ATTN: Out of State Hospitals (including New Hampshire hospitals within 15 miles of the Maine border)
September 24, 2012
There was a known issue with claims from Out of State Hospitals and New Hampshire hospitals within 15 miles of the Maine border. These hospital claims denied when the following codes were billed: 14301, 14302, 78452, 94726 and 94729.
If you submitted a claim for dates of service 9/1/2010 and after with one of these codes and received one of the following CARC Code denials, you may now re-submit your claims:
CARC code 204-This service/equipment/ drug not covered under the patient’s current benefit plan. (This appears as edit 202 in My Health PAS Online)
CARC code 185-The rendering provider is not eligible to perform the service billed. (This appears as edit 150 in My Health PAS Online)
Please note: Claims adjustments must be filed within 120 days after the Remittance Advice (RA) date but the MIHMS system cannot accurately calculate this. Because of this issue, an adjustment may get denied for timely filing if it arrives more than 120 days after the paid date. If you are filing a claim adjustment more than 120 days after the paid date, please contact your Provider Relations Specialist at Paula.Glendenning@Maine.gov for assistance. Prior Authorization requirements still apply for Out of State hospitals.