From provider at lists.maine.gov Fri May 1 08:12:20 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 1 May 2009 08:12:20 -0400 Subject: [Provider] Adopted Rule: Ambulance Services Message-ID: This message is to give notice that a rule has been adopted for Ch. 101, MaineCare Benefits Manual, Chapter II and III, Section 5, Ambulance Services. Adopted rules are final and no changes can be made at this point. AGENCY: DHHS - MaineCare Services CONCISE SUMMARY: The adopted rules reflect changes to this section to increase Ambulance Services base rates that will include ancillary services. Ancillary Services, which include oxygen, oxygen administration supplies such as disposable oxygen masks, intravenous therapy, EKG, endotracheal intubation, pulse oximetry, telemetry and defibrillation, will no longer be billed separately. RN services will also no longer be billed separately as the base rate for Specialty Care Transport has been increased. A definition of Specialty Care Transport has been added. These changes are being made so only HIPAA compliant codes will be utilized. Other changes to this section were made to update policy language. The proposed rule does not impose an economic burden on small business, municipalities or counties. See http://www.maine.gov/bms/rules/provider_rules_policies.htm for rules and related rulemaking documents. EFFECTIVE DATE: May 21, 2009 AGENCY CONTACT PERSON: Darrell S. Wood, Health Planner AGENCY NAME: Division of Policy and Performance ADDRESS: 442 Civic Center Drive 11 State House Station Augusta, Maine 04333-0011 TELEPHONE: (207)-287-6348, 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/20090501/62a45d70/attachment.html From provider at lists.maine.gov Fri May 1 14:16:38 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 1 May 2009 14:16:38 -0400 Subject: [Provider] Anesthesia billing codes Message-ID: ATTENTION: MaineCare Providers Billing Anesthesia Codes Providers that bill general anesthesiology for non-surgical services using the code Y9280 have been receiving incorrect reimbursement on some claims. Y9280 has four (4) base units. Reminder: For anesthesiology, MaineCare considers 15 minutes equal to one unit of service. In order to ensure appropriate payment is made, one of the following anesthesia modifiers must be entered on the claim: AA Anesthesia services performed by anesthesiologist QK Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals QX CRNA service with medical direction by a physician QY Medical direction of one CRNA by a physician QZ CRNA Service; without medical direction by a physician The claim will be denied if a modifier is not entered. This change will take place immediately and will include past dates of service, in order to reduce the number of voids or adjustments that would have to be filed. If you believe you have received incorrect payment, it is recommended claims be voided instead of adjusted since the modifier would need to be added to the adjusted claims. If you have any questions, please contact Customer Service 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/20090501/b8f40a6f/attachment.html From provider at lists.maine.gov Mon May 4 15:20:57 2009 From: provider at lists.maine.gov (Provider Notification) Date: Mon, 4 May 2009 15:20:57 -0400 Subject: [Provider] Budget Process Update Message-ID: ATTENTION: All MaineCare Providers The legislature continues its diligent work to pass the state budget and is wrestling with the challenge of closing a $569 million gap over fiscal years 09, 10 and 11. We want to make you aware that if the budget is not passed by the legislature and signed by the Governor by Monday, May 11, payment for your claims submitted to MaineCare will be delayed. The length of delay will be dependent upon when the budget passes and we will keep you informed as the work progresses. We wanted to make you aware of the potential that this may happen, so you can prepare. 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/20090504/39e55c9b/attachment.html From provider at lists.maine.gov Thu May 7 11:28:02 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 7 May 2009 11:28:02 -0400 Subject: [Provider] MIHMS Re-enrollment Training Announcement Message-ID: ATTENTION: All MaineCare Providers, Billing Agencies and Clearinghouses The time has come...for providers to register for their MIHMS re-enrollment training! This notice is to alert all providers that information for MIHMS re-enrollment and training for re-enrollment has been posted to the MaineCare web site. This information is also in the mail to all providers enrolled with MaineCare as of February 28 of this year. Training and re-enrollment is scheduled in three cycles, for Individuals, Groups and Facilities/Agencies/Organizations. Providers should identify which of the three categories they are associated with and then select a training session for that cycle. Descriptions of the categories are contained within the document MIHMS Provider Re-enrollment Information and Schedule on the MIHMS Provider Re-enrollment page of the MaineCare web site. Training for re-enrollment is recommended for all providers so that they can be sure all the information needed for the re-enrollment process is available. In addition, it will be helpful to "tour" the MIHMS provider web portal, prior to re-enrollment. Providers will receive a link to the provider portal when they attend training. Registration for training can be accomplished on-line, by FAX or by phone. 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/20090507/2b1f920b/attachment.html From provider at lists.maine.gov Fri May 8 10:25:56 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 8 May 2009 10:25:56 -0400 Subject: [Provider] Budget Process Update Message-ID: ATTENTION: All MaineCare Providers Earlier this week, we sent you a message about the potential that DHHS would begin missing cycle payments unless the State budget was completed by Monday, May 11. Recent information indicates that we should be able to make the next cycle payment on May 13 without the enactment of a new budget. Several factors have allowed us to be positioned to make the next payment. The fact that providers have filed fewer claims in the last two weekly cycles stretches resources, as does the Governor's signing of a financial order to providing funding for hospital settlements. This relief will likely get us through the next weekly cycle, but the budget must be passed next week, or payments will not be able to be made on May 20. 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/20090508/3d009439/attachment.html From provider at lists.maine.gov Fri May 15 17:26:35 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 15 May 2009 17:26:35 -0400 Subject: [Provider] Budget Process Impact on MaineCare Claims Payments Message-ID: ATTENTION: All MaineCare Providers Work continues in the Legislature to complete a State budget that would cover the remaining months of FY 2009 and FY 2010-11. Until a budget is complete, we will not be able to process claims, beginning with the cycle of May 20. This will be for all payment systems, including MeCMS and MePOPs. Providers will receive payments early next week from the May 13th cycle. Please understand that interim payments are not possible until a new budget for the Department provides authorization for further expenditures. We will resume payments as quickly as possible once the budget is completed, and we will work to keep you informed about what is going on. 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/20090515/775c73b9/attachment.html From provider at lists.maine.gov Wed May 20 16:55:35 2009 From: provider at lists.maine.gov (Provider Notification) Date: Wed, 20 May 2009 16:55:35 -0400 Subject: [Provider] Update on MaineCare Provider Payments Message-ID: ATTENTION: All MaineCare Providers Last week we sent the message that MaineCare provider payments would not take place beginning with the May 20th cycle, until a new state budget was passed. This is an update to that information. Provider payments will not be paid out for receipt Friday, May 22nd through Tuesday, May 26th. The Department will, however, resume payments with the May 27th cycle. Providers will receive two weeks of payments beginning Friday, May 29th, through Tuesday, June 2nd. Providers will receive one (1) combined remittance advice (RA) for the two weeks worth of payment information. Thank you for your service to MaineCare members and for your patience during this 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/20090520/8e08b328/attachment.html From provider at lists.maine.gov Thu May 28 08:31:48 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 28 May 2009 08:31:48 -0400 Subject: [Provider] Physician services rate adjustment Message-ID: ATTENTION: Physicians who bill for MaineCare services under Section 90 In the June 1st payment cycle, MaineCare will pay the new higher rates on claims for dates of service July 1, 2008 through December 24, 2008. The rate increase was retroactive to July 1, 2008, and the claims system started paying the new rate on December 24, 2008. This payment will apply the rate increase to the remaining claims that qualify for it. This adjustment will appear on the June 17, 2009 Remittance Advice Statement. Providers do not need to contact MaineCare or re-file claims. MaineCare's Online Procedure Code Lookup lists the rates and other coverage details. MaineCare Claims Adjustment Staff are also available to answer questions. For general billing questions, please 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 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/20090528/6ec6b307/attachment.html From provider at lists.maine.gov Thu May 28 09:32:27 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 28 May 2009 09:32:27 -0400 Subject: [Provider] MaineCare Provider Payment Reminder Message-ID: ATTENTION: All MaineCare Providers Providers will receive payments Friday May 29th through Tuesday June 2nd, as they would during a normal payment processing cycle. These payments will include claims processed from Saturday, May 9th through Thursday, May 21st. A single Remittance Advice will be generated for these two weeks of payments. Claims processed Friday, May 22nd through Friday, May 29th will be paid in the following cycle. Payments from these claims will be received by providers Friday, June 5th through Tuesday, June 9th. 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/20090528/92bf1cc6/attachment.html From provider at lists.maine.gov Thu May 28 15:11:04 2009 From: provider at lists.maine.gov (Provider Notification) Date: Thu, 28 May 2009 15:11:04 -0400 Subject: [Provider] Social services for MaineCare members Message-ID: ATTENTION: Mental health and social service providers A Social Services member who has no other eligibility: * is only eligible for Social Services (procedure codes all begin with "SS") * is not eligible for any other MaineCare services * must have a Prior Authorization (PA) for services. The Office of Child and Family Services (OCFS) handles the PA for Social Services members. Some MaineCare members are eligible for Social Service services AND for MaineCare services. These members * need PA for Social Services ("SS" procedure codes) from OCFS. * need PA from APS Healthcare for behavioral health services provided by an LCPC/LCSW/LMFT in private practice under Section 65 policy. Providers can find a member's eligibility by calling the MaineCare Interactive Voice Response (IVR) system at 1-800-321-5557 Option #2. The IVR system will state that the member is eligible for Social Services, and/or for full MaineCare benefits. Questions? Call 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/20090528/07985e66/attachment.html From provider at lists.maine.gov Fri May 29 15:13:05 2009 From: provider at lists.maine.gov (Provider Notification) Date: Fri, 29 May 2009 15:13:05 -0400 Subject: [Provider] Top 20 Physician-Administered Drug list Message-ID: ATTENTION: Maine Hospitals Physician-Administered Drugs Top 20 List Update CMS has updated the top 20 list of multiple-source, physician administered drugs. CMS modifies the list as dollar volumes change. States are required to collect National Drug Code (NDC) information on these drugs in order to get manufacturer rebates. The new top 20 multiple source drugs list can be found at the following CMS website. http://www.cms.hhs.gov/Reimbursement/15_PhysicianAdministeredDrugs.asp. This change is effective for dates of service May 1, 2009 and later (second quarter 2009). Roster billing for this time-period is due September 30, 2009. First quarter 2009, Roster Billing is due June 30, 2009. 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... 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