Attention Providers of Sections 18, 19, 20, 21 and 29: New COVID-19 Service Codes and Temporary Rate Increases through Appendix K Amendment

Attention Providers of Sections 18, 19, 20, 21 and 29: New COVID-19 Service Codes and Temporary Rate Increases through Appendix K Amendment

In response to the COVID-19 public health emergency, and under the authority of our approved Appendix K amendment to our Home- and Community-Based Services waivers, we will implement 10% rate increases for select services in Sections 18, 19, 20, 21 and 29, retroactive to March 1, 2020 and through May 31, 2020.

We will also implement temporary new service codes in Sections 18, 20, 21 and 29, retroactive to March 1, 2020 and through 30 days following the end of the emergency, as declared by Governor Mills, or February 28, 2021, whichever comes sooner.

Approval of the Appendix K gives us the flexibility to increase reimbursement rates for the most highly utilized direct care services in Sections 18, 19, 20, 21, and 29, with the expectation that providers will use most of this financial relief to retain and support their direct care staff, such as by offering hazard pay.

 

New Services

Emergency Quarantine Services: After receiving prior authorization from the Office of Aging and Disability Services, this service will be available for members who have tested positive for COVID-19 and must be isolated from others. This service is primarily for individuals who need to be quarantined away from their housemates and require support 24 hour a day. Services may be provided in the participant’s regular residential setting if isolation can be safely accomplished or may be provided in a temporary location approved by the Department.

This service is available in Sections 18, 20, 21, and 29, with a procedure code of T2025 and a rate of $665.28 per diem (Note: UB billers can use 0589 revenue code). Effective May 13, 2020, this service code will be added to the Health PAS Online Portal.

Shared Living: Shared Living will be added to Section 20 and will allow for up to two members to be served in a setting. See the code table for modifiers and rates. Effective May 13, 2020, the service codes for Shared Living in Section 20 will be added to the Health PAS Online Portal.  We will send another provider communication when new service codes are available for Shared Living in Sections 21 and 29. Shared Living in Sections 21 and 29 will be modified to allow for up to three members to be served in a setting.

 

Sections 19 and 20 Rate Increases

Effective May 13, 2020, Sections 19 and 20 will be updated in the Health PAS Online Portal for new claims and for retroactive adjustments to March 1, 2020 (see instructions at bottom of this communication). Please note that providers will be required to pay the service tax on the additional revenue they receive through the rate increase.

Please click here for a list of affected codes and services.

 

Sections 18, 21, and 29 Rate Increases

Information on the rate increases and associated billing instructions for select services provided through Sections 18, 21, and 29 will be communicated to providers later in May.

 

Instructions for Adjustment of Claims

Sections 19 and 20: To receive the temporary 10% rate increase, please adjust affected claims with dates of service March 1, 2020 through May 13, 2020 for Sections 19 and 20 after May 13, 2020, when the rate increase will be updated in the system. Please do not adjust claims with dates of service prior to March 1, 2020 for this rate increase. 

Sections 18, 21, and 20: Providers for services delivered through Sections 18, 21 and 29 should not adjust their claims until the rate increases have been implemented in the system and we have communicated that adjustments may occur, which we anticipate will be later this month.

Reversing versus Replacing a Claim 

You may reverse and replace any finalized paid claim or you may simply reverse the claim.

• A Reverse transaction negates everything on the claim including, but not limited to, the charged amount, the payment, and the units or visits. This is commonly referred to as “voiding” the claim. 

• During the Replace transaction, the claim data will be pre-populated. You will have the option of changing the data prior to resubmission. This is commonly referred to as “adjusting” the claim. 

While some providers may prefer to reverse (void) a claim, we recommend replacing (adjusting) the claim as it makes it easier to track a claim through its lifecycle and simplifies the provider’s accounting process.

To either reverse or replace a claim, begin by logging into your Trading Partner Account and select the View and Submit Claims link under the Form Entry Heading to access the Claim Status page. 

To Reverse a claim:

1. Search for a claim by clicking the icon. Enter the dates of service and member information to find a specific claim or date range of claims for a member and then select a claim from the Claim Status page.
2. Select Reverse at the lower right corner of the Claim Status page.
3. The next screen will auto-populate an adjustment process. Select the option to Reverse this claim only, which is the box on the far right of the screen.
4. Select Continue and click OK when the verification question pops up. You will receive a message stating that the claim has been successfully reversed and it will display the claim number with an R1 extension. 

To Replace a claim:

1. Search for a claim by clicking the icon and select a claim from the Claim Status page.
2. Select Reverse at the lower right corner of the Claim Status page.
3. The next screen will automatically default to an adjustment option. The radio button on the left will be filled in, the middle box will be checked, and the far-right box (straight reversal) will be blank. This populates the information to Reverse this claim and create a new claim. Preserve the existing data by keeping the default setting on Use the data from this claim as basis for the new claim. The new claim will have all applicable data copied over.
4. Select Continue and click OK when the verification question pops up. You will then get a message that the claim was successfully reversed and the R1 will populate the screen.
5. The next screen that pops up will allow you to edit the claim information at the line level and it will display the claim number with an R1 extension at the top of the screen. Make adjustments needed on the claim. Click Save and then Adjudicate to start processing the claim through the edits. If there are any errors, you will see them populated on the next screen. Once the claim is processed, the message will display the claim number with an A1 extension.

 If you have questions, please contact your Provider Relations Specialist, Tammy Usher, by email at Tammy.L.Usher@maine.gov.