State-initiated adjustments on claims over one year old

January 10, 2012

When MaineCare initiates claims re-processing or adjustments and the claims have service dates more than one year ago, the system will deny the claim. The denial is based upon the claim being past the one-year filing deadline. The system will then re-process or adjust the claim correctly. Providers may see a claim denial on a Remittance Advice (RA) Statement, and then the claim adjustment/re-processing on a later RA. Providers do not need to resubmit these claims.