Section 60 Medical Supplies and Durable Medical Equipment (DME), Billing Guidance and Corrections
Reimbursement Methodology Changes
Reminder for Billing Attending Provider on UB-04 and 837I Claims, CR 110840
This is a reminder that the attending provider is required on all UB-04 and 837I claims. Effective April 1, 2023, MaineCare will deny UB-04 and 837I claims submitted without an enrolled attending provider.
The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim/encounter. The attending provider requirement includes all claim submission methods (paper, HealthPAS Online Portal, or 837I).
Notice of Privacy Practices
Maine Department of Health and Human Services
MaineCare Services
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Notice of Privacy Practices
Maine Department of Health and Human Services
Riverview Psychiatric Center
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Maine Center for Disease Control and Prevention (CDC) Webinar on PrEP (Pre-Exposure Prophylaxis) and nPEP (non-occupational Post Exposure Prophylaxis)
Please save the date for the Maine Center for Disease Control and Prevention (CDC) webinar on PrEP (Pre-Exposure Prophylaxis) and nPEP (non-occupational Post Exposure Prophylaxis) in Maine on April 19, 2023, from 12-1:30 PM.
This session will feature presentations from PrEP207.org and a panel discussion on efforts to help individuals access PrEP and nPEP in Maine. The intended audience for this webinar is non-clinical HIV prevention and care partners in Maine.
Denials for JCode/NDC Combination, CR 115839
MaineCare has identified some pharmacy claim lines that denied in error for JCode/NDC missing or invalid due to a delay in the January 1, 2023, quarterly update from the Centers for Medicare & Medicaid Services (CMS). The Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) are as follows.
2023 Indian Health Services (IHS) Rate Update, CR 115822
Effective March 7, 2023, MaineCare increased the rate for IHS providers to $654.00 retroactively to January 1, 2023. We will adjust claims billed between January 1, 2023, and March 7, 2023, and you do not need to take action.
Please contact your Provider Relations Specialist with questions.
Vision Service Codes 92250 and 92341, CR 112321
MaineCare identified a claims issue where vision service codes 92250 and 92341 processed with MaineCare as the primary payor even though the member had an active primary vision insurance carrier that the provider did not bill first.
Electronic Visit Verification (EVV) Trainings and Forums
The federal deadline to implement the EVV requirements for Home Health providers delivering services under Section 40 and Hospice providers delivering services under Section 43 happened January 1, 2023.
We continue to offer weekly provider and aggregator trainings and forums. All trainings and forums are online via Microsoft Teams.
NOTE: The Absorb training system has been updated to allow providers to register for trainings and/or forums more than once.
Attention Section 43 Hospice Providers: Electronic Visit Verification (EVV) Implementation Temporarily Suspended
As of March 15, 2023, MaineCare temporarily excluded Hospice services from EVV requirements retroactive to January 1, 2023, as a delayed enforcement of our approved State Plan requirements. This temporary exclusion will continue until the Department can adopt final rules for Section 43, Hospice Services, which we currently anticipate will happen in the second half of 2023. This change affects hospice providers who bill codes T2042, G0299, G0155, and T2043.