Providers billing on the UB-04 for Medicare and MaineCare Dual Eligible Members

September 15, 2011

You may now bill MaineCare as primary for those services that are covered by MaineCare but not covered by Medicare. To bill for these services, use the occurrence span code 74 with the occurrence span dates which encompass the to and from dates of service being billed on the claim. The span code 74 indicates Medicare will not pay for the level of care needed for the member. Here are examples of when to use span code 74 and occurrence span dates: 1. When the member needs non-homebound Home Health Facility level of care, Medicare will not pay. Medicare will only pay for Home Health services when the member is homebound. The procedure codes used for homebound and non-homebound are the same, but the presence of the span code 74 tells the payer that the claim is for non-homebound Home Health Facility level of care. 2. When an in-patient hospital stay has been deemed not medically necessary because the member is waiting nursing home placement and has been classified by Goold Health System as “days awaiting placement”.