Medical Eligibility Upgrade Affecting Payment for Certain Services

April 17, 2012

During the past weekend (April 7-8), an upgrade was implemented to MIHMS that will allow for easier updates to medical eligibility for services such as Nursing Facility Services (Section 67), Home and Community Based Waivers (Sections 19, 21, 22, and 29), and others.

An issue has been discovered that is preventing some of these medical eligibility updates to occur. Services for these sections will not be paid without the medical eligibility being in place.

We are working to correct the issue and will notify you once there is an update. We will also provide details on how affected claims for these services will be handled.

In the meantime, if you want to know if a MaineCare member is showing eligibility for services under one of these sections of policy, check the eligibility screen of the MIHMS Health PAS Online Portal. It identifies the section of MaineCare policy that is covered for the member.