MaineCare Behavioral Health Payment Supports: Timing and Frequency

MaineCare Behavioral Health Payment Supports: Timing and Frequency  

On June 26, 2020 the Department announced that we will be offering financial support for targeted community-based behavioral health services by offering a special supplemental Per Member Per Month (PMPM) payment for services delivered in July and August.  The table below lists the targeted services and associated PMPM payments: 

Survey Request: 

To help us monitor the impact that these payments supports have on providers’ efforts to re-engage MaineCare members in services and on providers’ ability to cover COVID-related costs, we are asking providers of these targeted services to complete a brief (less than 10-minute) survey on the impact of these funds.   

The survey can be accessed via: https://www.surveymonkey.com/r/BHSupports. Participation in the survey may be anonymous, depending on provider preference. The Department asks that providers fill out one survey per organization and per targeted service provided.   

Payment Details: 

Please see below to learn more about when to expect these payments and how to identify them on the Remittance Advices (RAs). Please share this information with the staff responsible for posting your facilities’ payments and RAs.    

These payments will only occur in August, September, and October. You will receive these special payments automatically on the basis of the claims you regularly submit for the services.  MaineCare will analyze your claims to determine how many members were served during the month, and issue you a payment based on the number of members served times the corresponding PMPM rate for the service.  It is important that you submit claims in a timely manner to ensure you receive your PMPM payments according to the schedule outlined below. Any claims submitted after the August and September claim submission window will be accounted for in a final October payment. Claims submitted after the October submission deadline will not be eligible for the PMPM payment.  

The special PMPM payments can be identified on the printed RA summary page as “other.”  For providers who use the electronic RA (835), these payments can be identified in the PLB section of the 835 and will contain an invoice ID prefix of “BHSUP.”     

The RAs and 835s will not provide detailed claim information for these PMPM payments; this will be sent separately in October to assist with claim reconciliation. At that time, the following information will be provided: member ID, service month, first service date that activated the payment within that month, service location, procedure code, and any relevant modifier, payment amount, and payment month.   

Please contact Rebecca Maranda with questions.