MaineCare General E-Message - April 4, 2016

Update to MIHMS: Previously Denied Claims will Now Process When Resubmitted, CR 52983 

We have discovered an issue when some services are denying as a duplicate when the same date of services was denied on a previously paid claim. This is happening on claims that are processed but not all lines are paid. When the claim is in a paid status, but one or more lines on the claim is denied, a resubmission of the denied line will cause another denial as duplicate.  

Although this applies to all claims, one example of this occurrence is with crossover claims. When MIHMS processes crossover claims, the system can only either process coinsurance/deductible amounts, or non-covered charges.  In the case where a crossover claim processed a payment for the coinsurance/deductible amount and denied one of the lines, you need to bill the denied lines on a separate claim.  The resubmission of the second claim is currently being denied as a duplicate service. This correction will allow you to resubmit the denied lines without reversing the original claim, and receive payment as long as the services are covered by MaineCare. 

We will notify you when this issue is corrected.