Terminating a Rendering Provider or Service Location in MIHMS
January 10, 2014
It is important for pay-to providers to update their MIHMS enrollment when a Rendering Provider (RP) is leaving a practice or when a practice is closing or changing ownership. When this occurs, a full maintenance case must be submitted.
Dr. Smith is moving from Hospital A to Hospital B as of 02/01/14. Hospital A will need to submit a full maintenance case prior to 02/01/14 to terminate Dr. Smith’s affiliation to Hospital A with an effective date of 01/31/14. Hospital B will need to add an affiliation to Dr. Smith with a future date of 02/01/14.
Family Practice A is changing ownership. They will begin providing services with their new pay-to provider on 02/01/14. A full maintenance case will need to be submitted to add Family Practice A, as well as any affiliated RPs, to the new pay-to provider with a start date of 02/01/2014. The original pay-to provider will need to end the affiliation to Family Practice A, as well as any RPs that are leaving the pay-to, with an effective date of 01/31/14.
If these updates are not received timely, claims may not process correctly.
Previously, claims for dates of service prior to the termination date were incorrectly denying. Due to a process change, claims will no longer deny if the RP is terminated through a full maintenance case. RPs will still be considered “active” in the system for claims submitted for dates of service prior to the termination date.
Please remember to inactivate the terminated RP’s user rights in your Trading Partner (TP) account.
If you have any questions about how to complete a full maintenance case, please contact Provider Enrollment at 1-866-690-5585, option 2. Please choose option 3 if you have questions about TP changes or by email at MaineCareenroll@MolinaHealthcare.com.