Clarification of Interim Billing Guidance for January 1, 2023, Rate Study Increases for Sections 2, 13, 17, 26, 28, and 65

Jan 17, 2023

This message is to confirm and clarify that all providers of services under Sections 2, 13, 17, 26, 28, and 65 do not need to hold their claims and are able to currently bill for services in order to maintain cash flow as the Department works to implement rate updates. See additional detail below, which varies by section of policy.

 

Section 2: MaineCare is still in the process of finalizing rate amounts for these services. We continue to project a January 1, 2023, effective date for this service, but we do not yet have a timeframe for when the new rates will be available for billing. Providers should continue to bill using rates in effect prior to January 1, 2023. The Department will reimburse for these services at these lower amounts.

 

Sections 13, 17, and 26: As indicated in the January 11, 2023, message, updated rates are now available for billing in MIHMS for these sections. Providers should reference the January 11 message for additional information and guidance.

 

Section 28: The Department anticipates that Section 28 updates should be completed in MIHMS by February 1, 2023. We will send another message once these updates are live.

In the meantime, in order to maintain cash flow, providers may continue billing using rates with the code and modifier combinations in effect prior to January 1, 2023. The Department will reimburse for these services at these lower amounts. Once the rate increases and new modifier combinations are updated in MIHMS, providers will need to adjust their own claims to indicate the new rates and modifiers, and the Department will reimburse for the difference between the new and old rates retroactive to January 1, 2023.

For reference, new Section 28 rates are now available on the HealthPAS Online Portal, but providers seeking to maintain cash flow should not bill at these new rates until the rates have been updated in the system.

 

Section 65: The Department anticipates that Section 65 updates should be completed in MIHMS by February 1, 2023. We will send another message once these updates are live.

In the meantime, in order to maintain cash flow, providers may:

• For straight rate increases that DO NOT have any changes to modifiers or units, bill claims to MaineCare using the new rates as now identified in the HealthPAS Online Portal. The Department will pay these claims at the lower rates in effect prior to January 1, 2023, until MIHMS is updated, at which time the Department will adjust claims on behalf of providers to pay the differential to the increased amounts retroactive to January 1, 2023.
• For rates that DO have changes to modifiers and/or units, continue billing using rates with the code and modifier combinations in effect prior to January 1, 2023. The Department will reimburse now for these services at these lower amounts. Once the rate, modifier and/or unit changes are updated in MIHMS, providers will need to adjust their own claims to indicate the new rates, modifiers, and/or units, and the Department will reconcile payments between the new and old rates retroactive to January 1, 2023.

 

For additional information on billing options and guidance and modifier changes, reference the January 9, 2023, message on this topic.

For questions regarding any of these changes or guidance, please contact your Provider Relations Specialist.