Claim Denials Due to Incorrect Claim Form, TR 32267

October 9, 2013

Due to a recent system update, if you submit Direct Data Entry (DDE) claims through the MIHMS Health PAS Online Portal on an incorrect claim form type, your claims will be denied. When a claim is initiated using DDE, the portal defaults to the “Professional” claim type.” You must select the “Dental” or “Institutional” claim type if you are not intending to submit a “Professional” claim. If the incorrect claim form type is selected, the rendering providers are entered incorrectly and will result in either a denied claim or incorrect reimbursement.

Paper and 837 claims that are submitted electronically will also deny or reimburse incorrectly if the wrong claim form type is selected or if the rendering provider information is entered incorrectly. Please refer to the billing instructions to identify which claim form is appropriate according to your provider type and the appropriate policy section of the MaineCare Benefits Manual Section.

The Incorrect Claim Form Instructions document, gives you detailed information to ensure you are selecting the correct claim form type and are entering rendering providers correctly for appropriate claims processing and reimbursement. You can find the document by going to the Provider Home Page on the Health PAS Online Portal– Provider Documents- Billing Instructions- Supplemental Billing Information folder.