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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.

         

    • Remittance Advice (RA) and Electronic 835 Delay - December 5, 2014

      Please be advised that RAs and electronic 835s will be delayed by one day and available tomorrow. We apologize for any inconvenience.

         

    • cPrior Authorization (PA) Form for Methadone Clinic Services, CR 45080 - December 15, 2014

      Effective January 1, 2015, a PA will be required for MaineCare members receiving care at a methadone clinic for 24 months or longer. You can find the Prior Authorization Form for Methadone Clinic Services in the Authorizations and Referrals folder on the Health PAS Online Portal.

      For questions regarding these changes and the PA process, please contact Provider Relations Specialists Gary Bell at (207) 624-6914 or Michael Myers at (207) 624-6966.

         

    • Effective January 1, 2015, a PA will be required for MaineCare members receiving care at a methadone clinic for 24 months or longer. You can find the Prior Authorization Form for Methadone Clinic Services in the Authorizations and Referrals folder on the - December 15, 2014

      On December 16th, 2014, MIHMS will be updating EDIFECS Guidelines to the latest version in order to accommodate ICD-10. This is necessary to ensure that uploaded 837 batch claims are compliant when ICD-10 goes live on October 1st, 2015.

      Two edits are going to be newly enforced with this update.
      • If a claim has a patient status code of 20 [expired] in Loop 2300 reference CL103, the occurrence code 55 [date of death] is necessary.
      • If a claim has a non-specific procedure code (reference SV202-02), then the procedure code description (reference SV202-07) is required in Loop 2400.

      If you need more information or assistance, please contact the Provider Services EDI Help Desk at 1-866-690-5585 (TTY: 711).

         

    • Payment Cycle for the Christmas Holiday - December 15, 2014

      The claim payment cycle for the week of December 21, 2014 will be as follows, due to the Christmas holiday:

      • Payments received via EFT will be available 12/24 or 12/26 depending upon your bank. • PDF Remittance Advices and 835s will be available on the portal for download on 12/24. • Checks and paper Remittance Advices will be mailed on 12/29 or 12/30. • Providers may continue to submit claims through 12:00 pm on 12/26 to be included in the following week’s payment cycle.

         

    • Notification when MaineCare Provider and Member Services Closed Due to Inclement Weather - December 15, 2014

      With the approaching winter weather season, MaineCare Provider and Member Services Call Center will be closed any time State offices in Kennebec County are closed due to inclement weather.

      Notifications can be received via text messaging or email by signing up for Maine.gov Citizen Alert System. In addition, Government office closure and delay information is available on your local radio and television stations.

      The MyHealth PAS Online Portal and the IVR self-service options 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 Professional will not be available.

      Weather permitting, business will resume to normal hours on next business day from 7:00 AM EST until 6:00 PM EST.

         

    • Changes for the MyHealthPAS (MHP) Online Portal, CR 43781 - December 15, 2014

      Please note the following changes:

      1) Claims  Dental: Set the “EPSDT/Title XIX” field (box 1) to “Yes” if the services are a result of a referral from an Early Periodic Screening and Diagnostic Testing (EPSDT, also known as “Bright Futures” screening tools) screening examination. Currently, the system defaults to “No” on the portal. The Centers for Medicare and Medicaid Services (CMS) requires states to report EPSDT performance annually. It is important that providers make an accurate selection in this field.  Professional: Updates were made to support the new CMS-1500 Claim Form Version (02/12). • Consistent with the paper claim form (boxes 17a), the “Ordering Providers,” and “Supervising Provider” information, and “Condition Codes” (box 10d) is now supported. • Not all date fields are currently supported (box 14 & 15), and will be included in future enhancements.  Institutional: The system will now edit for a valid “HCPCS” code (box 44) prior to submission through the portal.
      2) Prior Authorizations (PA)  Two new PA types have been added for services at a methadone clinic and Chiropractic treatment services.

         

    • Medicare Cross Over Claim Denials, CR 45704 - December 15, 2014

      include bundled and unbundled CPTs.” Due to a MIHMS limitation which allows only one rendering per CMS 1500 claim form, some claims that cross over from Medicare and have more than one rendering provider are only processing under one rendering NPI. Since National Correct Coding Initiative (NCCI) is based on same rendering provider and same date of service, it is causing these claims to deny in error. This issue has been corrected, and claims that denied incorrectly will be reprocessed. No provider action is needed.

         

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          • Notification when MaineCare Provider and Member Services Closed Due to Inclement Weather - December 15, 2014

            With the approaching winter weather season, MaineCare Provider and Member Services Call Center will be closed any time State offices in Kennebec County are closed due to inclement weather.

            Notifications can be received via text messaging or email by signing up for Maine.gov Citizen Alert System. In addition, Government office closure and delay information is available on your local radio and television stations.

            The MyHealth PAS Online Portal and the IVR self-service options 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 Professional will not be available.

            Weather permitting, business will resume to normal hours on next business day from 7:00 AM EST until 6:00 PM EST.

               

           

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