Billing Information

Information for Providers Participating in MBCHP

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MBCHP Provider Informational Resources

  • MBCHP forms (for use by providers only)
  • MBCHP training resources
  • Archived letters and memos sent to providers

Billing Specific Resources

  • 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'.**

Program/Policy Specific Resources

  • 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 training resources:

Archive letters and memos sent to providers:

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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.

Note: Added new codes January 2018 in QNXT. Codes are effective October 01, 2017.

MBCHP Reimbursement Rate

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.

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.

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Program/Policy Specific Resources —

MBCHP Participating Provider Policy Manuals:

MBCHP Program Rules:

MaineCare Rules (The Treatment Act is a MaineCare expansion program):

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Updated July 9, 2018