Maine CDC Breast and Cervical Health Program (MBCHP)


Information for Providers Participating in MBCHP

Join our ListServe at: http://mailman.informe.org/mailman/listinfo/mbchp-provider

for policy & program updates, billing changes, and other MBCHP program specific updates.


MBCHP Provider Informational Resources

  • MBCHP forms (for use by providers only)

  • MBCHP training resources

  • Archived letters and memos sent to providers


Billing Specific Resources

  • List of Allowable Diagnosis Codes for Billing MBCHP

  • Lists of Allowable CPT Codes and Reimbursement Rates for Billing MBCHP

  • List of Allowable Revenue Codes for Billing MBCHP

**MBCHP claims have a maximum timely filing limit of 180 days from Date of Service after which time a claim may be denied as "untimely".**


Program/Policy Specific Resources

  • MBCHP Primary Care and Diagnostic Provider Manuals

  • MBCHP Program Rules

  • The Treatment Act (MaineCare) Rules



MBCHP Provider Informational Resources

MBCHP forms (for use by providers only)
  • MBCHP Member Initial Enrollment Form (for NEW Clients Only) Word* / PDF*
  • MBCHP Visit Form Part 1 & 2 Word* / PDF* (Updated 1/2013)
  • Abnormal Cervical Follow-up Report Word* / PDF*
  • Abnormal Breast Follow-up Report Word* / PDF*

MBCHP training resources:

 

  • Power Point presentation used for education/training at site visits (5/14/2013) PPT*

Archive letters and memos sent to providers:

 
  • Submitting MBCHP Visit Form (Part 1 & 2) and Screening Results to MBCHP (3/16/2010) PDF*(PCP)
  • Coverage for Cervical Cancer Screening HPV Co-testing (12/14/2012) PDF*(PCP)/ PDF*(LAB)
  • MBCHP Timely Filing for Claims Reimbursement (4/23/2013) PDF*(Hospital billers)
  • MBCHP Timely Filing for Claims Reimbursement (5/15/2013) PDF*(Laboratory/Mammography billers)
  • Cervical Cancer Screening Co-testing (6/6/2013) PDF*(PCP)
  • Claim Edit 5031 Biller Memo (7/12-2013) PDF*(FQHC/RHC billers)
  • ACA and MBCHP Memo to Providers (November 2013) PDF*(PCP)
    • Sample of Enclosed Member Letter referenced in Memo above PDF*
  • ACA and MBCHP Memo to Providers (October 2014) PDF*(PCP)
    • Sample of Enclosed Member Letter referenced in Memo above PDF*
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Billing Specific Resources

MBCHP allowable Diagnosis Codes

  • Diagnosis Codes (ICD-9) (2013) PDF*
Note:   QNXT may deny your claim if you use a Diagnosis Code NOT listed.
Use of Diagnosis Code V70.0 alone may also cause your claim to DENY. You must use another MBCHP Diagnosis Code in addition to V70.0 so we can tell that a screening service covered by MBCHP was performed during the office visit being billed.

 

  • Diagnosis Codes (ICD-10) (effective 10/2014) PDF*
Note:  These new codes will be in QNXT by October 1, 2014 when ICD-10 goes into effect. **NOTE**: ICD-10 implementation has been postponed by CMS until October 1, 2015.

 

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MBCHP Reimbursement Rates

CPT/HCPCS list by Provider Type

  • Laboratory CPT Codes and Rates (2011) Word* | PDF*
    • (Rates effective from 7/1/2011-6/30/2012)
  • Laboratory CPT Codes and Rates (2012) Word* | PDF*
    • (Rates effective from 7/1/2012-6/30/2013)
  • Laboratory CPT Codes and Rates (2013) Word* | PDF*
    • (Rates effective from 7/1/2013-6/30/2014)
  • Laboratory CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from 7/1/2014-6/30/2015)
  • Pathologists CPT Codes and Rates (2011) Word* | PDF*
    • (Rates effective from 7/1/2011-6/30/2012)
  • Pathologists CPT Codes and Rates (2012) Word* | PDF*
    • (Rates effective from 7/1/2012-6/30/2013)
  • Pathologists CPT Codes and Rates (2013) Word* | PDF*
    • (Rates effective from 7/1/2013-6/30/2014)
  • Pathologists CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from 7/1/2014-6/30/2015)
  • Mammography CPT Codes and Rates (2011) Word* | PDF*
    • (Rates effective from 7/1/2011-6/30/2012)
  • Mammography CPT Codes and Rates (2012) Word* | PDF*
    • (Rates effective from 7/1/2012-6/30/2013)
  • Mammography CPT Codes and Rates (2013) Word* | PDF*
    • (Rates effective from 7/1/2013-12/31/2013)
  • Mammography CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from 1/1/2014-6/30/2014) **NOTE** Effective 1/1/2014 77031 & 77032 were discontinued. Also, effective 1/1/2014, MBCHP now covers 77053.
  • Mammography CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from 7/1/2014-6/30/2015)
 
  • Primary Care Providers CPT Codes and Rates (2011) Word* | PDF*

    • (Rates effective from 7/1/2011-6/30/2012)
  • Primary Care Providers CPT Codes and Rates (2012) Word* | PDF*
    • (Rates effective from 7/1/2012-6/30/2013)
  • Primary Care Providers CPT Codes and Rates (2013) Word* | PDF*
    • (Rates effective from 7/1/2013-6/30/2014)
  • Primary Care Providers CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from 7/1/2014-6/30/2015)
  • Radiologists CPT Codes and Rates (2011) Word* | PDF*
    • (Rates effective from 7/1/2011-6/30/2012)
  • Radiologists CPT Codes and Rates (2012) Word* | PDF*
    • (Rates effective from 7/1/2012-6/30/2013)
  • Radiologists CPT Codes and Rates (2013) Word* | PDF*
    • (Rates effective from 7/1/2013-12/31/2013)
  • Radiologists CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from 1/1/2014-6/30/2014) **NOTE** Effective 1/1/2014, 77031 & 77032, 19102 & 19103, 19290 & 19291, & 19295 were discontinued. Also, effective 1/1/2014, MBCHP now covers 77053,& 19081 thru 19086.
  • Radiologists CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from 7/1/2014-6/30/2015)
  • Diagnostic Provider CPT Codes and Rates (2011) Word* | PDF*
    • (Rates effective from 7/1/2011-6/30/2012)
  • Diagnostic Provider CPT Codes and Rates (2012) Word* | PDF*
    • (Rates effective from 7/1/2012-6/30/2013)
  • Diagnostic Provider CPT Codes and Rates (2013) Word* | PDF*
    • (Rates effective from 7/1/2013-12/31/2013)
  • Diagnostic Provider CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from1/1/2014-6/30/2014) **NOTE** Effective 1/1/2014, 77031 & 77032, 19102 & 19103, 19290 & 19291, & 19295 were discontinued. Also, effective 1/1/2014, MBCHP now covers 77053, 19081 thru 19086,& 19281 thru 19288.
  • Diagnostic Provider CPT Codes and Rates (2014) Word* | PDF*
    • (Rates effective from7/1/2014-6/30/2015)
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MBCHP allowable Revenue Codes (UB-04)

  • Revenue Codes (Updated 2013) PDF*
Note: QNXT may deny your claim if you use a Revenue Code NOT listed on the Revenue Code list.

Billing MBCHP with TC or 26 modifiers

Modifiers TC & 26 are no longer REQUIRED for institutional claims (UB-04). For MBCHP claims, QNXT will now determine whether the claim line is for the professional or technical component based on the Revenue Code used on the claim line, i.e., 0960 77057 will pay the professional rate and 0403 77057 will pay the technical component rate.
TC & 26 modifiers may still be used on the UB-04 claim lines but are no longer REQUIRED for MBCHP claims to process.
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 Program/Policy Specific Resources

MBCHP Participating Provider Policy Manuals:

 

     MBCHP Program Rules:

 

         MaineCare Rules (The Treatment Act is a MaineCare expansion program):

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Updated September 30, 2014