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. MaineCare denies 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 with applicable billing requirements and to work collaboratively with individual providers and provider associations to address identified issues and provide guidance where needed. While progress has been made over the last several months, a higher-than-expected volume of billing errors continues to be identified specific to the attending provider requirements. MaineCare remains committed to supporting providers in improving claim accuracy and compliance with program requirements.

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

  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 the provider is not enrolled in MaineCare for the date of service on the claim.

Please see the March 23, 2023, message for more information or call Provider Services with questions at 1-866-690-5585.