Updates: Correct Excessive Copay on Multi-Month Claims, UB-04 Claim Denials, and Section 29 Clarification for Providers Interested in Adding Shared Living

Correct Excessive Copay on Multi-Month Claims, TR 50671 

The issue where the system was not correctly calculating copay totals for each month that is limited by the Deficit Reduction Act Maximum (DRA Max) out-of-pocket expenses when the dates of service on the claims spanned multiple months has been corrected. Affected claims will be reprocessed. No provider action is needed. 

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UB-04 Claim Denials, CR 58197 

An issue was discovered where some claim lines billed on the UB-04 were denied in error. This issue occurred when the same CPT/HCPC code was billed for the same date of service but the revenue code was different. The issue has been corrected and affected claims will be reprocessed. No provider action is needed.

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Section 29 Clarification for Providers Interested in Adding Shared Living

This is a clarification on how providers need to enroll to provide Shared Living services under Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Spectrum Disorder.

Chapter II, Section 29.02-25 defines Shared Living:

Shared Living (Foster Care-adult) is a model in which services are provided to a member by a person who meets all of the requirements of a Direct Support Professional with whom that member shares a home. The home may belong to the provider or the member, but the provider must enter into a contractual relationship with an Administrative Oversight Agency in order to provide services under this model. Only one member may receive services in any one Shared Living arrangement at the same time, unless a relationship existed prior to the service arrangement and the arrangement is approved by DHHS. In such case, no more than two members may be served in any one Shared Living arrangement concurrently. Please see 29.10-4 for additional qualifications.

Providers who are interested in being approved to provide this waiver service should contact Lynne Raymond at: lynne.raymond@maine.gov or 207-493-4126. 

If you are currently providing Shared Living services for Section 21 and you would like to provide this service for Section 29, you will not need to complete a new application with the Office of Aging and Disability Services (OADS), but you must still contact Lynne Raymond and receive written approval. 

When enrolling in MIHMS, you must enroll a new Service Location with a title that includes SL 29 for each location. The system will assign a unique identifier for each location.

Requirement	Instructions
Service Location Name	Add SL 29 to Service Location Name, e.g., Bradley House SL 29
Street Address	Add DEPT 29 to the Street Address, e.g., 53 Orchard Road DEPT 29
Provider Type/Specialty Type	You must enroll with this provider type/specialty combination:  73-Waiver Services Provider/078-IID Supports Waiver

If you need assistance with billing or have other questions, please contact Tammy Usher at: Tammy.L.Usher@maine.gov or 207-624-6933.