Member Medical Eligibility Update

June 13, 2012

This is an update to issues identified in listservs sent in mid-April related to member medical eligibility issues. Both issues have been resolved and medical eligibility for these members has been restored. Providers must re-bill any affected claims.

These issues were caused by a change to MIHMS in mid-April (listserv dated: 4/13/2012 titled “Medical Eligibility Upgrade affecting Payment for certain Services.”)

Medical Eligibility Upgrade affecting Payment for certain Services (4/13/2012 Listserv) 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.

There was another separate issue with members’ losing medical eligibility (listserv dated: 4/25/2012 Titled “MaineCare Member Medical Eligibility Error.”)

MaineCare Member Medical Eligibility Error (4/25/2012 Listserv)

1,825 members with medical eligibility in MIHMS in March 2012 lost their medical eligibility effective 3/31/12 in error. We are working to correct the problem as quickly as possible. If you are inquiring or billing for dates of service from 4/1/12 forward, where you expect the member should have medical eligibility, but does not appear to have the coverage in MIHMS, you can contact MaineCare Provider Services to determine if the member in question is part of this group.

Provider Services Phone: 1-866-690-5585 (TTY: 711) Fax: 1-877-314-8774 E-mail: