Secondary Billing Clarification

October 9, 2013

On 09/27/2013, we sent a listserv regarding Secondary Billing Updates. This message presented changes to how MIHMS processes Third Party Liability (TPL) and crossover claims. This change aligns with MaineCare policy to reimburse claims based on “lesser than” logic. Please note that FQHCs, RHCs, IHCs, and providers who are paid coinsurance and deductible based on Chapter I MaineCare Benefit Manual rules will continue to be paid as they were prior to the August 28th lesser than logic change. As a reminder, MaineCare providers have an agreement to accept MaineCare’s payment as payment in full and cannot balance bill members.