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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
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.
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.
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.
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.
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.
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).
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.
The Food and Drug Administration (FDA) announced on November 30, 2022, that bebtelovimab, 175mg, no longer has Emergency Use Authorization (EAU).
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Eli Lilly EUA Monoclonal Antibody COVID-19 Infusion Treatment-bebtelovimab, 175mg |
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Correction: Application Fee for 2023 Reminder, CR 114074Please note the application fee adjustment is for CY 2023, not 2022, as published in a previous message. | ||