From provider at lists.maine.gov Thu Mar 5 10:53:46 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 5 Mar 2009 10:53:46 -0500 Subject: [Provider] Substance Abuse Residential Rehabilitation Limits Message-ID: ATTENTION: Residential Rehabilitation Providers Substance Abuse Treatment PNMIs are reminded: * MaineCare limits residential rehabilitation to thirty (30) days for any single admission. * Members can have up to two (2) admissions and thirty (30) covered days per year. * Any continuous stay for more than twenty-eight (28) days requires documented need in the member's treatment plan. For more information, refer to Section 97.08-1D of the MaineCare Benefits Manual or contact your Provider Relations Specialist 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/20090305/44f3e522/attachment.html From provider at lists.maine.gov Fri Mar 6 10:21:25 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 6 Mar 2009 10:21:25 -0500 Subject: [Provider] FAQs on Hospital-Based Physician Billing Message-ID: ATTENTION: Hospitals that receive Prospective Interim Payments Last week, DHHS announced an emergency rule on billing for outpatient hospital-based physicians services. The emergency rule took effect February 21, 2009. To help providers understand and comply with the emergency rule, we have compiled a list of Frequently Asked Questions . We hope this is helpful as you enroll your hospital-based service providers. If you have questions, feel free to contact Cheryl Rood at 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. 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/20090306/ea94074f/attachment.html From provider at lists.maine.gov Sun Mar 8 15:28:32 2009 From: provider at lists.maine.gov (Provider Notification) Date: Sun, 8 Mar 2009 15:28:32 -0400 Subject: [Provider] Message from APS Healthcare-Maine Message-ID: ATTENTION: All MaineCare Providers Participating with APS Healthcare The following message is forwarded from APS Healthcare-Maine Dear Maine ASO Provider, The APS Healthcare-Maine website is www.qualitycareforme.com The Quality & Data page has been renamed the "Reports & Quality" page. Children's PNMI and Children's Crisis Unit Average Length of Stay (ALOS) Reports are now posted on the Reports & Quality Page at this link: http://www.qualitycareforme.com/MaineProvider_QualityImprovement.htm What does this mean for providers? These reports display the following, for each Child PNMI and Child Crisis Unit facility: 1. The average length of stay (ALOS) in days, for children currently in facilities (the column titled "Active ALOS") 2. The ALOS in days for children discharged in the previous week- 3. The number of children admitted in the previous week 4. The number of children discharged in the previous week Length of Stay is the measure of how long a person is in treatment. Average Length of Stay is an important measure of service delivery. DHHS and APS Healthcare are committed to increasing the treatment of children and families in their homes and communities. These reports are designed to support the goal of decreasing residential lengths of stay while increasing community based treatment. These reports are updated every Monday with data from the previous week. Providers can contact Sara Godfrey at APS Healthcare (1-866-521-0027 ext. 4903) if they have questions about these reports. What does this mean for MaineCare Members? These reports will not impact an individual MaineCare Member's service, but are available to all members to review. Members can ask their provider if they have questions about these reports. Members can also call the APS Healthcare Member Services Liaison (Simonne Maline) at 1-866-521-0027 ext. 4915 if they have questions about these reports. 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/20090308/1e21a7bb/attachment.html From provider at lists.maine.gov Tue Mar 10 14:04:15 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 10 Mar 2009 14:04:15 -0400 Subject: [Provider] A Letter from Tony Marple to All MaineCare Providers Message-ID: ATTENTION: All MaineCare Providers The following information is a letter from Tony Marple, Director of MaineCare Services to all MaineCare providers. Dear Provider, Maine's Department of Health and Human Services and MaineCare have embarked on a very significant project for us, for you and for our mutual clients, MaineCare members. We are now mid-way through the project to build a new Medicaid claims processing system. As you probably know, the new system is named the Maine Integrated Health Management Solution and is referred to as "MIHMS." The first outward phase of this project is a full provider re-enrollment. This is being done to ensure the accuracy of provider data in the new system and to allow use of National Provider Identifiers (NPI). It is important that all MaineCare providers of health care services complete their enumeration and receive their NPI prior to re-enrolling for MIHMS. A wealth of NPI information is available on the MaineCare web site and can found by scrolling to the "NPI Links" header on the MIHMS Project page. If you still have questions, you can forward those to MaineCare2010.DHHS at maine.gov Providers have been scheduled, by provider type, for one of three re-enrollment cycles in July, August and September. Training will be available in locations across the state in the month prior to each cycle. The first set of provider training will take place in June. Training for the second cycle will be held in July and the third and final set of training will be held in August and the first week of September. Current MaineCare provider organizations will receive individual notices of their training timeframe and re-enrollment cycle. The grouping of provider types by cycle is also available on the MaineCare web site at MIHMS Provider Re-enrollment . Training locations and dates will be confirmed soon. This information will be posted to the site and providers notified. Once this occurs, electronic registration for training will also be available at this link. If your organization does not yet receive information from MaineCare by listserv, I encourage you to sign up for this at MaineCare provider listserv . This is an exciting time for Maine's Medicaid program. We are building a fully HIPAA-compliant claims processing system that will adhere to the certification standards from the Centers for Medicare and Medicaid Services (CMS). MIHMS will offer you the ability to file all claims electronically and to monitor claim status on-line. You will have the ability to update provider data and to access member eligibility information via a web portal. Operation of the MIHMS system will allow MaineCare to join with you in focusing on the health and well-being of our members. Thank you for your commitment to the well-being of Maine's residents and for your participation in the MaineCare program. Anthony F. Marple Director, Office of MaineCare Services 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/20090310/b80a1b64/attachment.html From provider at lists.maine.gov Tue Mar 10 15:22:14 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 10 Mar 2009 15:22:14 -0400 Subject: [Provider] Proposed Rules Chapter X, Non-Categorical Adults Message-ID: ATTENTION: MaineCare Providers who serve "Non-Categorical Adults" This is notice of a proposed rule for Chapter X, Section 2 of the MaineCare Benefits Manual, Non-Categorical Adults. This is a major substantive rule for Non-Categorical Adults. Proposed rules are issued to the public for review and comment. These rules may change before finally adopted. CONCISE SUMMARY: The Department proposes to repeal 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 promulgate 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. PUBLIC HEARING: Date March 17, 2009 10:00 am DEADLINE FOR COMMENTS: Comments must be received by midnight March 27, 2009 AGENCY CONTACT PERSON: Melanie Miller, Comprehensive Health Planner TELEPHONE: 207-287-4459 ________________________________________________________________________ _______ 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/20090310/58133f62/attachment.html From provider at lists.maine.gov Mon Mar 16 09:10:26 2009 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 16 Mar 2009 09:10:26 -0400 Subject: [Provider] Notice of Rules Adopted for Principles of Reimbursement for Nursing Faciliies Message-ID: ATTENTION: MaineCare Nursing Facilities This message is to give notice that rules have been adopted for Chapter 101, MaineCare Benefits Manual, Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities. Adopted rules are final and no changes can be made at this point. CONCISE SUMMARY: The Department has permanently adopted rule changes for Chapter III, Section 67, Principles of Reimbursement for Nursing Facilities, in order to comply with budget appropriations for nursing facility reimbursement and State statute for conversion of nursing facility beds and medical director costs. Specifically, the new rate methodology changes the base year from 1998 to 2005 to calculate direct care and routine care costs; the rule clarifies the impact of conversion of nursing facility beds to residential care beds; and the base year cost for medical director is increased from $1,200 to $10,000. The Department also adopts changes that establish a new prospective per diem rate by adding a direct care regional cost component, hold harmless provision, and direct care add-on to the rule. In addition, all providers will receive a one time payment for the time period between July 1, 2008 and December 15, 2008, which equitably distributes a portion of the money appropriated in the budget. Other changes made in this rulemaking include the ability for the Department to waive administrator costs that are included under the management ceiling for smaller nursing facilities of forty (40) or fewer beds. Other minor technical, format and grammatical changes were adopted. EFFECTIVE DATE: March 15, 2009 AGENCY CONTACT PERSON: Alyssa Morrison, Health Planner TELEPHONE: (207)-287-9342 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/20090316/0d7e974a/attachment.html From provider at lists.maine.gov Fri Mar 20 16:14:28 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 20 Mar 2009 16:14:28 -0400 Subject: [Provider] NDC Roster Billing Due March 31st Message-ID: ATTENTION: Maine Hospitals NDC Roster Billing Due March 31st MaineCare is required to collect National Drug Codes (NDC) on claims for certain outpatient, physician-administered drugs. The Roster Billing for the 4th quarter 2008 is due March 31st. If your 3rd quarter roster was not processed due to errors or omissions, please resubmit it by March 31st as well. Revised instructions have been posted on MaineCare's website. Questions? Contact Cheryl Rood at 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/20090320/daca14e7/attachment.html From provider at lists.maine.gov Tue Mar 24 09:44:21 2009 From: provider at lists.maine.gov (Provider Notification) Date: Tue, 24 Mar 2009 09:44:21 -0400 Subject: [Provider] Select Pediatric Codes Get Rate Correction Message-ID: Select Pediatric Codes Get Rate Correction Certain codes for a pediatrician attending a birth were replaced on January 1, 2009. The new codes were assigned an incorrect rate. The codes and the correct rates effective January 1, 2009 are listed below. Code 99460 INIT NB EM PER DAY, HOSP $54.04 Code 99462 SBSQ NB EM PER DAY, HOSP $22.75 Code 99463 SAME DAY NB DISCHARGE $63.80 Code 99464 ATTENDANCE AT DELIVERY $66.22 If you billed one of these codes since January 1, 2009, please submit an adjustment claim. MaineCare will process the adjustment and pay the correct rate. If you have questions, please contact Billing & Information 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/20090324/0af03540/attachment.html From provider at lists.maine.gov Thu Mar 26 08:49:39 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 26 Mar 2009 08:49:39 -0400 Subject: [Provider] HIPAA Code Set Updates Message-ID: The following HIPAA Codes Sets have been updated in MaineCare's claims system. The changes will go into effect Wednesday, April 1. Claim Adjustment Reason Code B18 This "procedure code and modifier were invalid on the date of service" has been deleted by the Claim Adjustment Reason Code Committee. The code has been crosswalked to the following internal claims error reasons: Possible Claims Error Crosswalk Code Not Surgical Procedure 4- The procedure code is inconsistent with the modifier used or a required modifier is missing. Ambulance Origin/Destination Invalid 4- The procedure code is inconsistent with the modifier used or a required modifier is missing. HCPCS Proc/Mod Invalid 182-Procedure modifier was invalid on the date of service 1st Procedure Modifier Invalid 182- Procedure modifier was invalid on the date of service 2nd Procedure Modifier Invalid 182-Procedure modifier was invalid on the date of service 3rd Procedure Modifier Invalid 182- Procedure modifier was invalid on the date of service For providers who submit on the UB04 Although the following codes have been added, we will not be using them at this time for claims processing. A new patient status reason H2 Discharge by a Hospice Provider for a Cause. Two new UB Claim Form Bill Types: Bill Classification (Special Facilities Only) 2 Hospice (hospital based) Bill Classification (Clinics Only) 5 Comprehensive Outpatient Rehabilitation Facilities (CORFs) 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/20090326/3e041dff/attachment.html From provider at lists.maine.gov Thu Mar 26 16:30:09 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 26 Mar 2009 16:30:09 -0400 Subject: [Provider] Oxygen benefits for Medicare members Message-ID: Effective January 1, 2009, for Medicare members who have had 36 months of oxygen and equipment costs reimbursed, Medicare will pay only for contents (oxygen). After reviewing Medicare's policy and considering input from New England Medical Equipment Dealers (NEMED), the Department has decided how to proceed. MaineCare will follow the 36-month cap on oxygen for members who have both MaineCare and Medicare . All other members will continue to get the current oxygen benefit. The Department will refer to Medicare's Explanation of Benefits (EOB) to track the 36-month limit. When the time limit has passed, then the "content only" codes should be billed. These are new content only E codes: E0441 STATIONARY GASEOUS CONTENTS E0442 STATIONARY LIQUID CONTENTS E0443 PORTABLE GASEOUS CONTENTS E0444 PORTABLE LIQUID CONTENTS Effective April 1, 2009 Medicare and MaineCare will no longer accept code E1340 for repairs. Two new codes replace this code. K0739 REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT OTHER THAN OXYGEN REQUIRING THE SKILL OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES K0740 REPAIR OR NONROUTINE SERVICE FOR OXYGEN EQUIPMENT REQUIRING THE SKILL OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES If you have questions, please feel free to contact MaineCare 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... 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