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    • Primary Care Provider Incentive Payments (PCPIP) and Report Schedule - July 14, 2014

      MaineCare is currently completing the PCPIP and PCPIP49 reports for the reporting period of 10/01/2012 - 09/30/2013. The reports will be available on the MyHealthPAS Online Portal. Go to the Health PAS Online Portal and sign in to the secure trading partner page. Then, go to File Exchange > Reports > Other Reports.

      The schedule is as follows: - The reports are available on the MyHealthPAS Online Portal as of 07/11/2014. - The reports were mailed to providers that do not have a Trading Partner Account on 07/11/2014. - The payments will be processed with the 07/16/2014 payment cycle.

      For any questions, please email PCP Network Services.

         

    • Attention Maine-Administrative Service Organizations (ASO)/MaineCare Providers - July 18, 2014

      This notice is regarding assessing the medical necessity of Section 17 services.

      Effective August 1, 2014, APS Healthcare in collaboration with the Office of MaineCare Services, will assess medical necessity criteria for the waiver of a 30-day overlap of non-concurrent services for Section 17 services as outlined in the MaineCare Benefits Manual.

      MaineCare rules state which services are considered duplicative (identical or similar services) or non-concurrent (services that cannot be provided together). MaineCare policy has not changed and providers are still responsible to follow policy for services provided to MaineCare members.

      Section 17.05-2 Multiple Provider states the following:

      Only a single Community Support provider may be reimbursed at the same time for services to any one member under this Section for Community Integration Services, Community Rehabilitation Services, Intensive Case Management, or Assertive Community Treatment. Other Community Support Services are reimbursable under this Section to more than one Community Support Provider at a time. Requests for a waiver of the limitation on multiple providers may be approved by DHHS, upon request and in accordance with Section 17.08-2(C).
      A section 17 provider may request this waiver by logging in securely to the CareConnection system. You can request the waiver with the H215-Community Integration (CI)-30 day Waiver code for up to a 30 day period. . A rationale for the waiver is required at time of request in the CareConnection system.

      What does this mean for providers?

      Providers will need to coordinate with members to resolve issues of duplicative or non-concurrent services. Many of these issues can be avoided by promptly submitting a Discharge Review in the APS CareConnection web portal when a member is no longer receiving services from a provider. Providers may contact APS Provider Relations with questions, at 1-866-521-0027, Option 1, or via email at MaineCare-Prov@apshealthcare.com .

      What does this mean for members?

      Members will need to coordinate with their providers when transitioning services or switching providers. Members may contact the APS Member Liaison with questions, at 1-866-521-0027, Option 3, or via email at rlavigne@apshealthcare.com.

         

    • Direct Data Entry (DDE) Claim Adjustment Reminder, CR 43781 - July 28, 2014

      When adjusting a claim on the Health PAS Online Portal using DDE, please verify the service line information before submitting your claim. When completing the “to” date, the system will default to the “from” date when billing for services that span a period. For example, if billing three units for room and board, the “from” and “to” dates must span three days. By not entering the appropriate “to” date information, the claim will deny. The dates of service on the lines must be correct when adjusting the claim or the claim will deny. We are currently working on a solution that will alert you when the date of service and units do not match. This alert will give you an opportunity to fix the claim prior to submission.

         

    • Provider Services Call Center Will Close Early Friday July 25th - July 28, 2014

      The Provider Services Call Center will close at 3:00 PM today, July 25, 2014, to allow call center staff to attend training. The MyHealth PAS Online Portal will continue to be available during this time. The IVR self-service options will also remain available; however, the option to speak with a call center representative will not be available. The Provider Services Call Center will resume regular business hours on Monday, July 28, 2014.

         

    • NET Brokerage: Recurring Trips - July 28, 2014

      As we prepare to transition to new Non-Emergency Transportation brokers in Regions 1, 2, 4, 5, 6 and 7, we are asking providers that serve members who receive recurring transportation (also called standing order or subscription trips) to call the new broker in their regions and verify that the trips are scheduled properly. This will serve as one final safety check on the data, and ensure the member’s continue to receive transportation. Members can also contact the brokers directly to confirm their rides are properly scheduled.

      Below is the contact information for providers to use for trips on or after August 1, 2014:

      Logisticare – Regions 1, 2, 6, 7, 8

      • Medical Provider Phone: 1-877-659-1305; Fax: 1-877-637-9091
      • Transportation Provider (Transporter) Phone: 1-877-659-1304; Transportation Provider Fax: 1-877-637-9092

      MidCoast Connector (Waldo CAP) – Region 5

      • Medical Provider Phone: 1-855-930-7900, Prompt 4; Provider Fax: 207-218-1159

      Penquis CAP – Regions 3 & 4

      • Medical Provider Phone for Region 3: 1-855-437-5883
      • Medical Provider Phone or Region 4: 1-855-736-7847
      • Provider Fax for Regions 3 and 4: 207-941-2823
         

    • ICD-10 Implementation Update - July 28, 2014

      As we previously communicated on April 1, 2014, a bill was signed into law to delay the ICD-10 implementation for at least one additional year. The Centers for Medicare & Medicaid Services (CMS) recently communicated that the final rule will be promulgated and the tentative implementation date is October 1, 2015. Until CMS adopts the rule, this implementation date could change. MaineCare Services is actively continuing to prepare for this implementation to enable a successful transition, proceeding with remediation efforts with the October 1, 2015 deadline in mind. You will see MaineCare’s ICD-10 activity pick up in February 2015 in order for us to complete all tasks required prior to implementation.

      What does the ICD-10 delay mean for providers?

      With the delay, providers have additional time to prepare for the ICD-10 implementation. However, it is important that providers use this time to continue to prepare for ICD-10.

      When do providers need to be ready to submit ICD-10 claims?

      For all discharges and dates of service on or after the ICD-10 implementation date, diagnosis and inpatient procedure codes must be submitted using ICD-10 codes in order to receive reimbursement.

      We will continue to keep you updated on the ICD-10 implementation activities through ongoing listservs, webinars and MaineCare’s ICD-10 website. Please send questions and concerns to the ICD-10 Email Box.

         

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          • Attention Maine-Administrative Service Organizations (ASO)/MaineCare Providers - July 18, 2014

            This notice is regarding assessing the medical necessity of Section 17 services.

            Effective August 1, 2014, APS Healthcare in collaboration with the Office of MaineCare Services, will assess medical necessity criteria for the waiver of a 30-day overlap of non-concurrent services for Section 17 services as outlined in the MaineCare Benefits Manual.

            MaineCare rules state which services are considered duplicative (identical or similar services) or non-concurrent (services that cannot be provided together). MaineCare policy has not changed and providers are still responsible to follow policy for services provided to MaineCare members.

            Section 17.05-2 Multiple Provider states the following:

            Only a single Community Support provider may be reimbursed at the same time for services to any one member under this Section for Community Integration Services, Community Rehabilitation Services, Intensive Case Management, or Assertive Community Treatment. Other Community Support Services are reimbursable under this Section to more than one Community Support Provider at a time. Requests for a waiver of the limitation on multiple providers may be approved by DHHS, upon request and in accordance with Section 17.08-2(C).
            A section 17 provider may request this waiver by logging in securely to the CareConnection system. You can request the waiver with the H215-Community Integration (CI)-30 day Waiver code for up to a 30 day period. . A rationale for the waiver is required at time of request in the CareConnection system.

            What does this mean for providers?

            Providers will need to coordinate with members to resolve issues of duplicative or non-concurrent services. Many of these issues can be avoided by promptly submitting a Discharge Review in the APS CareConnection web portal when a member is no longer receiving services from a provider. Providers may contact APS Provider Relations with questions, at 1-866-521-0027, Option 1, or via email at MaineCare-Prov@apshealthcare.com .

            What does this mean for members?

            Members will need to coordinate with their providers when transitioning services or switching providers. Members may contact the APS Member Liaison with questions, at 1-866-521-0027, Option 3, or via email at rlavigne@apshealthcare.com.

               

          • ICD-10 Implementation Update - July 28, 2014

            As we previously communicated on April 1, 2014, a bill was signed into law to delay the ICD-10 implementation for at least one additional year. The Centers for Medicare & Medicaid Services (CMS) recently communicated that the final rule will be promulgated and the tentative implementation date is October 1, 2015. Until CMS adopts the rule, this implementation date could change. MaineCare Services is actively continuing to prepare for this implementation to enable a successful transition, proceeding with remediation efforts with the October 1, 2015 deadline in mind. You will see MaineCare’s ICD-10 activity pick up in February 2015 in order for us to complete all tasks required prior to implementation.

            What does the ICD-10 delay mean for providers?

            With the delay, providers have additional time to prepare for the ICD-10 implementation. However, it is important that providers use this time to continue to prepare for ICD-10.

            When do providers need to be ready to submit ICD-10 claims?

            For all discharges and dates of service on or after the ICD-10 implementation date, diagnosis and inpatient procedure codes must be submitted using ICD-10 codes in order to receive reimbursement.

            We will continue to keep you updated on the ICD-10 implementation activities through ongoing listservs, webinars and MaineCare’s ICD-10 website. Please send questions and concerns to the ICD-10 Email Box.

               

          • Non-Emergency Transportation (NET) Changes - July 30, 2014

            *Please note the phone and fax number for Penquis CAP, regions 3 and 4, have been corrected in the message below.

            Effective August 1, 2014, the NET brokerage system is changing. Coordinated Transportation Solutions (CTS) will no longer provide non-emergency transportation services to MaineCare members. For those members who had Logisticare or Penquis CAP prior to this change, their broker will not change. For those who had CTS previously, they will now have Logisticare, MidCoast Connector (Waldo CAP), or Penquis CAP.

            If you need to contact a NET broker to schedule a trip for a MaineCare member, please use the phone numbers that are designated for medical, school-based services, and transportation providers. These phone numbers are not the same numbers that members call to reach the brokers, and using the dedicated phone numbers will expedite your call.

            At this time, please continue to call the current broker contacts to schedule trips prior to August 1, 2014.

            Beginning July 18, 2014, the new phone lines will be open for trips on or after August 1, 2014.

            Below is the contact information for providers to use for trips on or after August 1, 2014:

            Logisticare – Regions 1, 2, 6, 7, 8

            • Medical Provider Phone: 1-877-659-1305; Fax: 1-877-637-9091
            • Transportation Provider (Transporter) Phone: 1-877-659-1304; Transportation Provider Fax: 1-877-637-9092

            MidCoast Connector (Waldo CAP) – Region 5

            • Medical Provider Phone: 1-855-930-7900, Prompt 4; Provider Fax: 207-218-1159

            Penquis CAP – Regions 3 & 4

            • Medical Provider Phone for Region 3: 1-855-437-5883
            • Medical Provider Phone or Region 4: 1-844-736-7847
            • Provider Fax for Regions 3 and 4: 207-941-2823

            The broker that a provider calls depends on the county and town where the member resides. The list of Broker Contact Information by County and Town is found on MaineCare’s Non-Emergency Transportation webpage.

            To see the letter to members and a complete list of the brokers ‘phone numbers that members will call, go to MaineCare’s Non-Emergency Transportation for Members webpage.

               

           

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              • NET Brokerage: Recurring Trips - July 28, 2014

                As we prepare to transition to new Non-Emergency Transportation brokers in Regions 1, 2, 4, 5, 6 and 7, we are asking providers that serve members who receive recurring transportation (also called standing order or subscription trips) to call the new broker in their regions and verify that the trips are scheduled properly. This will serve as one final safety check on the data, and ensure the member’s continue to receive transportation. Members can also contact the brokers directly to confirm their rides are properly scheduled.

                Below is the contact information for providers to use for trips on or after August 1, 2014:

                Logisticare – Regions 1, 2, 6, 7, 8

                • Medical Provider Phone: 1-877-659-1305; Fax: 1-877-637-9091
                • Transportation Provider (Transporter) Phone: 1-877-659-1304; Transportation Provider Fax: 1-877-637-9092

                MidCoast Connector (Waldo CAP) – Region 5

                • Medical Provider Phone: 1-855-930-7900, Prompt 4; Provider Fax: 207-218-1159

                Penquis CAP – Regions 3 & 4

                • Medical Provider Phone for Region 3: 1-855-437-5883
                • Medical Provider Phone or Region 4: 1-855-736-7847
                • Provider Fax for Regions 3 and 4: 207-941-2823
                   

              • Non-Emergency Transportation (NET) Changes - July 30, 2014

                *Please note the phone and fax number for Penquis CAP, regions 3 and 4, have been corrected in the message below.

                Effective August 1, 2014, the NET brokerage system is changing. Coordinated Transportation Solutions (CTS) will no longer provide non-emergency transportation services to MaineCare members. For those members who had Logisticare or Penquis CAP prior to this change, their broker will not change. For those who had CTS previously, they will now have Logisticare, MidCoast Connector (Waldo CAP), or Penquis CAP.

                If you need to contact a NET broker to schedule a trip for a MaineCare member, please use the phone numbers that are designated for medical, school-based services, and transportation providers. These phone numbers are not the same numbers that members call to reach the brokers, and using the dedicated phone numbers will expedite your call.

                At this time, please continue to call the current broker contacts to schedule trips prior to August 1, 2014.

                Beginning July 18, 2014, the new phone lines will be open for trips on or after August 1, 2014.

                Below is the contact information for providers to use for trips on or after August 1, 2014:

                Logisticare – Regions 1, 2, 6, 7, 8

                • Medical Provider Phone: 1-877-659-1305; Fax: 1-877-637-9091
                • Transportation Provider (Transporter) Phone: 1-877-659-1304; Transportation Provider Fax: 1-877-637-9092

                MidCoast Connector (Waldo CAP) – Region 5

                • Medical Provider Phone: 1-855-930-7900, Prompt 4; Provider Fax: 207-218-1159

                Penquis CAP – Regions 3 & 4

                • Medical Provider Phone for Region 3: 1-855-437-5883
                • Medical Provider Phone or Region 4: 1-844-736-7847
                • Provider Fax for Regions 3 and 4: 207-941-2823

                The broker that a provider calls depends on the county and town where the member resides. The list of Broker Contact Information by County and Town is found on MaineCare’s Non-Emergency Transportation webpage.

                To see the letter to members and a complete list of the brokers ‘phone numbers that members will call, go to MaineCare’s Non-Emergency Transportation for Members webpage.