Issue Corrected: Procedure Codes End-Dated in Error - Issue Corrected: Limited Eligibility Issue for FQHC, RHC, and IHS - Encounter Services Required When Billing T1015 Reminder

Issue Corrected: Procedure Codes End-Dated in Error, CR 93302

Procedure codes 97535 and 97537 were ended December 31, 2019 in error. The issue has been corrected and claims that were denied incorrectly will be reprocessed. No provider action is needed. 

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Issue Corrected:  Limited Eligibility Issue for Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Indian Health Services (IHS), TR 80615 

The issue where some crossover claims for FQHC, RHC, and IHS were not processing correctly when a member has limited eligibility and does not have Qualified Medicare Beneficiary (QMB) has been corrected.

Please see the e-message from August 30, 2018 that originally described this issue:

Limited Eligibility Issue for Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Indian Health Services (IHS), TR 80615 

An issue has been identified where some crossovers for FQHC, RHC, and IHS claims are not processing correctly. This is happening when the member has limited eligibility and does not have Qualified Medicare Beneficiary (QMB) after Medicare. We will notify you when the issue has been corrected.

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Encounter Services Required When Billing T1015 Reminder 

This is a reminder that Rural Health Centers (RHC), Federally Qualified Health Centers (FQHC), Indian Health Services (IHS), and School Health Center providers who bill T1015 are required to provide all encounter services related to the claim. Claims submitted with T1015 and no encounter services will be denied. The claim will also deny if all encounter services on the claim are not covered by MaineCare.