UPDATE: Pfizer and Moderna COVID-19 Bivalent Vaccine Authorized for Use in Individuals Aged Six Months to Five Years
On December 16, 2022, the Office of MaineCare Services (OMS) sent an announcement that we will cover the Pfizer BioN-Tech and Mode
Application Fee for 2023 Reminder, CR 114074
Effective January 1, 2023, in accordance with the Centers for Medicare & Medicaid Services (CMS) application fee requirements, MaineCare’s provider enrollment application fee will increase to $688 per enrollment application. This increase will apply to new, reactivating, or revalidating providers, or when adding new service locations to an existing enrollment. You can pay the application fee by credit or debit card at the time of application submission.
Attention Providers and Stakeholders of NDPP Program Services: Draft Rate Model Public Review and Comment
In the Spring of 2022, prior to P.L. 2021 Ch. 639 becoming effective, the Department began work to establish National Diabetes Prevention Program (NDPP) services as a new benefit for which a section under the MaineCare Benefits Manual has yet to be determined. This message outlines the next steps in the process to establish this new service model.
PUBLIC REVIEW AND COMMENT
Medicare Standardization Adjustments
Effective January 1, 2023, the Department is updating reimbursement rates for Medicare covered codes and services. The new reimbursement rates will apply to the services noted below, with the updated rates reflecting 72.4% of the 2023 Medicare rates.
Section 50, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) Rate Update, CR 113786
Effective January 1, 2023, the Calendar Year (CY) 2023 ICF-IID rate letters will be accessible on the Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: File Exchange > Reports > Rate Setting Letters.
Section 103, Rural Health Clinic (RHC) Rate Update, CR 114016
Effective January 1, 2023, the Calendar Year (CY) 2023 RHC rate letters will be accessible on the Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: File Exchange > Reports > Rate Setting Letters.
If you have questions about accessing the letters, please contact Provider Services at: 1-866-690-5585. If you have questions about the content of the letters, please contact Rate Setting directly using the contact name and phone number on the letters.
Section 31, Federally Qualified Health Center (FQHC) Rate Updates, CR 114022
Effective January 1, 2023, the Calendar Year (CY) 2023 FQHC rate letters will be accessible on the Health PAS Online Portal. You can view them by logging into your Trading Partner Account and following this pathway: File Exchange > Reports > Rate Setting Letters.
Ambulatory Payment Classifications (APC) Claims Overpaying, CR 114133
Some Ambulatory Payment Classifications (APC) claims are overpaying when COVID-19 administration codes are billed in addition to an office visit (i.e., HCPC G0643). The COVID-19 administration code is paying 100% of APC accurately, and the office visit code is paying 100% of APC in error. MaineCare is responsible for paying 100% of APC only on the COVID-19 administration codes. We will notify you once the system is updated. No provider action is needed. Claims that overpaid incorrectly will be adjusted.
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).
Donor Breast Milk Coverage for Infants Under 12 Months, CR 113541
On January 1, 2023, MaineCare will add coverage for donor breast milk (CPT code T2101 - Human breast milk processing, storage, and distribution) under Section 90, Physician Services, and Section 45, Hospital Services, in accordance with Maine P.L. 2021, Ch.