Instructions for Billing Services that Medicare does not Cover

September 4, 2012

MaineCare sometimes pays for services that Medicare does not cover. For claims to process appropriately, the claim that is submitted to MaineCare must be billed in the same manner as it is when billing MaineCare as the primary payer.

Hospitals: An issue has been identified when hospital claims that are billed as primary to MaineCare are being paid at zero when the member has full MaineCare coverage. We working to resolve this issue and will notify you when it has been resolved.

For non-hospital providers: Submitting claims to MaineCare that only include Medicare non-covered services:

  • UB-04: Field Locator-50 line “A” needs to reflect the word MaineCare. Field Locator’s 58 and 60 must reflect the member’s name and MaineCare ID respectively.
  • CMS-1500: Bill according to Appendix A of the MaineCare Billing Instructions.
  • Attach the Explanation of Medicare Benefits (EOMB), and at the top of the EOMB write “non-covered charges.” Do not write on the claim, only on the EOMB. This is required when submitting both UB-04 and CMS-1500 claims.
  • When entering claim on the Health PAS Online Portal DO NOT add any information on the COB tab such as allowed, coinsurance, or paid amounts. Submitting claims to MaineCare that include covered and non-covered services billed to Medicare: Covered and non-covered services must be billed on separate claims. For example, if you are billing for a line item that was denied by Medicare and another line on the same claim has a deductible amount, you must submit two separate claims.

For questions, contact Provider Services at 1-866-690-5585.