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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The following HIPAA Codes Sets have been updated in MaineCare’s
claims system. The changes will go into effect Wednesday, April 1.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>Claim Adjustment Reason Code B18<o:p></o:p></span></font></b></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>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</span></font><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=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0 width=607
style='width:455.4pt;margin-left:-5.8pt;border-collapse:collapse;border:none'>
<tr>
<td width=235 valign=top style='width:2.45in;border:solid windowtext 1.0pt;
padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>Possible Claims Error
<o:p></o:p></span></font></b></p>
</td>
<td width=372 valign=top style='width:279.0pt;border:solid windowtext 1.0pt;
border-left:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>Crosswalk Code<o:p></o:p></span></font></b></p>
</td>
</tr>
<tr>
<td width=235 valign=top style='width:2.45in;border:solid windowtext 1.0pt;
border-top:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Not Surgical Procedure <o:p></o:p></span></font></p>
</td>
<td width=372 valign=top style='width:279.0pt;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=3 face="Times New Roman"><span
style='font-size:12.0pt'>4- The procedure code is inconsistent with the
modifier used or a required modifier is missing.<o:p></o:p></span></font></p>
</td>
</tr>
<tr>
<td width=235 valign=top style='width:2.45in;border:solid windowtext 1.0pt;
border-top:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Ambulance Origin/Destination Invalid <o:p></o:p></span></font></p>
</td>
<td width=372 valign=top style='width:279.0pt;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=3 face="Times New Roman"><span
style='font-size:12.0pt'>4- The procedure code is inconsistent with the
modifier used or a required modifier is missing.<o:p></o:p></span></font></p>
</td>
</tr>
<tr>
<td width=235 valign=top style='width:2.45in;border:solid windowtext 1.0pt;
border-top:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>HCPCS Proc/Mod Invalid <o:p></o:p></span></font></p>
</td>
<td width=372 valign=top style='width:279.0pt;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=3 face="Times New Roman"><span
style='font-size:12.0pt'>182-Procedure modifier was invalid on the date
of service <o:p></o:p></span></font></p>
</td>
</tr>
<tr>
<td width=235 valign=top style='width:2.45in;border:solid windowtext 1.0pt;
border-top:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>1st Procedure Modifier Invalid <o:p></o:p></span></font></p>
</td>
<td width=372 valign=top style='width:279.0pt;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=3 face="Times New Roman"><span
style='font-size:12.0pt'>182- Procedure modifier was invalid on the date of service<o:p></o:p></span></font></p>
</td>
</tr>
<tr>
<td width=235 valign=top style='width:2.45in;border:solid windowtext 1.0pt;
border-top:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>2nd Procedure Modifier Invalid <o:p></o:p></span></font></p>
</td>
<td width=372 valign=top style='width:279.0pt;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=3 face="Times New Roman"><span
style='font-size:12.0pt'>182-Procedure modifier was invalid on the date of
service<o:p></o:p></span></font></p>
</td>
</tr>
<tr>
<td width=235 valign=top style='width:2.45in;border:solid windowtext 1.0pt;
border-top:none;padding:0in 5.4pt 0in 5.4pt'>
<p class=MsoNormal><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>3rd Procedure Modifier Invalid <o:p></o:p></span></font></p>
</td>
<td width=372 valign=top style='width:279.0pt;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=3 face="Times New Roman"><span
style='font-size:12.0pt'>182- Procedure modifier was invalid on the date of
service<o:p></o:p></span></font></p>
</td>
</tr>
</table>
<p class=MsoNormal style='margin-left:3.0in;text-indent:-3.0in'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>For providers who submit on the UB04</span></font></b>
<o:p></o:p></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Although the following codes have been added, we will not be using them
at this time for claims processing. <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:3.0in;text-indent:-3.0in'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:3.0in;text-indent:-2.5in'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>A new patient status
reason H2 Discharge by a Hospice Provider for a Cause. <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:3.0in;text-indent:-3.0in'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><b><font size=3 face="Times New Roman"><span
style='font-size:12.0pt;font-weight:bold'>Two new UB Claim Form Bill Types</span></font></b>:<o:p></o:p></p>
<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>Bill Classification (Special Facilities Only) 2
Hospice (hospital based) <o:p></o:p></span></font></p>
<div style='mso-element:para-border-div;border:none;border-bottom:solid windowtext 1.5pt;
padding:0in 0in 1.0pt 0in;margin-left:.5in;margin-right:0in'>
<p class=MsoNormal style='border:none;padding:0in'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>Bill Classification
(Clinics Only) 5 Comprehensive Outpatient Rehabilitation Facilities (CORFs) <o:p></o:p></span></font></p>
<p class=MsoNormal style='border:none;padding:0in'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'><o:p> </o:p></span></font></p>
</div>
<div style='mso-element:para-border-div;border:none;border-bottom:solid windowtext 1.5pt;
padding:0in 0in 1.0pt 0in'>
<p class=MsoNormal style='border:none;padding:0in'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;font-style:italic'>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.<o:p></o:p></span></font></i></p>
<p class=MsoNormal style='border:none;padding:0in'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;font-style:italic'><o:p> </o:p></span></font></i></p>
<p class=MsoNormal style='border:none;padding:0in'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;font-style:italic'> If you would
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href="http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml">MaineCare's
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<p class=MsoNormal style='border:none;padding:0in'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;font-style:italic'><o:p> </o:p></span></font></i></p>
<p class=MsoNormal style='border:none;padding:0in'><i><font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial;font-style:italic'>Do not reply to
this e-mail. Your e-mail will not receive response. If you have questions,
please call 1-800-321-5557. </span></font></i><o:p></o:p></p>
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