Frequently Asked Billing Questions by MBCHP Providers...

1. If I provide a non-covered service to a MBCHP client, can I bill the woman for the service?

Before a MBCHP provider performs a non-covered service on a MBCHP client, the provider must explain to the patient that they will be financially responsible for the non-covered service. The MBCHP clients may only be charged for a non-covered service.
Providers participating in the MBCHP network are required to accept as payment in full, the allowances established by MBCHP for covered services.
Clients cannot be billed for any portion of a MBCHP covered service.
Providers may not submit claims to Collection Agencies for MBCHP covered services.
Any provider or billing agency with questions should call MBCHP before processing bills.

2. If I have a billing issue for a MBCHP client, what should I do?

First, please call the MaineCare Provider line to check on the status of claim or client eligibility:
- MaineCare Provider Line 1-800-321-5557
Second, if you have a specific claims issue, please fax a copy of the claim, including Remittance Advice (RA) and Explanation of Medical Benefit (EOB) to the MBCHP with a brief description of the issue on the fax cover sheet:
- MBCHP fax number: 207-287-4100
- MBCHP fax number 207-287-8944
Third, call MBCHP if you have a claim that is stuck in the Mainecare system for over 60 days.

3. How do I handle a covered service claim for a MBCHP client who has private or group insurance benefits?

MBCHP is the payor of last resort. It is the responsibility of the provider to determine from each MBCHP client whether there are any other resources (private or group insurance benefits, etc.) that are available for payment of the service and to seek payment from such resource prior to billing MBCHP.
Once the claim has been processed by the third-party insurer, a copy of the Explanation of Benefits (EOB) must be attached to the MBCHP claim and submitted to:
- Medical Assistance Claims Processing
  M-500
  Augusta, ME 04330