New Billing Instructions Available on Portal

July 10, 2012

Version 3.0 of the CMS1500, UB04 and Dental Billing Instructions have been posted to the MIHMS Health PAS Online Portal.

Below, is a high-level summary of the changes for each form type:

CMS1500 Updates: - Additional policy sections added to MIHMS Provider Type Table as per MaineCare policy updates. - More detailed definition for “Required,” “Situational,” “Optional,” and “Not Used” selections. - Figures replaced to include more detail. - POS 17 Walk-in Retail Health Clinic added to Place of Service Code List. - Information regarding the use of modifiers FP and SL. - Additional Provider Types that require Rendering Provider ID on claim. - Box 32 on CMS1500 is now a “Required” field for a private practice physician, when services are rendered at a facility (e.g. hospital or nursing home). - Specific Coordination of Benefits (COB) requirements regarding Medicare Part C Plans. - New COB language added.

UB04 Updates: - Additional policy sections added to MIHMS Provider Type Table as per MaineCare policy updates. - Figures replaced to include more detail. - Updated type of bill codes. - Added additional provider types where FL12 Admission Date is required. - Use of Occurrence Code A3 and 22 defined. - Added language regarding Occurrence Span Code 74 added. - Added information regarding the use of modifiers FP and SL. - FL76 is now a “Required” field except for non-scheduled transportation claims.

Dental Updates: - Language added regarding billing for Interpreter Services on CMS1500. - Figures replaced to include more detail. - Further defined procedures for billing code D4341. - Box 32 is now defined as “Not Used” - Box 33 must equal the total of Box 31 on the final page of a claim. *Changes to billing instructions that may occur as a result of 5010 will be communicated in advance of implementation. Billing updates are added to the Billing Update document as changes occur. These changes will be included in the next version of the Billing Instructions document.

Contact Provider Services at 1-866-690-5585 if you need assistance or have questions regarding the billing updates.