Reminder for Billing Attending Provider on UB-04 and 837I Claims, CR 110840

Mar 23, 2023

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).

MaineCare continues to monitor claims for compliance and to reach out to individual providers and provider associations. While there has been some progress over the last few months, we are still seeing a high volume of errors: some providers are still submitting hundreds of non-compliant claims per month. After April 1, 2023, MaineCare will deny claims that do not include an enrolled attending provider.

To help you make corrections to your claims, below are the most common errors we are seeing:

1. There is no information in the attending provider field, or the information is not valid.
2. Providers are submitting a Type 2 NPI instead of a Type 1 NPI. Providers must use a Type 1 NPI unless self-referred screening mammography is the only service billed on the claim.
3. The attending provider is not enrolled in MaineCare or was not enrolled in MaineCare for the date of service on the claim.

Please see the August 19, 2022, and the October 26, 2022, messages for more information, or call Provider Services with questions at 1-866-690-5585.