FQHC, RHC, and IHS Claim Pricing After Third Party Liability (TPL) CR 37072

October 22, 2013

As previously communicated in a listserv on 09/27/2013, TPL secondary payment has been changed to pay up to the lower of the MaineCare allowance or the primary insurance allowance. This change was made for all providers, however; this secondary payment methodology is incorrect for FQHCs, RHCs or IHCs. When emergency CR 37072 is implemented, the system will resume paying up to the MaineCare rate when calculating secondary benefits for these services. Once this change is complete, affected claims will be reprocessed and no provider action will be needed.