ICD-10 codes are required on claims with dates of service on or after 10/1/2015. Failure to do so will delay claims and payment processing. If you have questions regarding ICD-10, please check out MaineCare's ICD-10 webpage for additional resources.
The MIHMS Provider Known Issues List offers information about Change Requests and Trouble Reports that affect MaineCare Providers. You can sort the list by provider type, issue type, or date. E-mail us with issues to add to the list.
|Portal Upgrades and Changes |
The Health PAS Online Portal is regularly upgraded. As portal upgrades are made, you can see all the changes summarized on the Provider Updates webpage. The date of the upgrade is in the document’s title for easy reference.
|Reminder: Timeframe to Initiate Adjustments for Underpayment |
MaineCare Benefits Manual, Chapter I guidelines specify when a provider believes an underpayment has been made for covered services rendered, based upon policy and procedures as described in this manual, the provider should accept and cash the check issued for the services provided. The provider must request a review of payments, using the MaineCare Adjustment Request form, within one hundred and twenty (120) days of the remittance statement date or waive any right to a review of that payment. Please contact your Provider Relations Specialist with questions.
|Individuals Excluded by Maine or Federal Government|
MaineCare providers are prohibited from employing people who have been excluded by the state or federal government. Visit the Maine Excluded Providers Database to check for individuals excluded by the State of Maine. Providers should also check exclusion by the federal government at these two sites: Office of Inspector General Excluded Providers Database and the System for Award Management. All potential employees should be checked, including employees who do not provide direct care to MaineCare members. Employing excluded individuals may result in monetary penalties. If you have questions, please contact the Program Integrity Unit at 207-287-4660.
|Code/Rate Additions, Deletions, and Corrections |
The “Code and Rate Additions, Deletions, and Corrections” spreadsheet has recently been updated. The spreadsheets are used to notify you of code and rate changes. You can view these spreadsheets on the Claims, Billing, and Enrollment webpage.
|2016 Primary Care Payment Increase Attestation Form|
The 2016 Primary Care Payment Increase Attestation Form has been updated. Please ensure you are using the correct version of the form. The 2016 Primary Care Payment Increase Letter and Attestation Form are available on MaineCare’s Provider Resources webpage.
Please contact Donna Sutter with question at: (207) 629-4280
|Using the correct Prior Authorization (PA) form |
The PA forms were updated in February 2014. Some of you are still using old versions of the forms. Please be sure you are using the correct PA forms when submitting requests to avoid delays in the PA process. You can access the newest Prior Authorization Request form on the Health PAS Online Portal by following this pathway: Provider Home page > Provider Forms > Authorizations and Referrals folder.
|Keeping the Information You Share with MaineCare Current|
MaineCare uses the demographic information you supply through the enrollment process to track our provider networks and to contact you directly when necessary. To ensure you receive important notices and information, please take a moment to review your address, telephone number, and other demographic information associated with your MaineCare provider file. You must log into your Trading Partner account on the MIHMS Health PAS Online Portal to view your demographic information or to make changes. If you find we have incorrect information after logging into your trading partner account, please open a provider maintenance case by clicking on “Provider Maintenance – Demographic” under the Provider Enrollment link or by calling Provider Services at 1-866-690-5585.
By opening a “Provider Maintenance – Demographic” case, you can quickly update the following:
· Contact name
· Telephone number
· Email address
· Service location address
· Office hours
· Patient restrictions
· Languages spoken
· Rendering provider address
· Rendering provider phone number
· Rendering provider email address
· Whether a service location or rendering provider is accepting new patients or not
If you need to make any other changes, please open a “Provider Maintenance – Full” case.
|Managing Users in Trading Partner Accounts|
It is very important for Trading Partners to actively manage user accounts for the MIHMS Health PAS Online Portal. Managing users can be done by clicking on “Account Maintenance” and then “Manage Users.” Existing users may be edited, deactivated or reactivated by clicking on the row of the user you would like to manage. The Administrator of the account and users with a security role of “‘R7-User Management” are allowed to use these features.
Deactivation or managing the security roles of users is essential when access requirements have changed or when access is no longer needed. Deactivation of individuals no longer working for your organization is imperative as it will help prevent inappropriate access to Protected Health Information (PHI).
Some survey participants expressed that they were not aware that data could be exported into an Excel spreadsheet or how it is done. You can export MIHMS data into an Excel spreadsheet from the following Health PAS Online Portal status screens:
• Prior Authorization
• Payment Status
• Patient Roster
• Primary Care Roster
Once you are on the appropriate screen in MIHMS, there is an option to “export” the information to Excel. When you click the export icon, all available records are exported to an Excel spreadsheet. Once exported, you can sort the information as needed and print it for your records.
If you have difficulty exporting to Excel, please contact Provider Services at 866-690-5585. Offices hours are 7:00 AM EST until 6:00 PM EST.
|MaineCare Benefit Packages and Covered Services|
Some survey participants requested more information about MaineCare benefits and covered services. You can read about specific policies by service and about allowances for services in the MaineCare Benefits Manual, which is the legal document that explains covered services. The MaineCare Member Handbook was designed for MaineCare members and explains the basics of the MaineCare program and gives details about the benefit packages. The MaineCare Eligibility document holds information about MaineCare eligibility in MIHMS as well as the link to the MyHealthPAS Eligibility User Guide which explains how to use the portal in verifying MaineCare eligibility.
|Password Protect to Keep Patients’ Information Safe |
Password protecting in a Word or Excel document and attaching it to an email is more secure than adding Protected Health Information (PHI) to the body of the email.
PHI is any information about health status, health care, or payment for health care that can be linked to a specific individual.
PHI consists of:
b. Street address, city, county, precinct, zip code
c. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older
d. Phone numbers
e. Fax numbers
f. E-mail addresses
g. Social Security numbers
h. Medical record numbers
i. Health plan beneficiary numbers
j. Account numbers
k. Certificate/license numbers
l. Vehicle identifiers and serial numbers, including license plate numbers
m. Device identifiers and serial numbers
n. Web Universal Resource Locators (URLs)
o. Internet Protocol (IP) address numbers
p. Biometric identifiers, including finger and voice prints
q. Full face photographic images and any comparable images
r. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)
s. Genetic information such as family history and test results
When sending PHI in email, please:
- Password protect all documents containing PHI
- Do not include any PHI in the subject line of the email
- Contact the intended recipient with the password to the secure document. Please do not send the password in an email with the protected document.
- Do not send the password in an email with the protected document.
For instructions on how to password protect a document or Excel workbook, visit the Microsoft Office Support website. You can search “password protect a document” using the version of Microsoft Office you have in the search.
|Fax Protocol to Protect Patient Information |
Sending Protected Health Information (PHI) in a password protected document is more secure than faxing. If you need to fax a document to MaineCare, please do the following:
· Notify the intended recipient that you are sending the fax.
· Use a fax cover sheet and do not include any PHI on the cover sheet.
· Identify the intended recipient on the cover sheet.
RAs (Remittance Advices) that are over one (1) year old are archived and removed from the MIHMS Online Portal on a daily basis.
Providers can obtain their archived RAs by contacting Provider Services EDI Helpdesk at 1-866-690-5585, Option 3.
|Copy and Paste into Fields|
Some survey participants indicated they did not think information can be copied and pasted into fields on the portal but you are able to copy and paste in two ways:
1. Highlight the text you wish to copy and press Ctrl+C. Then, select the desired field and press Ctrl+V. The information should now be visible in the field.
2. Highlight the text you wish to copy and right click to select “Copy” from the pop-up menu. Click the cursor in the desired field, right click again, and select “Paste” from the pop-up menu. The information should now be visible in the field.
Depending on the browser you are using, you may only be able to use one of the above options.
|Beyond Claims and Billing |
Stay up to date with MaineCare’s current and new initiatives, projects, and programs by visiting MaineCare’s website. Information regarding MaineCare policy changes, contact program leads, public meeting/forums materials, and listserv subscription form can also be found on this site.
Check out the Primary Care Case Management (PCCM) Webpage for information on the PCCM program. This website also has tools for PCCM PCPs and Specialists that will help PCPs know when to submit referrals, and will help Specialists correctly submit PCCM services claim that require a referral.
Contact PCP Network Services with any questions at: PCP-Network-Services.DHHS@maine.gov.
The Office of MaineCare Services sponsors Provider Advisory Group and Technical Advisory Group (“PAG/TAG”) committee meetings in Augusta on dates shown on our calendar. See past PAG/TAG Meetings.
You can visit MaineCare’s Pharmacy Unit Home Page for Prior Authorization (PA) forms for pharmacy services, Preferred Drug Lists (PDL), Medicare Part D Prescription Drug Plan information, and more.
|Forms & User Guides|
Downloadable Forms and User Guides change frequently. To save time, make sure you are using the most up-to-date version.