Provider Update 2/1/08

New Materials Posted on the Website:

• The Member Handbook is now posted on the Member page
• The full, consolidated Provider Manual is now posted on the Provider Manual page
• Revised review forms, also on the Provider Manual page

MaineCare Billing Advisory

The Maine Behavioral Health Administrative Services Organization (ASO) PA/UR requirements may not apply to dual-eligible members, who have coverage with both Medicare and MaineCare, and where Medicare is the primary payer.

If Medicare pays claims for behavioral health services, and MaineCare is billed for the co-pay and deductible, then no registration or review is needed with APS Healthcare, and no PA number is required for MeCMS billing.

If it appears that MaineCare will be the primary payer (in other words, that Medicare may not pay in a particular situation, but MaineCare will), then the provider must follow the ASO PA/UR requirements and obtain a PA number for MaineCare billing prior to providing the service or the claim will be denied.

Please contact MaineCare Billing and Information Unit at 1-800-321-5557, Option 8 if you have any questions about this advisory.

Service Grid Revised

Version 2/1/08 with Nursing Facility Services now listed. The Nursing Facility service code will be operational in APS CareConnection® 2/15/08. 2 new codes added for 65MN Collateral billing.

Review Form Changes effective 2/15/08

All service review forms have been rearranged to conform to the layout in CareConnection. The revised forms are posted on this website. They have been updated with changes to reflect changes to be made in APS CareConnection® effective 2/15/08. Detailed changes are noted on the APS CareConnection® Update 2/1/08

Review Forms and DHHS Licensing Requirements

Effective 2/15/08, the Treatment Plan in APS CareConnection® has been revised to be consistent with DHHS mental health licensing standards. Some providers may choose to include an addendum page with the printed APS CareConnection® Treatment Plan if there are additional elements they wish to include in their particular plans or to satisfy other regulatory requirements. The assessment components in APS CareConnection® are not designed to fully satisfy licensing requirements. Providers will need to provide a supplement to do so.