From provider at lists.maine.gov Thu Jun 4 12:55:09 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 4 Jun 2009 12:55:09 -0400 Subject: [Provider] MR Waiver Providers Message-ID: ATTENTION: MR Waiver Providers MaineCare has reviewed all paid claims from July 2005 through December 2007 for procedure codes W114 and W125. We have identified all claims that were underpaid. MaineCare will reprocess these claims during the first week of June. The adjustments will appear on Remittance Advice statements approximately two weeks later. The adjustment will correct the provider rate and the service provider tax. Please note, if you have already adjusted a specific claim you will not see an adjustment through this process. If the provider owes money to MaineCare for interim payments, that amount will be subtracted from the adjustment payment. If you have questions about this message please contact Eric Spear, Claims Division @ 287-1808 or Eric.N.Spear at maine.gov. 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/20090604/147c7f1a/attachment.html From provider at lists.maine.gov Thu Jun 4 15:16:13 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 4 Jun 2009 15:16:13 -0400 Subject: [Provider] MR Waiver Providers - schedule change Message-ID: ATTENTION: MR Waiver Providers - schedule change The claims system will begin running the rate adjustments in the second week of June, not the first week as previously reported. 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/20090604/7999b045/attachment.html From provider at lists.maine.gov Tue Jun 9 16:26:58 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 9 Jun 2009 16:26:58 -0400 Subject: [Provider] FW: Adopted rules: Sections 21 (HCB for Members with MR or Autistic Disorder), 45 (Hospital services), and 97 (PNMI) Message-ID: Type of Rule: Adopted (These rules are final and no changes can be made at this point) Section 21 Home and Community Benefits for Members with Mental Retardation or Autistic Disorder Section 45, Hospital Services Section 97, and Appendices B, D, E, and F, Private Non-Medical Institution Services 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: This rule permanently adopts major substantive rules approved by the Maine State Legislature and currently in effect by emergency rule. EFFECTIVE DATE: June 8, 2009 AGENCY CONTACT PERSON: Ginger Roberts-Scott, Comprehensive Health Planner 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 and III, Section 45, Hospital Services CONCISE SUMMARY: This adopted rule adjusts hospital reimbursement methodology. Chapter III, Section 45 clarifies and revises reporting requirements and defines the MaineCare Supplemental Data Form, and clarifies that cross-over payments are made to the extent required by CMS. Chapter III also increases the supplemental pool to be distributed among non-critical access hospitals from approximately $36 to $45 million and counts 50% of the psychiatric discharges when distributing the pool; increases the pool for the critical access hospital from $2 to 3.5 million; increases the PIP cap to approximately 81%; creates a separate section for Hospitals Reclassified to a Wage Area Outside Maine by the Medicare Geographic Classification Review Board and limits reimbursement under that section to hospitals reclassified prior to the effective date of the rule; revises sections 45.03, 45.04, 45.05 and 45.06 to separate the calculation of the PIP from the calculation of the Department's obligation at settlement; establishes base discharge rates for acute care non-critical access hospitals (Franklin Memorial hospital services rate was changed due to a revision made to the base year report); and removes outdated material. Several provisions have a retroactive effective date of 10/1/08. Pursuant to 22 M.R.S.A. ?42(8), the Department is authorized to adopt rules with retroactive application when, as here, it is necessary to maximize available revenue sources, and there is no adverse financial impact on any MaineCare provider or member. These rules permanently adopt emergency rules, effective February 21, 2009, that reduce hospital-based physician reimbursement to 46.21% of costs, which is the closest to 70% of the Medicare fee schedule that the Department could fund with the resources used for physician reimbursement, as adjusted by the Supplemental Budget, which reduced reimbursement by $1,947,490 of state dollars. A percentage of costs is being used to calculate 70% of the Medicare fee schedule absent claims-based data. Prospective Interim Payments (PIP) will be lowered in an amount corresponding to the anticipated hospital-based physician payment reimbursement, which are paid separately and not paid as part of PIP. Permanent adoption of this methodology change will be contingent upon approval by the U.S. Center for Medicare and Medicaid Services (CMS). Two proposed changes were withdrawn as a result of comments and legislative action. The provision for hospitals to report professional services on a CMS 1500 form separate from facility fees was withdrawn due to a moratorium enacted by Congress. Also, the reimbursement of non-emergency room hospital-based physicians at 70% of the Medicare fee schedule was withdrawn due to contrary pending legislation in the 1st session of the 124th Legislature. Two links were updated in Chapter II, Section 45.11 and Section 45.12. This rulemaking does not adversely impact counties or municipalities, and it does not adversely impact small businesses of twenty (20) or fewer employees because the service affected by the rate reduction is not provided by small businesses. EFFECTIVE DATE: May 23, 2009 AGENCY CONTACT PERSON: Derrick Grant, Health Planner TELEPHONE: (207)-287-6124 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 97, and Appendices B, D, E, and F, Private Non-Medical Institution Services CONCISE SUMMARY: These rules permanently adopt emergency rules already in place that have recently been approved by the Maine State Legislature in LR 1883(03). The rules eliminate bedhold day reimbursement for PNMI services. Specific changes in these rules include that bedhold day codes are eliminated from Chapter III, including BQL, BRL, MRPL, RHL RHL9, RML RML2, RTSL, and PL. Some language regarding occupancy rates was also eliminated from Appendices B, D, E, and F. The Department also replaced some local codes with HIPAA-compliant standard codes that will not be implemented until further notice when the new claims system is operating. Providers will be given prior notice of the change for these billing codes. EFFECTIVE DATE: June 15, 2009 AGENCY CONTACT PERSON: Patricia Dushuttle, Manager, 287-9362 The Division of Policy posts all proposed and recently adopted rules on MaineCare's website. This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefit Manual is available on-line at the Secretary of State's website . 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/20090609/2f7836a4/attachment.html From provider at lists.maine.gov Thu Jun 11 13:17:35 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 11 Jun 2009 13:17:35 -0400 Subject: [Provider] Provider Payment Update Message-ID: ATTENTION: All MaineCare Providers Receiving Payments Through MeCMS Last week's MeCMS payment cycle included a higher than normal claims volume, due to a rate adjustment. As a result, additional time was required for claims processing. The additional time needed has resulted in a one-day delay for payments. EFT payments will begin to be received on Friday this week and check payments will be mailed on Tuesday of next week. We apologize for any inconvenience this may cause. 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/20090611/7221fa84/attachment.html From provider at lists.maine.gov Thu Jun 11 15:33:44 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 11 Jun 2009 15:33:44 -0400 Subject: [Provider] Emergency Rule - Nursing Facilities Message-ID: ATTENTION: Nursing Facilities billing under MaineCare Benefits Manual Section 67 This emergency rule was just filed: CHAPTER NUMBER AND TITLE: Chapter 101, 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 one-time payment methodology. Since March 15, 2009, the Centers for Medicare and Medicaid Services (CMS) has informed the Department that its state plan must be modified to clarify the one time supplemental payment. Specifically, the dates of service on which the payment will be based will begin January 1, 2009 instead of July 1, 2008. In addition, the Department was required to add more specific language that describes the methodology that will be used for the calculation of the one-time payment. These emergency rules will be in effect for ninety (90) days. EFFECTIVE DATE: June 11, 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) ________________________________________________________________________ ______ The Division of Policy posts all proposed and recently adopted rules on MaineCare's website. This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefit Manual is available on-line at the Secretary of State's website . 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/20090611/3b3c5c77/attachment.html From provider at lists.maine.gov Mon Jun 15 15:56:41 2009 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 15 Jun 2009 15:56:41 -0400 Subject: [Provider] Update on the Maine Integrated Health Management Solution (MIHMS) Project Message-ID: ATTENTION: All MaineCare Providers The June Provider Forum presentation for the Maine Integrated Health Management Solution (MIHMS) has been posted to the MaineCare web site and can be found at http://www.maine.gov/dhhs/oms/fiscal_agent_project_index.html Training sessions for provider re-enrollment began today, Monday, June 15. These will be conducted state-wide throughout the summer and are for learning to re-enroll using the MIHMS provider portal. These are not actual re-enrollment sessions. Testing continues of the MIHMS provider portal and it is not yet available. Once the portal is available, re-enrollment can begin and will take place in cycles. Providers will receive written notice of its availability and invitations to re-enroll with specific dates for their cycle. Re-enrollment cannot be accessed through the current MaineCare web site. However, information needed to prepare for re-enrollment can be found on the MaineCare web site, at the link above. For more information on the MIHMS provider portal, please go to http://www.maine.gov/dhhs/oms/member/innerthird/fa_mihms_reenroll.html and click on the "Update for MIHMS Provider Portal." Providers should note that changes to their information should continue to be made for MeCMS until MIHMS is fully operational in 2010. For MeCMS prior to MIHMS operations, providers should continue to make these changes with the MaineCare provider enrollment unit as they have in the past. Information for this is found on the MaineCare web site at http://www.maine.gov/dhhs/oms/providerfiles/provider_enrollment.html or by calling 1-800-321-5557, Option 6 or (207) 287-4082. For MIHMS, providers will be able to make updates to their information through the provider portal. This functionality will be available following the re-enrollment cycles, before MIHMS go-live in 2010. Questions on the MIHMS project can be emailed to MaineCare2010.DHHS at maine.gov 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/20090615/c2ae8554/attachment.html From provider at lists.maine.gov Wed Jun 17 07:39:04 2009 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 17 Jun 2009 07:39:04 -0400 Subject: [Provider] Provider Payment Update Message-ID: ATTENTION: All MaineCare Providers receiving payments through MeCMS Once again, this week's MeCMS payment cycle included a higher than normal claims volume, due to rate adjustments. As a result, additional time was required for claims processing. The additional time needed has resulted in a delay for payments. EFT payments will begin to be received on Friday this week (June 19th) and check payments and RA's will be mailed on Wednesday (June 24th) of next week. We apologize for any inconvenience this may cause. 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/20090617/26d28d5c/attachment.html From provider at lists.maine.gov Thu Jun 18 08:31:26 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 18 Jun 2009 08:31:26 -0400 Subject: [Provider] APS Healthcare Announcement for Nursing Home Providers and Referral Sources Message-ID: ATTENTION: MaineCare Providers of Nursing Home Services and Providers Who Refer MaineCare Members to Nursing Homes Effective 7/1/09, APS Healthcare will conduct the PASRR-MI process for all adults being admitted to nursing facilities. Please see the attached announcement for details. Questions related to this change can be directed to Kelly Bickmore, APS Healthcare Operations Director at 1-866-521-0027 or kbickmore at apshealthcare.com 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/20090618/e2437936/attachment.html -------------- next part -------------- A non-text attachment was scrubbed... Name: APS-PASRR Announcement for 7-1-09.doc Type: application/msword Size: 99328 bytes Desc: APS-PASRR Announcement for 7-1-09.doc Url : http://mailman.informe.org/pipermail/provider/attachments/20090618/e2437936/APS-PASRRAnnouncementfor7-1-09.doc From provider at lists.maine.gov Fri Jun 19 09:30:39 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 19 Jun 2009 09:30:39 -0400 Subject: [Provider] MaineCare Pharmacy and Durable Medical Equipment Update Message-ID: ATTENTION: MaineCare Providers Billing Procedure Code T4554 Procedure code T4554 for Disposable Underpads, all sizes, such as CHUX, is not in either the 2008 or 2009 HCPCS book and can no longer be billed. The code is being closed as of the date of this listserv notice (June 19, 2009). Please consult a current HCPCS book for the appropriate code. If you have any questions please contact MaineCare Customer Service at 1-800-321-5557. 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/20090619/e5e83069/attachment.html From provider at lists.maine.gov Tue Jun 23 11:18:32 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 23 Jun 2009 11:18:32 -0400 Subject: [Provider] HIPAA Code Updates Message-ID: The following HIPAA Code Sets have been updated in MaineCare's claims processing system. The changes will go into effect on Wednesday, July 1. Code Type Code Explanation Condition Code (Added) Code 42 Continuing care not Related to inpatient hospitalization. Claims Adjustment Reason Code (End Dated) Code 17 This code has been cross-walked to Code 16 Requested information was not provided or was insufficient / incomplete. UB Claim Form Bill Type, Bill Classification (Clinics Only) *These codes were added but MeCMS cannot process these bill types. Code 5 Code 2 Comprehensive outpatient rehabilitation facilities (CORFs) Hospice (hospital-based) **Not all of the codes that are published are used by MaineCare. Please continue to follow MaineCare billing instructions that can be found by clicking on the following link http://www.maine.gov/dhhs/oms/providerfiles/billing_instructions.html 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/20090623/536126de/attachment.html From provider at lists.maine.gov Thu Jun 25 10:00:59 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 25 Jun 2009 10:00:59 -0400 Subject: [Provider] Repeal of Chapters II and III, Section 6 Message-ID: ATTENTION: All MaineCare providers of Assisted Living Services This message is to give notice that MaineCare Benefits Manual, Chapters II and III, Section 6, Assisted Living Services has been repealed. No changes can be made at this point. Concise Summary: In this rulemaking, the Department eliminated services provided under MaineCare Benefits Manual, Chapters II and III, Section 6, Assisted Living Services. The Department has determined that it is necessary to repeal these rules because these services were never approved as MaineCare services by CMS. Section 6 Assisted Living Services will no longer be provided under MaineCare as of July 1, 2009. The Members currently receiving Assisted Living services will receive required notification of the discontinuation of these services and will receive an eligibility determination to assess what benefits and services they remain eligible for. Most will be eligible for MaineCare services under Section 96, Private Duty Nursing and Personal Care Services. See http://www.maine.gov/oms/rules/provider_rules_policies.htm for rules and related rulemaking documents. Effective Date: July 1, 2009 Agency Contact Person: Patricia Dushuttle, Manager Division of Policy and Performance Agency Name: MaineCare Services 442 Civic Center Drive 11 State House Station Augusta, ME 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 Listserv 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/20090625/90b70083/attachment.html From provider at lists.maine.gov Thu Jun 25 10:10:40 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 25 Jun 2009 10:10:40 -0400 Subject: [Provider] Repeal of MaineCare Benefits Manual, Chapter X, Section 2 Message-ID: ATTENTION: All MaineCare providers of services to Non-Categorical Adults This message is to give notice that MaineCare Benefits Manual, Chapter X, Section 2 (Non-Categorical Adults) has been repealed and a new Chapter X, Section 2 promulgated. This is final and no changes can be made at this point. Concise Summary: The final rule repeals MaineCare Benefits Manual, Chapter X, Section 2, Benefits for Childless Adults, because most of the sub-sections duplicate rules in the MaineCare Eligibility Manual, Section 11000, and promulgates a new Chapter X, Section 2, now called Non-Categorical Adults, listing the covered services for this coverage group. In July 2008, the Department repealed sections 58, 100, and 111, and incorporated those services into Section 65 services. The covered services have not changed but the list of covered services has been revised to reflect the changes made in the consolidated MaineCare Benefits Manual, Chapter II, Section 65, Behavioral Health Services rules, adopted as final rules on October 29, 2008. This rule will not have any adverse impact on the administration of small businesses. Effective Date: 6/30/2009 Agency Contact Person: Melanie Miller, Health Planner Division of Policy and Performance Agency Name: MaineCare Services 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 Telephone: (207) 287-4459 FAX: (207) 287-9369 TTY: 1-800-423-4331 or 207-287-1828 (Deaf/Hard of Hearing) The Division of Policy posts all proposed and adopted rules on the MaineCare website at: http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html 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 Listserv 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/20090625/81b7c209/attachment.html From provider at lists.maine.gov Thu Jun 25 10:19:56 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 25 Jun 2009 10:19:56 -0400 Subject: [Provider] Proposed Rule for MaineCare Benefits Manual, Chapter II & III, Section 103 Message-ID: ATTENTION: All MaineCare providers of Rural Health Centers Proposed rules are issued to the public for review and comment. These rules may change before being finally adopted. Rule Title or Subject: MaineCare Benefits Manual, Chapters II & III, Section 103, Rural Health Center Services Concise Summary: The Department intends to transition to a new information system, MIHMS, in 2010 with 30 days notice to providers. Upon implementation of MIHMS, the Department proposes to delete the current local billing codes in Chapter III, Table 1, and replace them with the codes in Chapter III, Table 2, to become compliant with Federal HIPAA regulations. Furthermore, the Department proposes requiring providers to bill services, including documenting the type of visit, diagnoses and procedures on the UB04 claim form, which will replace the CMS 1500 form. All proposed rules are posted to the MaineCare web site at http://www.maine.gov/dhhs/oms/rules/proposed.html Public Hearing: July 16, 2009, 9:00 AM Conference Room #4 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 July 27, 2009. Agency Contact Person: Nicole Rooney Comprehensive Health Planner II Agency Name: MaineCare Services 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 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 MaineCare's Listserv 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/20090625/6b477e56/attachment.html From provider at lists.maine.gov Thu Jun 25 10:41:46 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 25 Jun 2009 10:41:46 -0400 Subject: [Provider] Legacy Claim Adjustments (Pre-MeCMS Claims) Message-ID: ATTENTION: All MaineCare Providers that submitted pinks or greens for pre-MeCMS claims adjustment The MaineCare Services' Claims Division has received authorization to settle MaineCare Reimbursement Forms/Provider Additional Payment Request Forms ("Pinks/Greens") that the Adjustment Unit currently has on file. The Adjustment Unit will settle these by netting the overpayments "pinks" and underpayments "greens" to arrive at an amount either owed the provider, or owed MaineCare. These claims will not be adjusted in MeCMS. Each provider that we have forms on file for will be mailed a summary of their MaineCare Reimbursement Forms/Provider Additional Payment Request Forms on a spreadsheet beginning in July. Providers due a net payment by MaineCare will see the payment appear on their RA. These payments are identified with an invoice number beginning with LCYPAY followed by a four digit number, i.e. LCYPAY0001. The MaineCare payment will be the net of any amount the provider owes to any other state agency, i.e., Interim Payment Recovery. Maine hospital claims are reconciled in the cost settlement process, not by claim adjustments. These claims are not part of this special processing. (Please Note: the time limit has passed for filing adjustments for underpayments on these claims.) Providers will receive begin to receive their spreadsheet summaries in July. Questions about the adjustment summaries should be forwarded to the provider's Medical Support Specialist (Claims Adjuster). The link to the roster of Claims Adjusters is here: http://www.maine.gov/dhhs/oms/pdfs_doc/provider/medical_support_speciali sts052609.pdf For general questions about billing, please feel free to contact the 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 Listserv 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/20090625/d4d15f7b/attachment.html From provider at lists.maine.gov Thu Jun 25 11:34:15 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 25 Jun 2009 11:34:15 -0400 Subject: [Provider] Update for Assisted Living Services Message Message-ID: ATTENTION: All MaineCare providers of Assisted Living Services An earlier listserv message today on rule-making for Assisted Living Services included an incorrect web link for MaineCare rules. That correct link is http://www.maine.gov/dhhs/oms/rules/provider_rules_policies.html We apologize for any inconvenience this may have caused. 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 Listserv 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/20090625/9fbf0459/attachment.html From provider at lists.maine.gov Thu Jun 25 12:49:36 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 25 Jun 2009 12:49:36 -0400 Subject: [Provider] MIHMS Training for Provider Re-enrollment is Underway - Q&A Available Message-ID: ATTENTION: All MaineCare Providers : The MIHMS re-enrollment web page has been updated Training for MIHMS Provider Re-enrollment began Monday, June 15 and continues through the summer in locations throughout the State of Maine. All current MaineCare providers that wish to continue submission of claims and wish to be paid for services, once MIHMS becomes operational, must complete the following steps, in this order: * Apply for and receive their National Provider Identifier(s) (NPIs) The only providers that don't need an NPI are the Atypical Providers of Day Habilitation Services, Fiscal Employer Agents and Non-Emergency Transportation. * Register for Re-enrollment Training Training is optional and providers are not required to attend training prior to re-enrollment. However, the training sessions allow providers to become familiar with the MIHMS provider portal, the re-enrollment application and to ask questions. Information about training and instructions for registration are on the MaineCare web site at http://www.maine.gov/dhhs/oms/member/innerthird/fa_mihms_reenroll.html * Attend Re-enrollment Training * Re-enroll All current MaineCare providers will receive written notice, by mail, of the date their re-enrollment can begin. Re-enrollment for MIHMS is not currently available and the MIHMS provider portal will not be available until later this summer. The provider enrollment materials on the MaineCare web site are not for use by MIHMS. Questions and Answers from the training sessions are now available on the MaineCare web site. To view these, go to http://www.maine.gov/dhhs/oms/member/innerthird/fa_mihms_reenroll.html and click the "Provider Re-enrollment FAQ" link. If providers can't find answers to their specific questions on the web site, they can write to MaineCare2010.dhhs at maine.gov 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 Listserv 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/20090625/3d01ae4e/attachment.html From provider at lists.maine.gov Tue Jun 30 12:30:52 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 30 Jun 2009 12:30:52 -0400 Subject: [Provider] Update on Rule-Making for MaineCare Benefits Manual Section 13, Targeted Case Management Message-ID: Attention: All MaineCare Providers of Targeted Case Management As providers know, the Department has been working on a revision of MBM Section 13, Targeted Case Management. The intent is to simplify the rule and to clearly define those who are eligible to receive case management services. Those eligible include Children with Developmental Disabilities and Behavioral Health Disorders, Adults with Developmental Disabilities, Behavioral Health Disorders, Substance Abuse Disorders, HIV, and Long Term Care Needs and any member experiencing homelessness. The rule will require prior authorization and utilization review for children's targeted case management. This rule will also clarify that MaineCare will not cover duplicative services and it will set forth the requirement for MaineCare members to transition to one comprehensive case manager. This rule will not be proposed for a July 1, 2009 emergency implementation, as previously discussed. However, the Department continues its work on this rule-making and anticipates the rule will be proposed, still for emergency implementation, within the first two weeks of July. Questions regarding this rule-making can be directed to Melanie.Miller at maine.gov or Kathy.Bubar at maine.gov 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 Listserv 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/20090630/cf306bcc/attachment.html From provider at lists.maine.gov Tue Jun 30 12:53:43 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 30 Jun 2009 12:53:43 -0400 Subject: [Provider] Update on PNMI Rule-making Message-ID: ATTENTION: All MaineCare Private Non-Medical Institution Providers The implementation of the new PNMI rule for both Children and Adults has been delayed and will not occur on July 1. The Department anticipates that the effective date will not be later than July 15. Until then, nothing will change. Thank you for your patience. If you have questions please contact Kathy.Bubar at maine.gov 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 Listserv 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/20090630/8c5cf75d/attachment.html