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    • Changes to State Involvement in Helping Medicare Savings Program (MSP) Members Select Medicare Part D Plans -

      Starting this fall, MSP benefit recipients will need to review their Medicare Part D Plans. The State of Maine will no longer pick a Medicare Part D plan for them. The local Area Agency on Aging is available to help these individuals. They will help them see if their medications are covered and select an appropriate plan. The Area Agency on Aging has several offices in the state. The office the member calls depends on where he/she resides. Please see the list of Area Agency on Aging phone numbers below:

      • Aroostook Agency on Aging, serves people who live in Aroostook County, 1-800-439-1789 or 764-3396

      • Eastern Area Agency on Aging, serves people who live in Hancock, Penobscot, Piscataquis or Washington counties, 1-800-432-7812 or 941-2865

      • Seniors Plus, serves people who live in Androscoggin, Franklin or Oxford counties, 1-800-427-1241 or 795-4010

      • Spectrum Generations serves people who live in Kennebec, Knox, Lincoln, Sagadahoc, Somerset, Waldo counties, and people who live in the towns of Brunswick or Harpswell, 1-800-639-1553 or 622-9212

      • Southern Maine Area Agency on Aging, serves people who live in York County, or Cumberland County except the towns of Harpswell and Brunswick, 1-800-427-7411 or 396-6500

      For more information, please see the 2014 Medicare Part D Member letter that was sent to benefit recipients on MaineCare’s Member webpage.

         

    • Fee Schedule Changes, CR 19681 - October 14, 2014

      MaineCare will be changing the way the fee schedules are posted on the Health PAS Online Portal. They will no longer be posted as tabs within one file. They will now be posted as individual files in three different formats, CSV, .PDF and EXCEL (2003). Before using this new version of the fee schedules, please take some time to read the MaineCare Fee Schedule Preface (found with the fee schedule) for important information regarding the use of the fee schedules. The files will be updated weekly, on Mondays, beginning October 20, 2014.

      You can find the fee schedule in the Provider Fee Schedule folder on the Health PAS Online Portal.

      Some tips for using these files:

      • CSV can be saved to any version of EXCEL
      • We recommend using freeze top row view in EXCEL
      • We recommend that you enable filtering under the data menu
      • We do not recommend working with printed versions because these files are updated weekly and these documents are very large
      • If you need to print these files, we recommend that you set the header row to repeat
         

    • Code and Rate Additions, Deletions, and Corrections - October 14, 2014

      The “Code and Rate Additions, Deletions, and Corrections” spreadsheets have recently been updated. The spreadsheets are used to notify you of code and rate changes. You can view these spreadsheets on the "Claims, Billing, and Enrollment webpage. We will send a listserv update when new information is added.

         

    • Placement of the Prior Authorization (PA) Documents on the Health PAS Online Portal - October 28, 2014

      The Authorizations Pathways folder will be removed from the portal as of October 31, 2014. The Pathways Radiology form has been moved to the Authorizations and Referrals folder and the Pathways Radiology PA Request Guide and Radiology CPT Screening Guide have been moved to the Provider Handbooks folder. These changes are being made to be consistent with the placement of all other forms and guides available on the portal.

         

    • Extended Health PAS Online Portal Maintenance Time - January 9, 2015

      The Health PAS Online Portal will be unavailable from Saturday, January 10, 2015 at 3:00 PM until Sunday, January 11, 2015 at 3:00 PM for maintenance. All portal functions will be unavailable during this time. We apologize for the inconvenience and appreciate your patience.

         

    • Code and Rate Additions, Deletions, and Corrections - January 9, 2015

      The “Code and Rate Additions, Deletions, and Corrections” spreadsheets have recently been updated. The spreadsheets are used to notify you of code and rate changes. You can view these spreadsheets on the Claims, Billing, and Enrollment webpage. We will send a listserv update when new information is added.

         

    • Emergency Relax Edifecs Edits, CR 47346 - January 13, 2015

      While implementing updates to Edifecs software, certain edits are now being enforced. These edits are causing claim rejections for electronic submissions for 837I (UB-04) & 837P (1500s). After reviewing the edits, we have decided to relax them. Once the edits are relaxed, claims with this information will be accepted and processed. Claims rejected prior to this change will need to be resubmitted.

      The following Edifecs EDI Edits will be relaxed:

       0x3938aea - Loop 2300 - DTP453 (Acute Manifestation) is missing when CR208 = A or M in the 2300 loop. Date for Acute Manifestation is required on Medicare claims involving spinal manipulation for acute condition.  0x3938b8e - DTP096 (Discharge hour) should be used only for inpatient claims in Loop 2300.  0x3939312 - Service Facility Location NPI in Loop 2310C should not be used when it has the same value as the Billing Provider NPI in Loop 2010AA.  0x393941d - DTP431 (Onset of Current Illness or Symptom) in Loop 2300 should not be used with the same value as the Service Date (DTP472) in Loop 2400.

      We will notify you when MIHMS has been updated and these edits have been relaxed.

         

    • Update to MaineCare Benefits Manual Section 85, Physical Therapy (PT) and Section 68, Occupational Therapy (OT) - January 14, 2015

      MaineCare has made recent changes to the PT and OT policies to encumber the following:

      • The link located in Section 85.06-5 and 68.06-5 for splinting codes has been updated. These codes can be found on the Department’s Rate Setting Webpage. The updated rates are listed by individual policy under the corresponding fee schedule.

      • Code L3929 (Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise) has been added to benefits and is now available for submission. The L3929 code can be found in the Rate Setting Webpage as listed above.

         

    • MaineCare Secondary Billing Reminder - January 20, 2015

      We have recently noticed some errors when billing MaineCare as a secondary insurance. Billing incorrectly can cause improper payment. For clarification regarding common mistakes in Direct Data Entry (DDE), paper claim submission, and electronic claim submission, please see the MaineCare Secondary Billing Reminder document in the Supplemental Billing Information section of the Health PAS Online Portal.

         

    • J-Code Issues for ParaGard, Nexplanon, Skyla and Kadcyla, CR 43692, CR 46952, CR 46974, CR 46975, CR 46976 - January 21, 2015

      The issue where claims were denying in error for J-Code combinations affecting ParaGard, Nexplanon, Skyla and Kadcyla has now been corrected. The claims were denying due to edit 5021 “Drug not rebatable” and Edit 5022 - NDC/JCode is Missing/Invalid.

      You can identify these claims on your Remittance Advice (RA) by these reason and remark codes:

      • CARC - 16 - Claim/service lacks information or has submission/billing error(s) which are needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. • RARC - M119 - Missing/incomplete/invalid/deactivated/withdrawn National Drug Code (NDC). Affected claims will be reprocessed and no provider action is needed. If you are holding your claims, please submit them at this time.

         

    • Claims for ParaGard Denying Incorrectly, CR 43692 - January 21, 2015

      The following message relates to this issue and was sent by listserv on 08/01/2014:

      Claims for ParaGard Denying Incorrectly, CR 43692

      Some claims for NDC 51285020401 (ParaGard DS)/ J7300 Intrauterine copper contraceptive are denying in error due to edit 5021 “Drug not rebatable” and Edit 5022 - NDC/JCode is Missing/Invalid.

      You can identify these claims on your Remittance Advice (RA) by these reason and remark codes:

      • CARC - 16 - Claim/service lacks information or has submission/billing error(s) which are needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. • RARC - M119 - Missing/incomplete/invalid/deactivated/withdrawn National Drug Code (NDC). We are working to correct this issue and will notify you when it is resolved. No provider action is needed at this time.

         

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