[Provider] Recent Remittance Advice and Electronic Remittance Advice Changes for MaineCare Providers

[Provider Notification]

ATTENTION: All MaineCare Providers

 

This notice explains recent Remittance Advice (RA) and Electronic
Remittance Advice (835) Changes.  These changes are not necessarily due
to the void functionality, but occurred at the same time void
functionality was implemented. 

 

RA/835 Adjustment Reason Code 142:  

*         In the past, this adjustment code reflected Cost-of-Care.
Code 142 will now also include patient liability amounts, patient paid
amounts, and spend-down amounts.

 

*         The Claim Adjustment (CAS) Segment that contains the group
code for adjustment reason code 142 is Contractual Obligation.
MaineCare is aware that the CAS Segment - group code should be the
patient responsibility (PR) but was not able to change this as part of
void functionality.  

 

*         Adjustment codes that start with Contractual Obligation (CO)
are usually programmed to post a credit transaction from the 835 to your
accounting systems.  If providers choose to continue using the 835 for
posting their MaineCare remittances they will need to make adjustments
to their program to ensure that the 142 is posting a CAS Segment group
code PR and not CO.

 

To further complicate matters, spenddown claims for hospital providers
are not adjudicating properly in MeCMS.  The patient responsibility
amount is populating on every line.  Therefore, the 142 code which
displays the member responsibility is incorrect.  Providers will not be
able to balance their remittance advice using the dollar amounts that
are applied to the 142 code. 

 

MaineCare Services is analyzing possible solutions for the CAS segment -
142 issue.  A correction for the spenddown claims issue is planned for
implementation to MeCMS and notice will be given of its introduction.

 

If you have questions, please call 1-800-321-5557, Option 8.

 

 

This is a one-way communication.  Please do not respond to this message.

 

 

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