MaineCare Updates

Maine Department of Health & Human Services sent this bulletin at 09/05/2017 09:36 AM EDT

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Section 19 Services: Code G0155 and the U7 Modifier, CR 70479

Effective immediately, when using procedure code G0155, please use the U7 modifier for any claims with dates of service on or after June 1, 2017.

See Ch. III - Section 19: Home and Community Benefits for the Elderly and for Adults with Disabilities. Please contact Tammy.l.Usher@maine.gov if you have any questions.

Issue Corrected: Duplicate Claims Paying Incorrectly, TR 59243

The issue with duplicate claims payment for some Medicare COBA file claims has been corrected. Please see the e-message from July 8, 2016 that originally described this issue:

Duplicate Claims Paying Incorrectly, TR 59243

We have discovered an issue that has resulted in duplicate payment claims for some Medicare COBA file claims. Claims with an alpha adjustment frequency are not pending for review but instead are being paid automatically. We are working to correct this issue and will notify you when it has been resolved. Affected claims will be reprocessed and no provider action is needed.

Issue with NCCI Edit on CPT Codes 77295 and 77300, CR 61541

An issue occurred where some claims or claim lines have denied in error. This is due to an update with NCCI where the CPT code combination 77295 (3-dimensional radiotherapy plans, including dose-volume histograms) and 77300 (Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician) were bundling against one another. This NCCI bundling combo 77295/77300 was updated in July 2016, and was retroactive to January 1, 2016. Claims that denied in error will be reprocessed. No provider action is needed.

Medically Unlikely Edits Should Not Deny Claim Lines that Are Prior Authorized, CR 59426

An issue was discovered where some claim lines were being denied for “medically unlikely” when the claim had a prior authorization. This denial was an error. The system has been updated and affected claims will be reprocessed. No provider action is needed.

Unless otherwise noted in this e-message, please call Provider Services with questions at: 1-866-690-5585.

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