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<p class=MsoNormal style='margin-right:-.25in'><b><font size=3 face=Arial><span
style='font-size:12.0pt;font-family:Arial;font-weight:bold'>ATTENTION: All
Active MaineCare Providers<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-right:-.25in'><b><font size=3 face=Arial><span
style='font-size:12.0pt;font-family:Arial;font-weight:bold'> </span></font></b><font
size=2 face=Arial><span style='font-size:11.0pt;font-family:Arial'>The
following information is from an issue of MaineCare Matters <o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:-.25in;
margin-bottom:0in;margin-left:1.5in;margin-bottom:.0001pt'><font size=2
face=Arial><span style='font-size:11.0pt;font-family:Arial'>that has been
mailed to all active billing providers.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-right:-.25in'><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 style='margin-right:-.25in'><font size=3 face=Arial><span
style='font-size:12.0pt;font-family:Arial'>As you may know, the State of <st1:State
w:st="on"><st1:place w:st="on">Maine</st1:place></st1:State>, the Department of
Health and Human Services and MaineCare Services have begun work to implement a
new Medicaid claims processing system. Over the past year, the Centers
for Medicare and Medicaid Services (CMS) approved the State’s plan for transitioning
MaineCare to a fiscal agent model of operation. This includes contracting
with a fiscal agent vendor for some MaineCare operations, including a new HIPAA
compliant, CMS certified claims processing system. <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'>Unisys was selected to be the fiscal vendor in December
2007. Unisys brings to MaineCare its transfer claims processing system
known as “HealthPAS.” The new system is scheduled to begin
processing claims in early 2010. Between now and then, the team will fully
design and test the system.<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 style='margin-right:-.25in'><b><font size=3 face=Arial><span
style='font-size:12.0pt;font-family:Arial;font-weight:bold'>The first phase of
the new system’s implementation, provider re-enrollment, will take place
during 2009.</span></font></b><font face=Arial><span style='font-family:Arial'>
Re-enrollment is vital to the overall project because it will ensure that
the most up-to-date provider information is in the new system. The
re-enrollment process is being designed to minimize any short-term negative
impact on providers. MaineCare is working to make the process of collecting
all the required information as easy as possible.<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 style='margin-right:-.25in'><font size=3 face=Arial><span
style='font-size:12.0pt;font-family:Arial'>Once a provider re-enrolls in
MaineCare and also enrolls as an Electronic Data Interchange (EDI) Trading
Partner, they will be able to submit electronic claims, as well as batch
claims, to MaineCare. Electronic claims will be submitted through the
Unisys HealthPAS OnLine (the new claims processing provider web portal). Providers
that re-enroll will also be able to add their National Provider Identification
(NPI) number(s) to claims. Even providers who won’t be using NPI can
re-enroll and submit electronic claims beginning in 2009. Prior to the
new system starting in 2010, the current MeCMS system will continue to process
claims and generate paper Remittance Advice statements as well as Electronic
Remittance Advice statements.<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'>With the re-enrollment, MaineCare plans to kick-off some of
the HealthPAS OnLine functions. <b><span style='font-weight:bold'>In
2009, once providers re-enroll they will be able to go to the web site and:</span></b><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 style='margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1'><![if !supportLists]><font
size=3 face=Wingdings><span style='font-size:12.0pt;font-family:Wingdings'><span
style='mso-list:Ignore'>ü<font size=1 face="Times New Roman"><span
style='font:7.0pt "Times New Roman"'> </span></font></span></span></font><![endif]><font
face=Arial><span style='font-family:Arial'>Enroll, re-enroll and change their
enrollment information<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1'><![if !supportLists]><font
size=3 face=Wingdings><span style='font-size:12.0pt;font-family:Wingdings'><span
style='mso-list:Ignore'>ü<font size=1 face="Times New Roman"><span
style='font:7.0pt "Times New Roman"'> </span></font></span></span></font><![endif]><font
face=Arial><span style='font-family:Arial'>Get Electronic Data Interchange
(EDI) claim submission companion guides<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1'><![if !supportLists]><font
size=3 face=Wingdings><span style='font-size:12.0pt;font-family:Wingdings'><span
style='mso-list:Ignore'>ü<font size=1 face="Times New Roman"><span
style='font:7.0pt "Times New Roman"'> </span></font></span></span></font><![endif]><font
face=Arial><span style='font-family:Arial'>Submit HIPAA compliant 837
Professional, Institutional and Dental claim transaction files (batch upload)
or onto a claims entry screen for transfer to submission in MeCMS for
processing (anticipated in mid-2009).<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'><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'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>Once the new claims system is fully implemented
in 2010, the provider portal web site will provide:<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'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo2'><![if !supportLists]><font
size=3 face=Wingdings><span style='font-size:12.0pt;font-family:Wingdings'><span
style='mso-list:Ignore'>ü<font size=1 face="Times New Roman"><span
style='font:7.0pt "Times New Roman"'> </span></font></span></span></font><![endif]><font
face=Arial><span style='font-family:Arial'>Member eligibility<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo2'><![if !supportLists]><font
size=3 face=Wingdings><span style='font-size:12.0pt;font-family:Wingdings'><span
style='mso-list:Ignore'>ü<font size=1 face="Times New Roman"><span
style='font:7.0pt "Times New Roman"'> </span></font></span></span></font><![endif]><font
face=Arial><span style='font-family:Arial'>Prior authorization <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo2'><![if !supportLists]><font
size=3 face=Wingdings><span style='font-size:12.0pt;font-family:Wingdings'><span
style='mso-list:Ignore'>ü<font size=1 face="Times New Roman"><span
style='font:7.0pt "Times New Roman"'> </span></font></span></span></font><![endif]><font
face=Arial><span style='font-family:Arial'>Claim status and history <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo2'><![if !supportLists]><font
size=3 face=Wingdings><span style='font-size:12.0pt;font-family:Wingdings'><span
style='mso-list:Ignore'>ü<font size=1 face="Times New Roman"><span
style='font:7.0pt "Times New Roman"'> </span></font></span></span></font><![endif]><font
face=Arial><span style='font-family:Arial'>Payment status and history<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo2'><![if !supportLists]><font
size=3 face=Wingdings><span style='font-size:12.0pt;font-family:Wingdings'><span
style='mso-list:Ignore'>ü<font size=1 face="Times New Roman"><span
style='font:7.0pt "Times New Roman"'> </span></font></span></span></font><![endif]><font
face=Arial><span style='font-family:Arial'>Member rosters<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.25in'><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'>At all levels there will be look-up tables, pull down menus,
tools to drill down to detailed information and help screens.<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 style='margin-right:-.25in'><font size=3 face=Arial><span
style='font-size:12.0pt;font-family:Arial'>MaineCare will send additional
re-enrollment information in the coming months. Watch for the MaineCare
Matters newsletter, other updates like this and listserv announcements. Please
visit <a href="http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml">http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml</a>
to sign up for the MaineCare listserv. The MaineCare Providers’ Advisory
and Technical Advisory groups will also be discussing this and other fiscal
agent activities in their future meetings. In the meantime, if you have
questions, please send them to <a href="mailto:MaineCare2010.DHHS@maine.gov">MaineCare2010.DHHS@maine.gov</a>
or contact 1-800-321-5557, option 8.<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'>Thank you!<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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