Provider Update 12/19/07

1. Change in the Dates that the MECMS Billing Number is Required for Billing, for the Maine Behavioral Health ASO- posted on this site.

2. APS CareConnection® Training Site link now available on the Provider Training page.

3. Service Grid Revised (Most Current Version is v12/19/07):

• Column added for date MECMS PA billing number required for each procedure code
• ICI Procedure codes corrected
• PNMI “Bed-Hold” Days (Leave of Absence procedure codes) auth units & days corrected
• PNMI Substance Abuse RH9 initial authorization days/units increased to match RH4
• Children’s Services – new 65M&N codes added, to be used when the revised Section 65 rules are adopted

4. LOC Criteria Revised- (Most Current Version is v12/19/07). Clarification in the continued stay criteria, pertinent to Targeted Case Management agencies who provide service only to children with MR/DD.

5. PNMI Bed-Hold Days Clarification (for use of procedure codes for Leave of Absence).

• Providers may request bed-hold days over a 30 day period
• They may either request bed-hold days in advance, or retroactively. For example, when planning a transition home, the plan may be that the child will spend the next 3 weekends at home. The provider may request 6 bed-hold days to use in the coming month. After a child has run away or been hospitalized, the provider may request bed-hold days retroactively to cover those absences
• Providers must present the clinical rationale for the bed-hold, when making the request
• They will be issued a MECMS PA number to use when billing the bedhold
• Providers will still have the existing auth and MECMS PA number for the PNMI treatment that they use for billing that service