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MIHMS Questions and Answers
MIHMS Questions and Answers
Topic Question Answer
NPI, National Provider ID (Back to Top)
  Can the same NPI be used for more than one location? Yes. A three-digit extension to the NPI will be used to signify the multiple locations.
  What is NPPES and how can we contact them?

The NPPES stands for the National Plan and Provider Enumeration System.

The Center for Medicare and Medicaid Services (CMS) has contracted with Fox Systems, Inc. to serve as the NPI Enumerator. The NPI Enumerator is responsible for assisting health care providers in applying for their NPIs and updating their information in NPPES.

The NPI Enumerator may be contacted as follows:

Phone: 1-800-465-3203 or TTY 1-800-692-2326

E-mail: customerservice@npienumerator.com

Mail: NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059
 

Will the new system, MIHMS take our service number on claims?

No, only the NPI.

Board Members / Ownership (Back to Top)
  Can a CEO be listed as a board member? Yes, if he serves on the board.
  What should I put in as the start date of my board members or owners?

The actual start date.

  I have a physician who is owner and board member and who has also designed a component that is used in surgical procedures. Should I disclose that information as he receives royalties for that and we bill Medicaid for that component?

Yes.

 

What if I have a board member who is also an owner? How should I enter this person’s information on the CMS1513?

The board member must be listed as both.
  What is the CMS1513 form? Is this the same as we already have on file in MeCMS?

The CMS 1513 Form is the Disclosure of Ownership and Control Interest Statement. This is not maintained in MeCMS.

  Who is required to fill out the CMS1513? All MaineCare applicants.
  On the CMS1513 a question asks if we have other interests with Medicaid. Does this mean just Maine Medicaid or other state Medicaid programs?
 Any and all Medicaid programs.
  What if our ownership changes will I need to do a new enrollment? The details of ownership changes have not yet been determined.
Enrollment Applications (Back to Top)
 

Are there any use application requirements to download or view documents provided on the portal? Do I need Word 2003 or 2007?

These are the minimum system requirements for re-enrollment:

  • Reliable online connection
  • Web browser
  • Adobe Flash Player 10 or above
  • Adobe Acrobat Reader
  Will providers need to sign a contract again? Yes. Providers will be required to complete a wet signature (pen on paper) on a new contract.
  When will the re-enrollment applications be mailed? Applications won’t actually be mailed because the re-enrollment will be done through an on-line web portal. However, providers will receive a notice when they are scheduled to re-enroll.
  Will we be able to print applications and/or complete them on-line? Yes. The only paper application that needs to be mailed to MaineCare is the Provider Agreement itself. Everything else can be completed and submitted on line.
  Can I get a paper copy of the application so I will have a list of questions to ask my employees the legal questions?

The required questions are listed in the Enrollment Guides.

  Is there a way for me to print a blank application for my physician to review?

Please contact the Provider Enrollment Unit at (207)287-4082 or 1-800-321-5557, Option 6 to obtain a copy of the appropriate paper application.

  Will MIHMS accept electronic signatures? Yes, except for the Provider Agreement which must be printed, signed with a “wet” signature, and mailed to provider enrollment. MIHMS can accept electronic signatures for any other form.
  Who should sign the actual re-enrollment application from the provider organization? This should be whoever is authorized by your organization to enter into legal agreements.
  How will the Trading Partner Agreement (TPA) agreement take place with providers who are also billing agencies in MeCMS (as previously required)?  Will there be one agreement or two?

This depends.

1) If a provider is currently registered as a billing agent in MeCMS only to facilitate the ability to submit claims for all of the organization’s own MaineCare billing numbers (not for other independent agencies), only one registration and TPA will be required after successfully re-enrolling in MIHMS. 

2) If a provider has dual-roles, two trading partner agreements would be required, one as a provider and a separate one as a billing agent.  There would be separate logons/passwords for the provider and billing agent accounts. 

This means the following:

When the new provider portal goes live, the dual-role provider/billing agent will be asked to register as a trading partner for the billing agent function.

Later, after re-enrolling successfully, the dual-role provider/billing agent will be asked to obtain a second trading partner submission ID for the provider function.

This will entail signing two TPAs (electronically), one for each function.
  If a provider has multiple NPIs or multiple provider ID’s, will they need multiple Trading Partner Agreements (TPA)? No, only one TPA is needed per provider organization. All of the organization’s NPIs will be affiliated to the one TPA.
Enrollment Data (Back to Top)
  Will certain data fields be pre-populated for re-enrollment? Fields will not be pre-populated with MeCMS’ data. However, MIHMS will interface with some databases such as the NPI database and download information for related data fields for you.
  Will batch enrollment be available? No. A standard batch enrollment format does not exist for Medicaid. However, the NPI structure will reduce the volume of enrollments providers need to complete. Additionally, MaineCare is making the enrollment portal and process as user friendly as possible.
  Will there be a crosswalk for provider enrollment from MeCMS to MIHMS? Because the structures of the two systems are totally different and because MeCMS has many limitations, a crosswalk could potentially have a negative impact on both current operations and incorrectly translating data to the new system. For this reason, providers will need to maintain their MeCMS provider file until MIHMS begins operation.
  Will there be new provider billing IDs for the new system? Provider billing for MIHMS will use the National Provider Identification (NPI) number(s). Providers will need to include both their NPI and their MeCMS billing ID once they re-enroll and until MIHMS begins operation, if they elect to use the Direct Data Entry feature of the new portal. (EMC batch filing and Paper Claims will still require the MaineCare Billing IDs). This is because claims will still be processed by MeCMS until MIHMS is implemented.
  MeCMS does not list my change in my entities business structure, how will this affect MIHMS as it is not listed in MeCMS correctly? Who should I contact about the information not being correct in MeCMS?

The incorrect information in MeCMS will not affect your re-enrollment information in MIHMS. You will re-enroll in MIHMS with your entity’s correct business structure. You should contact Provider Enrollment Unit at (207)287-4082 or 1-800-321-5557, Option 6.

  Where do I find or get my PCCM number?

Please call the PCP Network Services 287-4827 for assistance with obtaining your PCCM number.

 

What do I do when my license has not been reviewed or renewed? I have a letter extending my license. What date do I put into the enrollment fields?

Enter the dates of your current license including the expiration date. Then mail in a copy of the extension letter along with the provider agreement(s) and other supporting documents.

Enrollment Provider (Back to Top)
  Why is MaineCare re-enrolling providers? The new system will be fully compliant with the CMS regulation that requires healthcare payers to support National Provider Identification (NPI). Because this structure is completely different, in order to capture data accurately, providers are required to re-enroll.
  Does a provider have to re-enroll? Yes. If a provider intends to continue to see Medicaid patients and file claims with MaineCare, they will need to re-enroll.
  What is the deadline to re-enroll? Providers must re-enroll in the new system by December 23, 2009 in order to be paid in the first payment cycle of the new system. Providers who re-enroll after the December 23 deadline may have their payments and prior authorizations delayed.
  Will the re-enrollment require providers to re-enroll with AdvantageME (the financial system that issues payments)? No, MaineCare will transfer the needed enrollment information to AdvantageME. New vendor IDs will be created for AdvantageME, as a result.
  How does a provider sign on with AdvantageME? If you are receiving current payments from MaineCare and you submitted a W9 at the time of enrollment, you are already signed on with AdvantageME.
  Will providers be able to re-enroll, with their laptop, at the training sessions? Yes, re-enrollment can be accomplished from anywhere there is internet access. Not all training sites will have this capability.
  We are a physician group and we rent space to another provider. Do we register that provider who rents space? No, that provider will be re-enrolling with his legal address. This business relationship does not affect re-enrollment.
  Do school districts that provide MaineCare services need to re-enroll?

Yes.

  What is the distinct part unit on the facility information screen?

The term “distinct part” refers to a portion of an institution or institutional complex (e.g., a nursing home or a hospital) that is certified to provide specific services such as Skilled Nursing Facility and/or Nursing Facility services, rehabilitation services or psychiatric services. A distinct part must be physically distinguishable from the larger institution and fiscally separate for cost reporting purposes. This portion of an institution or institutional complex must be certified as a Distinct Part Unit by Medicare.

Enrollment Rendering Provider (Back to Top)
  Do providers need to re-enroll their servicing/rendering providers? Yes, providers will need to re-enroll all servicing/rendering providers that they will be working with. However, if a servicing provider supports multiple entities (NPIs), the complete information only needs to be entered once. Then the servicing provider can be associated with multiple entities by NPI.
 

Do we have to verify that all employees have not been sanctioned or if an employee has record of the information?

Providers are responsible for developing an internal process to ensure that all staff are in compliance with all regulatory requirements.

Enrollment Schedule (Back to Top)
  When will the re-enrollment take place? The Re-enrollment Portal is now open to all providers. Please re-enroll now if you have not already.
Billing agents and Clearinghouses (Back to Top)
  Will billing agencies need to re-enroll? Billing agencies that submit claims for providers will need to register as a Trading Partner and sign a Trading Partner Agreement.
 

How do I as the billing agent associate all my Pay-To NPIs?

If you are a provider with several Pay-To NPIs, you will not be enrolling as a billing agent like you did in MeCMS. You will apply for a billing provider Trading Partner ID using one of your Pay-To NPIs. Once that Trading Partner (TP) registration is approved, you will be able to add all of your other Pay-To NPIs to that TP registration.

If you are truly a billing agent, you will apply for a TP registration using the Tax ID, NPI (or API) and the Enrollment Case Number ECN of one of your associated providers. Once that Trading Partner (TP) registration is approved, you will be able to add all of your other providers to that TP registration. The providers you bill for must supply you with their enrollment case number as an indication that they authorize you to act on their behalf.

  If a provider is handling billing for other entities do they need to register as a “billing agent” in MIHMS? Yes, if they are truly performing the function of a billing agent for other organizations (as opposed to submitting claims as a billing agent for themselves), they will need to register as a trading partner and sign a Trading Partner Agreement.
  Are billing agents (billing services and clearinghouses) going to be validating their clients? No, the provider must authorize the billing agents to submit claims on their behalf. This can be completed electronically in the portal. It is the provider’s responsibility to ensure that Business Associates Agreements are in place between their organization and their billing agents. The onus is on the provider to ensure that they comply with HIPAA Privacy requirements.
  Does choosing a billing agent prevent providers from submitting their own claims, as well? No. Providers can choose a billing agent to submit some claims and continue to submit claims for other components of their services. For example, a billing agent can be retained to submit dental claims while the provider continues to submit claims for childcare services.
  Are billing agents (billing services and clearinghouses) going to be validating their clients? No, the provider must authorize the billing agents to submit claims on their behalf. This can be completed electronically in the portal. It is the provider’s responsibility to ensure that Business Associates Agreements are in place between their organization and their billing agents. The onus is on the provider to ensure that they comply with HIPAA Privacy requirements.
Trading Partner Agreements (Back to Top)
  What is the process for Trading Partner Agreements?

Clearinghouses and Billing Services will register with MIHMS first as soon as the Portal goes live. They will sign a Trading Partner Agreement (TPA) and receive a USER ID and password.

Providers will be required to re-enroll. When their re-enrollment is approved, they will then sign TPA and receive a User ID and password. At that time, providers will affiliate their NPI(s) with their clearinghouse or billing service.
  Will a paper version be available for Trading Partner Agreements (TPA)? Yes, but a great need for this is not anticipated since an electronic signature is preferred. The TPA will be down-loadable and can be printed.
Billing codes (Back to Top)
  Are any changes in billing codes anticipated for MIHMS? We are working to eliminate all local codes because these are not HIPAA compliant. As such, MaineCare is moving to national code sets for the MIHMS implementation. HIPAA compliant code crosswalks are available.
Claims, electronic filing (Back to Top)
  If I am currently filing claims electronically, will anything change? Providers should continue to submit claims electronically in the same way they are today, until MIHMS becomes fully operational. At that time, electronic claims must conform to the HIPAA compliant ANSI ASC X12 837 standard formats.
  Will software be needed for electronic submissions to MIHMS?

The answer depends on the volume of claims submitted. Once the MIHMS claims portal is on-line, providers can submit claims via direct data entry into the claims portal and will not require special software. (MeCMS will continue processing claims until MIHMS is fully implemented.)

For a large volume of claims, providers will need HIPAA compliant software to submit electronic claims directly to MIHMS. This will allow them to upload the ANSI ASC X12 837 standard claim formats.

Providers currently using software to submit claims to MeCMS should check with their vendor to determine their capability to submit HIPAA compliant claims.
  What are 837 and 835 files?

The 837 is the HIPAA standard format for submission of electronic claims. There are three versions of the 837: the Institutional (comparable to the UB-04 paper claim), the Professional (comparable to the CMS 1500 paper claim), and the Dental (comparable to the ADA paper claim).

The 835 is the electronic remittance that is received back by the provider.
Claims Processing (Back to Top)
 

Are the business rules for processing claims published somewhere?

When the rules become available, they will be published on the provider portal.
Claims, mental health (Back to Top)
  Will MIHMS communicate with APS Healthcare to ensure approvals are accurately processed (i.e.: Number of units, dollars allocated, PA numbers)? Yes. The MIHMS interface team is working with APS to make this happen.
Claims, online entry (Back to Top)
  Will the online portal functions include the actual submission of claims or will we have to purchase billing software? The online portal does not require you to have any software on your computer.
  What is direct data entry (DDE)? Will training be provided (if so, when?)

Direct Data Entry is the ability to type text into a form on the computer in contrast with copying or importing data from another source. When the functionality to enter claims via DDE is available and a provider has successfully re-enrolled in MIHMS, they will be able to enter individual claims information directly on the web portal. Until MIHMS becomes fully operational, this information will then be translated to MeCMS for processing.

Training will be provided, however a schedule has not yet been determined.
  When will DDE be available? MaineCare is in the process of finalizing the date.
Claims, paper (Back to Top)
  Will we still be able to submit claims on paper in MIHMS?

Yes.

  My organization currently submits paper claims and receives paper remittance statements.  When MIHMS is implemented will we have to do electronic billing?  The online portal introduced as part of the new claims processing system will allow for the submission of claims.  This will be done either by entering information for one claim at a time, or by uploading claims data from the provider database.  There will not be a need for paper claims.
  In MIHMS, can we use the old CMS1500 forms or do we need to use the new forms?

Old CMS 1500 forms CAN NOT be used in the new system.

Remittance Advice Statements (Back to Top)
  Has the design of Remittance Advice Statements begun? That has not yet begun, but will soon.
System Transition (Back to Top)
  When is the new claim processing system scheduled to go live? The new MMIS (Medicaid Management Information System) in development by MaineCare and Unisys is scheduled to come online in February 2010. The new system is named the Maine Integrated Health Management Solution (MIHMS).
  Will MeCMS continue to be available once the new system begins in 2010? MeCMS will not be available for processing claims once MIHMS begins operation.
  Will the Oracle Financial system go away with MIHMS? Yes, Oracle will be replaced with Flexi Financial System.
  Will a system like Welfre still be place? Yes. We need a system to bring eligibility information into MIHMS. Understanding the limitations of Welfre, the Data Hub project is underway to move eligibility information from other systems to MIHMS.
  What about MeCMS claims that remain unpaid? Providers should be working with their provider relations specialists to resolve as many unpaid claims as possible. Planning is underway for resolution of remaining or “stalled” MeCMS claims now.
Claims Adjustments (Back to Top)
  As a rule, will providers be able to adjust a claim in MIHMS that was originally submitted and processed in MeCMS? Yes, this will be possible for claims with dates of service on or after 1-1-2008.
Claims, data access (Back to Top)
  Will providers continue to have access to claims data for claims that were submitted to MeCMS and adjudicated prior to MIHMS? Yes, MaineCare will convert five years of data into MIHMS.
Service Locations / Mailing Issues (Back to Top)
  We have 18 programs with different service locations. How do we ensure all mail and checks go to one address?

Checks will be sent to the W9 address listed in the re-enrollment application. If all of the 18 programs use the same W9 address, then all of your checks will be delivered to that address.

 

The Pay-To address, does it have to be a physical location or can it be a PO Box?

A Pay-To address must be a physical address. Service Location mailing addresses can be a PO Box, however.

  If the Pay-To entity changes will I need to do a new enrollment?

Yes.

Signatures on enrollment forms (Back to Top)
  When I sign electronically which provider name should I use, the Pay-To NPI name or the physician name?

You should sign with any name that is authorized by your organization to sign this type of application.

  Under the electronic signature page what is the SSN field for?
 The Social Security Number is required as part of an “electronic signature.”
  Who should sign the legal document?

This document must be signed by an individual who is empowered by the board or ownership to enter into this type of agreement.

 

I am concerned about signing this legal document not knowing all employees background. Is this new?

This is not new. The onus has always been on providers to ensure that employees have background checks verifying all legal requirements of the MaineCare contract.

  Why is it required that you have a wet signature when all the documents will be scanned and accessed electronically?

This is a legal requirement of the State of Maine Attorney General’s Office.

  If you have to mail in a provider agreement with a wet signature, why would you bother to re-enroll electronically?

The provider agreement requires an initial wet signature which agrees to the use of an electronic signature in future agreements. The initial wet signature is required by the State of Maine’s Attorney General’s office.

Training for Providers (Back to Top)
 

Will you be having more training on how to do maintenance?

This will be covered in the Phase 2 training sessions.
 

Will there be more training on claim submissions?

Yes, in early 2010.

 

 

If you have a question related to the MIHMS project, forward it to MaineCare2010.DHHS@maine.gov

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