claims at 70% of the 2008 Medicare rate. Also, all physician/professional charges must be billed on the CMS1500 forms. These claims will be excluded from your cost settlement, the same way 1500 form claims are excluded now. Your PIP may be adjusted again on July 1, since more of your billing will come from 1500 form claims. Questions? For questions about enrolling your Servicing Providers, please contact Cheryl Rood at 287-5735. For questions about your PIPs, please contact Michael Ballard at 287-4254. For general questions about billing and rates, contact your Provider Relations Specialist or MaineCare's Billing & Information line at 1-800-321-5557, Option 8. 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/20090130/97cf529a/attachment.html