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CHANGE NOTIFICATION TO REIMBURSEMENT POLICIES

Thu, 2013-02-28 09:55

For claims with for dates of service on or after May 20, 2013, Travel allowance services for collection of a Lab Specimen reported with HCPCS codes P9603 and P9604 are not eligible for separate reimbursement even when reported with modifier 59. The Laboratory and Venipuncture Services reimbursement policy will also be updated to reflect this change.

New Rate for Procedure Code 84999

Thu, 2012-09-27 10:27

Effective 9/1/2010, procedure code 84999-“Unlisted Chemistry procedure” now has a rate of $20.00.  Claims already submitted were paid at zero dollars.  These claims will be reprocessed at the $20.00 rate.  Providers do not need to re-submit these claims. Out of state providers need a Prior Authorization to get reimbursed for this code.

Source: MaineCare Listserv 09-18-2012

Medicare Medical Necessity Claims Update

Thu, 2012-08-30 17:00

Claims that have denied for medical necessity by Medicare will no longer be automatically denied by MaineCare. These claims will now ìPENDî for a manual review to determine if the appropriate documents are attached to the claim. This includes the original denial and the appeal results.

Code/Modifier Combination Denials

Mon, 2012-07-23 17:00

An issue was identified recently where certain service code/modifier combinations were not recognized as appropriate combinations for some claims with dates of service between 09/01/2010 and 09/30/2011. These denials were reported on the Remittance Advice with the Claim Adjustment Reason Code 182- "procedure modifier was invalid on the date of service." The MIHMS Edit Rule 508- "invalid modifier code on Date of Service" will appear in the portal. This issue has been corrected. Claims which were denied in error have been identified and will be reprocessed.

Claim denials related to "no active provider contract"

Mon, 2012-04-23 17:00

Some providers may have received denials on claims with the denial reason "No active provider contract." Research of these claims shows that the system did not pick up the member’s eligibility. This denial reason was issued because the claim could not find a member’s eligibility so it couldn’t pull the provider contract for payment. Medicaid Maine is working to find the cause of this issue. In the meantime, they will manually work these claims and reprocess those claims that denied inappropriately.

Selected Physician, Laboratory Codes ñ Rate Decrease

Thu, 2011-11-17 16:00

For dates of service 11/16/2011 and later, MaineCare will decrease its rates on selected physician and laboratory codes. The rate reduction is to keep MaineCare’s rates at the regulated percentage of Medicare rates. On these codes, Medicare rates decreased in January 2011.

Selected Physician, Laboratory Codes ñ Rate Decrease

Thu, 2011-11-17 16:00

For dates of service 11/16/2011 and later, MaineCare will decrease its rates on selected physician and laboratory codes. The rate reduction is to keep MaineCare’s rates at the regulated percentage of Medicare rates. On these codes, Medicare rates decreased in January 2011.

Cross-over Claims to be Re-processed

Mon, 2011-10-31 17:00

Since September 1, 2011 some Medicare cross-over claims have been denied in error. The denials have appeared under Edit 150 (no contract term found for service) and Claim Adjustment Reason Code 185 (The rendering provider is not eligible to perform the service billed). These claims will be re-processed. You do not need to resubmit these claims.

HCPCS Code Change: G0431 -

Mon, 2011-10-31 17:00

Medicare changed their reimbursement method for G0431 as of 1/1/2011 to a per encounter code. We have modified our system and rate to be consistent with Medicare. The reimbursement rate is $82.20 per encounter. If you did not bill the G0431 as an encounter code, you will need to submit adjustments.

Cross-over Claims to be Re-processed

Mon, 2011-10-31 17:00

Since September 1, 2011 some Medicare cross-over claims have been denied in error. The denials have appeared under Edit 150 (no contract term found for service) and Claim Adjustment Reason Code 185 (The rendering provider is not eligible to perform the service billed). These claims will be re-processed. You do not need to resubmit these claims.

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