[Provider] HIPAA Code Set Updates

[Provider Notification]

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) 

 

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MaineCare up to date so your Remittance Statements and checks arrive on
time.  Call Provider Enrollment at 1-800-321-5557 Option #6.

 

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