Information for Providers Participating in MBCHP
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- MBCHP forms (for use by providers only)
- MBCHP training resources
- Archived letters and memos sent to providers
- List of Allowable Diagnosis Codes for Billing MBCHP
- Lists of Allowable CPT Codes and Reimbursement Rates for Billing MBCHP
- List of Allowable Revenue Codes for Billing MBCHP
**MBCHP claims have a maximum timely filing limit of 180 days from Date of Service after which time a claim may be denied as 'untimely'.**
- MBCHP Primary Care and Diagnostic Provider Manuals
- MBCHP Program Rules
- The Treatment Act (MaineCare) Rules
MBCHP Provider Informational Resources —
MBCHP forms (for use by providers only)
- MBCHP Visit Form Part 1 & 2 (Word) | also as PDF (Updated 1/2013)
- Abnormal Cervical Follow-up Report (Word) | also as PDF
- Abnormal Breast Follow-up Report (Word) | also as PDF
MBCHP training resources:
Archive letters and memos sent to providers:
- Submitting MBCHP Visit Form (Part 1 & 2) and Screening Results to MBCHP (3/16/2010) (PDF) (PCP)
- Coverage for Cervical Cancer Screening HPV Co-testing (12/14/2012) (PDF) (PCP) | PDF (LAB)
- MBCHP Timely Filing for Claims Reimbursement (4/23/2013) (PDF) (Hospital billers)
- MBCHP Timely Filing for Claims Reimbursement (5/15/2013) (PDF) (Laboratory/Mammography billers)
- Cervical Cancer Screening Co-testing (6/6/2013) (PDF) (PCP)
- Claim Edit 5031 Biller Memo (7/12-2013) (PDF) (FQHC/RHC billers)
- ACA and MBCHP Memo to Providers (November 2013) (PDF) (PCP)
- ACA and MBCHP Memo to Providers (October 2014) (PDF) (PCP)
- MBCHP Coverage for Cervical Diagnostic Excisional Procedures (PDF) (December 2014) (Facilities Providing Colposcopy Services for MBCHP Members)
- MBCHP Memo advising unencumbered fee-for-service contracts no longer required (March 2015) (PDF)
- Sample of ACA and MBCHP Letter sent to Members (October 2015) (PDF)
- Sample of ACA and MBCHP Letter sent to Members (October 2016) (PDF)
- Sample of Tomosynthesis reimbursement memo sent to mamm Facilities (Nov 2016) (PDF)
Billing Specific Resources —
MBCHP allowable Diagnosis Codes
Note: QNXT may deny your claim if you use a Diagnosis Code NOT listed.
Use of Diagnosis Code V70.0 or Z00.00/Z00.01 alone may also cause your claim to DENY. You must use another MBCHP Diagnosis Code in addition to V70.0 or Z00.00/Z00.01 so we can tell that a screening service covered by MBCHP was performed during the office visit being billed. MBCHP can only reimburse for an office visit where at least one breast or cervical cancer screening service was performed during the visit. Office visit must include a Clinical Breast Exam (CBE), Pelvic Exem, or Pap Test for claim to be paid.
To help our service locations in the switch from ICD-9 to ICD-10 Diagnosis Codes, below are two PDF documents that map MBCHP ICD-9 codes to their ICD-10 equivalents. The first is sorted by the ICD-9 column numerically and the second is sorted by ICD-10 column numerically. These documents should help you in cross referencing covered MBCHP diagnosis codes from ICD-9 to ICD-10. If you have any questions, please contact MBCHP.
- MBCHP ICD-9 to ICD-10 Mapping (sorted by ICD-9) (PDF)
- MBCHP ICD-9 to ICD-10 Mapping (sorted by ICD-10) (PDF)
- MBCHP ICD-9 to ICD-10 Mapping (with new codes) (PDF)
Note: Added new codes January 2018 in QNXT. Codes are effective October 01, 2017.
MBCHP Reimbursement Rate
- List of Allowable CPT Codes and Reimbursement Rates for Billing MBCHP (July 2015 through June 2019) (PDF)
MBCHP allowable Revenue Codes (UB-04)
Note: QNXT may deny your claim if you use a Revenue Code NOT listed on the Revenue Code list.
- Revenue Codes (Updated March 2015) (PDF)
- Revenue Codes (Updated June 2015) (PDF)
- Revenue Codes (Updated July 2016) (PDF)
- Revenue Codes (Updated July 2017) (PDF)
Note: Effective July 2015, RHC/FQHC may bill using Revenue Code 0960 OR 0521.
Billing MBCHP with TC or 26 modifiers
Modifiers TC & 26 are no longer REQUIRED for institutional claims (UB-04). For MBCHP claims, QNXT will now determine whether the claim line is for the professional or technical component based on the Revenue Code used on the claim line, i.e., 0960 77057 will pay the professional rate and 0403 77057 will pay the technical component rate.
TC & 26 modifiers may still be used on the UB-04 claim lines but are no longer REQUIRED for MBCHP claims to process.
Program/Policy Specific Resources —
MBCHP Participating Provider Policy Manuals:
- MBCHP Primary Care Provider (PCP) Service Location Policy Manual (PDF) (Updated 10/2016)
- MBCHP Participating Diagnostic Provider Policy Manual (PDF) (Updated 1/2017)
MBCHP Program Rules:
- Rules relating to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP)in Maine (PDF)