Spend Down Claims – Update

March 29, 2011

Some claims have been handled incorrectly for members in the spend-down program. For members who have more than one type of MaineCare coverage, the system did not prioritize the member’s plans correctly. Thus, the system may have assigned a claim to the member’s spend down program when another MaineCare coverage was also available and should have paid it.

As a short-term solution, claims will be pended and manually reviewed for spend-down members who have other MaineCare coverage. Once the system is corrected, a manual review will not be needed for these claims except when the other MaineCare coverage is not appropriate to pay the claim.