Claims Billed with a Primary Insurance other than MaineCare

July 26, 2013

When you bill for services for members who have a primary insurance carrier in addition to MaineCare, please make sure your MaineCare claims are billed with the codes found in your section of MaineCare policy in the MaineCare Benefits Manual. Some claims have been denied when the code on the primary insurance carrier’s Explanation of Benefits (EOBs) were not the same codes that were on the MaineCare claim, even when they defined the same service. Claim processing has now been updated and claims will no longer deny when the code required by MaineCare does not match the code required by the primary carrier for the same service.

Claims or claim lines that denied incorrectly can be submitted for reprocessing if the entire claim denied. Affected claims can be adjusted if the claim paid but some claim lines denied.