Medicare Medical Necessity Claims Update

August 29, 2012

Claims that have denied for medical necessity by Medicare will no longer be automatically denied by MaineCare. These claims will now “PEND” for a manual review to determine if the appropriate documents are attached to the claim. This includes the original denial and the appeal results. Please refer to the MaineCare Benefits Manual, Section 1.07 for additional information regarding MaineCare’s Third Party Liability policy specific to Medicare claims.