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    • MaineCare Dental Providers: 2014 Adult Dental Care Survey - September 12, 2014

      In an effort to reduce inefficient and inappropriate use of hospital emergency and outpatient departments for dental care for adults (individuals 21 years of age and older), and to provide the right care to MaineCare members at the right time and in the right setting, the Office of MaineCare Services in partnership with the MaineCare Dental Advisory Committee, would like a better understanding of your perspective on the following:

      • The statutory provision for the treatment of dental pain, infection, and imminent tooth loss of adult MaineCare members according to Chapter II, Section 25 (Dental Services) of the MaineCare Benefits Manual
      • Appropriate usage of adult dental care procedures for adult MaineCare members

      Please take a few minutes to complete a short survey using the online Survey Monkey tool. Your responses to survey questions are completely confidential and cannot be associated in any way with you as an individual or with your dental practice. To complete the survey, please select the following link:

      https://www.surveymonkey.com/s/adult-dental

      Thank you for your participation If you have questions, please contact Beth Pearce.

         

    • Attention Institutional Providers, CR43421 & CR43673 - September 18, 2014

      MaineCare requires the date of admission on inpatient claims with the following bill types: 011X, 012X, 018X, 021X, 028X, 032X, 033X, 041X, 065X, 066X, 081X, 082X, 086X, and 089X. A listserv message sent previously stated 033X, 081X, & 082X did not require an admit date. After further review, we have determined these additional bill types require an admit date. MIHMS will be updated to ensure this information is required moving forward. The following bill types cannot be submitted by paper claim submission at this time: 033X, 081X, 082X, & 089X. Please submit these claims using Electronic Data Interchange (EDI) or the Health PAS Online Portal.

      Below is the listserv sent on January 9, 2014 regarding TR 38600, which is related to this issue:

      Attention Institutional Providers, TR 38600 MaineCare requires the date of admission on inpatient claims with the following bill types: 011X, 012X, 018X, 021X, 028X, 041X, 065X, 066X, 086X, and 089X. However, a recent system upgrade requires admission dates for additional bill types that MaineCare does not. These include bill types: 022X, 033X, 051X, 074X, 075X, 081X, 082X. As a result, claims with these additional bill types are denying in error. We will notify you when this issue has been corrected and affected claims will be reprocessed. No provider action is needed.

         

    • Tobacco Cessation Counseling in Section 65, Behavioral Health Services - September 19, 2014

      As was noted in the August 5, 2014 listserv, “Tobacco Cessation Services,” effective August 1, 2014, tobacco cessation counseling became a covered service in Section 65, Behavioral Health Services. This message is a follow-up to the previous listserv to provide specific information for behavioral health providers in Section 65.

      Tobacco cessation counseling may be provided in the form of individual or group counseling and billed utilizing the four Current Procedural Terminology (CPT) codes below.

      Individual: - 99406 (smoking and tobacco use cessation counseling visit, greater than three and up to 10 minutes) RATE: $8.67 - 99407 (smoking and tobacco use cessation counseling visit, greater than 10 minutes) RATE: $16.81

      Group: - 99411 (preventive medicine, group counseling, 30 minutes) RATE: $11.54 - 99412 (preventive medicine, group counseling, 60 minutes) RATE: $15.04

      Both forms of tobacco cessation counseling may be provided by licensed clinicians practicing within the scope of licensure as defined under State law and who are eligible to provide other coverable services in Section 65. No additional certification such as Tobacco Treatment Specialist (TTS-C) is required.

      Providers may bill these services alone or in addition to other Section 65 covered services provided on the same date of service. Documentation of tobacco cessation counseling must be included in the member’s record.

      As a reminder, no co-payments or other cost-sharing may be imposed on these services and there is no limitation placed on the number of annual tobacco cessation counseling sessions available to MaineCare members.

      There are a number of Tobacco Treatment trainings that can be found on the Maine Center for Disease Control and Prevention Partnership for a Tobacco Free-Maine’s Tobacco Treatment Training Events webpage. In addition, the Partnership for A Tobacco-Free Maine and the Breathe Easy Coalition websites are available resources.

      Please see the Provider Relations Specialist Policy Assignment list to contact your specialist with questions.

         

    • CORRECTION to MaineCare Benefits Manual Section 25, Dental Services - September 23, 2014

      We have discovered a typographical error in the Chapter II, Section 25, Dental Services policy. The Appendix III, MaineCare Temporary Filling Standardized Written Agreement Form referenced an incorrect section of the MaineCare Benefits Manual. Section 1: Independent Practice Dental Hygienist Section and Section 2: Dentist Section, both contained an incorrect reference to Chapter 101, MaineCare Benefits Manual, Chapter II, Section 25.07-5(E)(2)(b). The correct reference is to 25.07-6 (B) (2).

      For Questions: Please contact Provider Relations Specialist, Shelly Hayward at Email: Shelly.l.hayward@maine.gov or Phone: (207) 624-6933.

         

    • Remittance Advice (RA) Delay - September 25, 2014

      RA generation for today, September 25th, has been delayed until tomorrow, September 26th. Providers can expect their weekly RA to be available at that time. 835 remits should be posted and available later this afternoon. Electronic Funds Transfers (EFTs) and paper checks will not be affected.

      Thank you for your patience.

         

    • Hospital and Other Referrals to Goold Health Systems (GHS) for Long Term Care Assessments - September 29, 2014

      Please be aware that there is a mandatory statewide DHHS training for all RN assessors of GHS on Tuesday, September 30, 2014 and Wednesday, October 1, 2014.

      This means:

      • If a hospital referral is made on Monday or Tuesday (September 29th or 30th), every effort will be made to complete the assessment within twenty-four hours of the referral date as is the usual practice. However, depending on the geographic location of the referral and the availability of RN assessors, the assessment may be delayed until Thursday, October 2, 2014.

      • Depending on referral volume, this may impact the timing of non-hospital assessment referrals as well.

         

    • Adobe Reader Upgrade: Remittance Advice (RA) Issue - September 29, 2014

      Due to a recent upgrade to Adobe Acrobat Reader, computers running operating systems Windows 7 or 8 may experience issues viewing RAs in the PDF format. To work around this problem, please follow the steps below:

      • Open the "Start" menu and click on "Default Programs."
      • Click "Associate a file type or protocol with a program." The window lists the types of files stored on your computer.
      • Select ".pdf" from the list and click the "Change Program" button in the top right portion of the window.
      • Select Adobe Reader as the default program to open PDFs.
      • Select the program and click "Open." Your computer should now open PDFs with Adobe Acrobat Reader.

      If you need help, please contact the Provide Services EDI Help Desk at 1-866-690-5585 (TTY: 711).

         

    • Radiology Professional Component Prior Authorization (PA) Reminder - September 29, 2014

      In an effort to reduce unnecessary PA denials, please read the following important reminder.

      MaineCare does not require a PA for the professional component on Radiology Services. When a PA is requested for Radiology Services, this creates one (1) unit for the technical component of the service.

      When you are billing Radiology services that have a PA, do not attach the PA number to the claim with the 26 modifier. The PA number needs to be added to the claim for the technical component.

         

    • Adding Code E0190 to Durable Medical Equipment (DME) Contracts, CR 45195 - September 29, 2014

      Effective October 1, 2014, code E0190 (Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories) will be added as an allowable service to DME contracts. In order to be reimbursed, you must attach an invoice to your claim.

         

    • 2014 Affordable Care Act (ACA) Primary Care Physician (PCP) Rates Updated, CR 42885 - September 29, 2014

      The ACA PCP fee schedule has been updated effective January 1, 2014. The new rates are available at the Department of Health and Human Services Rate Setting website. Affected claims will be reprocessed. No provider action is needed.

         

    • Planned Disaster Recovery Testing from 8:00 AM Saturday October 11th to 12:00 PM October 13th - September 29, 2014

      MIHMS and the Health PAS Online Portal will be unavailable from 8:00 AM on Saturday, October 11, 2013 through Monday, October 13, 2013 at 12:00 PM (noon). MaineCare will perform a scheduled Disaster Recovery Test on the system during this time.

      Payment processing cycle impact:

      • Claims adjudicated during the October 4th cycle starting at 12:01 AM through noon October 9th (6 days) will be paid on October 15th.
      • Claims adjudicated during the October 9th cycle starting at 12:01 PM through October 17th at noon (8 days) will be paid on October 22rd.

      Claims adjudicated during October 18th cycle, will return to seven (7) day processing and payment cycles.

      During the test period, the Health PAS Online Portal will be unavailable. Providers and billing agents can:

      • Check MaineCare eligibility through the Interactive Voice Response (IVR) by calling 1-866-690-5585. Eligibility verification data will be current as of Friday, October 10th.
      • Expect payments to be on the regular weekly schedule, but please note:

        • Payments for the week ending October 10th will include six (6) days of claims rather than a full week.

        • Payments for the week ending October 17th will include eight (8) days of claims rather than a full week.

        • Electronic Fund Transfer (EFT), PDF Remittance Advices (RAs) and 835s will not be affected. Paper RAs and checks will be on schedule.

        • The portal will be available until 8:00 AM on Saturday, October 11th so that you can download your 835s prior to the scheduled downtime

        • For the entire period of the Disaster Recovery exercise, the maintenance page will be displayed on the portal.

      While the Health PAS Online Portal is unavailable, providers and billing agents cannot:

      • Submit Direct Data Entry (DDE) or electronic claims
      • View any portal documents
      • Retrieve a PDF RA or 835
      • Perform a new provider enrollment or submit a maintenance case for an existing enrollment
      • Use any portal functionality (Including 837, 270 or 271 submissions)
         

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          • MaineCare Dental Providers: 2014 Adult Dental Care Survey - September 12, 2014

            In an effort to reduce inefficient and inappropriate use of hospital emergency and outpatient departments for dental care for adults (individuals 21 years of age and older), and to provide the right care to MaineCare members at the right time and in the right setting, the Office of MaineCare Services in partnership with the MaineCare Dental Advisory Committee, would like a better understanding of your perspective on the following:

            • The statutory provision for the treatment of dental pain, infection, and imminent tooth loss of adult MaineCare members according to Chapter II, Section 25 (Dental Services) of the MaineCare Benefits Manual
            • Appropriate usage of adult dental care procedures for adult MaineCare members

            Please take a few minutes to complete a short survey using the online Survey Monkey tool. Your responses to survey questions are completely confidential and cannot be associated in any way with you as an individual or with your dental practice. To complete the survey, please select the following link:

            https://www.surveymonkey.com/s/adult-dental

            Thank you for your participation If you have questions, please contact Beth Pearce.

               

          • Tobacco Cessation Counseling in Section 65, Behavioral Health Services - September 19, 2014

            As was noted in the August 5, 2014 listserv, “Tobacco Cessation Services,” effective August 1, 2014, tobacco cessation counseling became a covered service in Section 65, Behavioral Health Services. This message is a follow-up to the previous listserv to provide specific information for behavioral health providers in Section 65.

            Tobacco cessation counseling may be provided in the form of individual or group counseling and billed utilizing the four Current Procedural Terminology (CPT) codes below.

            Individual: - 99406 (smoking and tobacco use cessation counseling visit, greater than three and up to 10 minutes) RATE: $8.67 - 99407 (smoking and tobacco use cessation counseling visit, greater than 10 minutes) RATE: $16.81

            Group: - 99411 (preventive medicine, group counseling, 30 minutes) RATE: $11.54 - 99412 (preventive medicine, group counseling, 60 minutes) RATE: $15.04

            Both forms of tobacco cessation counseling may be provided by licensed clinicians practicing within the scope of licensure as defined under State law and who are eligible to provide other coverable services in Section 65. No additional certification such as Tobacco Treatment Specialist (TTS-C) is required.

            Providers may bill these services alone or in addition to other Section 65 covered services provided on the same date of service. Documentation of tobacco cessation counseling must be included in the member’s record.

            As a reminder, no co-payments or other cost-sharing may be imposed on these services and there is no limitation placed on the number of annual tobacco cessation counseling sessions available to MaineCare members.

            There are a number of Tobacco Treatment trainings that can be found on the Maine Center for Disease Control and Prevention Partnership for a Tobacco Free-Maine’s Tobacco Treatment Training Events webpage. In addition, the Partnership for A Tobacco-Free Maine and the Breathe Easy Coalition websites are available resources.

            Please see the Provider Relations Specialist Policy Assignment list to contact your specialist with questions.

               

           

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