Update for Billing Attending Providers on UB-04 and 837I Claims

Update for Billing Attending Providers on UB-04 and 837I Claims

This message is a follow up to our message sent on August 19, 2022. To align with a new enforcement deadline set by Medicare, effective April 1, 2023, MaineCare will deny UB-04 and 837I claims submitted without an enrolled attending provider. This is a change from the previous implementation date, and this will be the last extension of the deadline.

The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim/encounter. The attending provider requirement includes all claim submission methods (paper, HealthPAS Online Portal, or 837I).

MaineCare continues to monitor claims for compliance and to reach out to individual providers and provider associations. While there has been some progress over the last few months, we are still seeing a high volume of errors: some providers are still submitting hundreds of non-compliant claims per month. After April 1, 2023, MaineCare will deny claims that do not include an enrolled attending provider. Although we are delaying the implementation date, providers must continue to work to come into compliance. To help you make corrections to your claims, below are the most common errors we are seeing:

1. There is no information in the attending provider field, or the information is not valid.
2. Providers are submitting a Type 2 NPI instead of a Type 1 NPI. Providers must use a Type 1 NPI unless self-referred screening mammography is the only service billed on the claim.
3. The attending provider is not enrolled in MaineCare or was not enrolled in MaineCare for the date of service on the claim. 

Through March 2023, the Remittance Advice Remark Code (RARC) is N613: "Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.”

Please note that while the language of the RARC above references an ordering provider, this RARC will appear when there is no valid attending provider on the claim.

Please see the August 19, 2022, message for more information and call Provider Services with questions at 1-866-690-5585.