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<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>ATTENTION: All MaineCare Providers
that bill Medicare C (Medicare Advantage Plans) <o:p></o:p></span></font></b></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial'>This notice is to inform providers of an update to Medicare
C co-payment billing instructions. Please utilize the following value codes
when billing on the UB92 or UB04 claim form.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial'>A1 = Deductible<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial'>A2 = Co-insurance and / or Co-pay<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>If you are billing for a MaineCare member who has Medicare C
(Medicare Advantage Plans) or Railroad Medicare please follow the revised
billing instructions outlined below.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
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<p class=MsoNormal align=center style='text-align:center'><b><font size=2
face=Arial><span style='font-size:11.0pt;font-family:Arial;font-weight:bold'>UB92<o:p></o:p></span></font></b></p>
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border-left:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal align=center style='text-align:center'><b><font size=2
face=Arial><span style='font-size:11.0pt;font-family:Arial;font-weight:bold'>UB04<o:p></o:p></span></font></b></p>
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border-left:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal align=center style='text-align:center'><b><font size=2
face=Arial><span style='font-size:11.0pt;font-family:Arial;font-weight:bold'>CMS
1500<o:p></o:p></span></font></b></p>
<p class=MsoNormal align=center style='text-align:center'><b><font size=2
face=Arial><span style='font-size:11.0pt;font-family:Arial;font-weight:bold'><o:p> </o:p></span></font></b></p>
</td>
</tr>
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<td width=197 valign=top style='width:2.05in;border:solid windowtext 1.0pt;
border-top:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>Field Locator 50A needs to contain the word Medicare.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>Field Locator 50B needs to contain the word MaineCare.<o:p></o:p></span></font></p>
</td>
<td width=197 valign=top style='width:2.05in;border-top:none;border-left:
none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>Field Locator 50A needs to contain the word Medicare<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>Field Locator 50B needs to contain the word MaineCare.<o:p></o:p></span></font></p>
</td>
<td width=197 valign=top style='width:2.05in;border-top:none;border-left:
none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>Field Locator 9D needs to contain the word Medicare
Replacement<o:p></o:p></span></font></p>
</td>
</tr>
<tr>
<td width=197 valign=top style='width:2.05in;border:solid windowtext 1.0pt;
border-top:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>Field Locator 84 (remarks) needs to say Medicare
Replacement or Medicare Railroad depending on which plan pertains to your
billing.<o:p></o:p></span></font></p>
</td>
<td width=197 valign=top style='width:2.05in;border-top:none;border-left:
none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>Field Locator 80 (remarks) needs to say Medicare
Replacement or Medicare Railroad depending on which plan pertains to your
billing.<o:p></o:p></span></font></p>
</td>
<td width=197 valign=top style='width:2.05in;border-top:none;border-left:
none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
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<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>If you have questions regarding this message please contact
1-800-321-5557 Option # 8.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face="Times New Roman"><span style='font-size:
11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><i><font size=1 face=Arial><span style='font-size:9.0pt;
font-family:Arial;font-style:italic'>This is a one-way communication. Please
do not respond to this message.<o:p></o:p></span></font></i></p>
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