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

January 7, 2014

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, the secondary payment methodology was incorrect for FQHCs, RHCs or IHSs. This issue has now been corrected. The system will resume paying up to the MaineCare rate when calculating secondary benefits for these services. Over the next few months, affected claims will be reprocessed and no provider action is needed.