Duplicate Claims Payments in MIHMS

March 8, 2011

Some duplicate claims have inappropriately been paid as result of corrections made to member enrollments. Some providers may have noticed credit balances due to these overpayments. MaineCare has developed both a long-term fix to correct this issue and a short term fix to reverse the claims to clear the credit balances.

Short-Term fix: This fix will reverse the duplicate claims paid prior to incorporating the long-term fix. The claims will reverse at the document level. Therefore, providers will need to re-bill specific lines if these claims were not a duplicate. In order to have minimal impact to providers during a given week, the claim reversal process will occur over the course of the month starting the week of March 7th.

Long-Term fix: A custom edit (edit 6024) will be created to deny duplicate claims being paid as a result of a change in the member enrollment. This fix is currently in testing.

We apologize for any inconvenience and continue to work to resolve these issues and to keep the provider community informed.