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PCPIP and PCPIP48 Reports in process…

 Important Updates

Primary Care Provider Incentive Payments (PCPIP) and Report Schedule 
by WebFlash
 4/18/2014 1:39 PM

MaineCare is currently completing the PCPIP and PCPIP48 reports for the reporting period of 04/01/2012 - 03/31/2013.

 

The schedule is as follows:

 

-    The reports were mailed to eligible providers on Friday, 04/11/2014

-    The payment will...

 
Code and Rate Additions, Deletions, and Corrections 
by WebFlash
 4/18/2014 1:39 PM

We have recently created a “Code and Rate Additions, Deletions, and Corrections” spreadsheet that we will use to notify you of code and rate changes. You can view these spreadsheets on the Claims, Billing, and Enrollment webpage. When spreadsheets are...

 
Reduced Data- Entry Wait Time 
by WebFlash
 4/18/2014 1:38 PM
When using the Provider Enrollment Application (PEA) for provider enrollment or maintenance, the default setting is to save the entire application every time the user moves from one screen to another (auto-save). The application is also saved when...
 
Updated McKesson InterQual Criteria Sheets and (PA) Changes 
by WebFlash
 4/4/2014 1:53 PM

Effective today, certain McKesson InterQual Criteria Sheets have been updated from the current version on the Health PAS Online Portal to the 2013 version and will be used as guidelines to approve or deny –Prior Authorization requests. Please note...

 

 Keep in Mind ...

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Known Issues
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.
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.
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). 
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.
PCP Increase
The Office MaineCare Services (OMS) has implemented Section 1202 of the Affordable Care Act (ACA), effective January 1, 2013 which requires Medicaid programs to pay “for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014. In order to receive the increased rate, providers must complete and submit the 2013-14 PCP Increase Self Attestation form.
PCCM Webpage

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 managed services claim that require a referral.


Contact PCP Network Services with any questions at: PCP-Network-Services.DHHS@maine.gov.

PAG/TAG Link
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.
Pharmacy Resources
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.
Website Maintenance
Due to website maintenance, the MIHMS Health PAS Online Portal will not be available as follows:
 
From
Until
9pm Tuesdays
6am Wednesdays
6pm Saturdays
12-noon Sundays
 
Times shown are Eastern Standard or Eastern Daylight, as appropriate.
Old RAs

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.
Excel Export

You can now export claims, referrals, prior authorizations, and payment status data to an Excel spreadsheet.  Log in under your Trading Partner.  After you generate any of the four status reports, choose the “Export to Excel” button.

Forms & User Guides

Downloadable Forms and User Guides change frequently.  To save time, make sure you are using the most up-to-date version.

LMS
To learn more on how to use the Online Portal, take online training by visiting the Learning Management System. To access, please log in to your Health PAS Online trading partner account.
MHP User Guides
The MyHealth PAS User Guides are found on the Left Menu of the Provider Tab under Provider Manuals.
Accessibility
If you have specific accessibility requirements, call 1-866-690-5585 and we will assist you.

 Welcome to MIHMS

Explore these valuable documents that will help you use the Maine Integrated Health Management Solution (MIHMS):

Getting Started Provider Enrollment—detailed guides to enroll on-line. Choose between In-State or Out-of-State and type of provider.

Provider Checklist—steps you need to submit claims to the MIHMS

Important IRS Information—your MaineCare payments may be affected if IRS and MIHMS information do not match. Review to ensure compliance with IRS rules.

Trading Partner Registration—step-by-step guides for Trading Partner registration. Applies to billing providers, billing agents, and clearinghouses. Providers can register after enrollment approval; billing agents, after receiving an Enrollment Case Number from at least one associated billing provider; and clearinghouses, anytime.

Provider Maintenance—guides for completing provider maintenance on-line. Provider maintenance is available for approved providers and billing agents registered as Trading Partners.

EDI Testing—test file instructions for Trading Partner approval to submit electronic HIPAA transactions: Health Care Claims (837), Eligibility Requests (270), Claim Status Requests (276) and Prior Authorization/Referrals (278).
Sign in as a Trading Partner to access this feature

EDI Companion Guides—Maine-specific technical guides on how to submit electronic HIPAA transactions

Billing Instructions—field-by-field instructions specific to MaineCare Services—these are useful even if you plan to use DDE (Direct Data Entry) to submit claims or use EDI 837 to upload claim transactions

Prior Authorization Manual—what you need to know about the prior authorization process and requirements

Provider Quick Reference—shows you where to find many commonly used items on the MIHMS and MaineCare websites

MaineCare Provider RSS Feed—get timely automatic updates and important information by joining MaineCare's RSS feed
 

 ICD-10

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Webpage
Have you seen the ICD-10 webpage? The MaineCare ICD-10 webpage has recently been updated. Check the webpage for breaking news and updates as the project moves forward.
Provider Informational Series
As a result of feedback from the Provider Readiness survey, we have developed this series to share knowledge and to direct you towards preparing for transitioning to ICD-10. Please visit ICD-10 Webpage to see the full series of documents.
CMS Implementation Guide
The Centers for Medicare & Medicaid Services (CMS) released an online “ICD-10 Implementation Guide” to help you plan for the transition to ICD-10. It contains information, such as:
 
    • ICD-10 overview
    • Roadmap to ICD-10 readiness
    • Questions to consider for transitioning to ICD-10
 
The guide has sections for various provider types, including small/medium physician practices, large physician practices, and small hospitals so, you can find the information that is most relevant to your organization. You can access the guide via the Provider Resources page on the CMS website or directly by clicking here.
Email Us
Do you have ICD-10 questions? An ICD-10 email box is available for all ICD-10 related questions.

 MaineCare Event Calendar

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6/13/20149am-noon
AugustaUse SHIFT+ENTER to open the menu (new window).
221 State Street (Main Conference Room)
PAG/TAG
8/8/20149am-noon
AugustaUse SHIFT+ENTER to open the menu (new window).
221 State Street
PAG/TAG
10/10/20149am-noon
AugustaUse SHIFT+ENTER to open the menu (new window).
221 State Street (Main Conference Room)
PAG/TAG
12/12/20149am-noon
AugustaUse SHIFT+ENTER to open the menu (new window).
221 State Street (Main Conference Room)
PAG/TAG
 
 
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