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

December 19, 2013

As previously communicated in a listserv on 10/22/2013, 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 IHSs. It is taking longer than anticipated to complete. We continue to work on it and will let you know when it is completed. 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.