Delivery System Reform Unit (DSRU) Annual Forums

Registration is now open for MaineCare's annual forums for Accountable Communities (AC), Behavioral Health Homes (BHH), Community Care Teams (CCT) including HOME providers, MaineMOM, Opioid Health Homes (OHH), and Primary Care Plus (PCPlus) providers.   

MaineCare is offering three different opportunities for trainings this year. Two different forum learning sessions are available virtually. The third is available in-person and will feature the same information at each session. Please see the table below.    

Delivery System Reform Unit (DSRU) Annual Forums

Registration is now open for MaineCare's annual forums for Accountable Communities (AC), Behavioral Health Homes (BHH), Community Care Teams (CCT) including HOME providers, MaineMOM, Opioid Health Homes (OHH), and Primary Care Plus (PCPlus) providers.   

MaineCare is offering three different opportunities for trainings this year. Two different forum learning sessions are available virtually. The third is available in-person and will feature the same information at each session. Please see the table below.   

Section 25 Dental Providers: Health PAS Online Portal Direct Data Entry (DDE) Claims Submission Issue, TR 116587

On April 11, 2023, we notified providers there was an issue with the Health PAS Online Portal that affects the ability to submit multiple service lines on claims. We have corrected the issue.

You can now adjust paid claims to add missing claim lines for full payment or submit new claims with the missing unpaid claim lines.

Attention Dental Providers: How to Add Coordination of Benefits (COB) Information for Medicare C Primary Dental Claims, CR 117131

Currently, the Health PAS Online Portal does not accept Medicare Part C dental COB data in the COB field of the Direct Data Entry (DDE) Dental claim. Entering Medicare Part C primary dental payment information as a Third Party Liability (TPL) primary payment on the portal may result in a claim processing incorrectly. 

Until this issue is corrected, please submit dental claims with a Medicare Part C payment either on a paper claim or via an Electronic Data Interchange (EDI) submission.

Maine Pediatric & Behavioral Health Partnership Webinar Fostering Resilience

Please join us on May 10, 2023, 7:30-8:30 AM, via Zoom Webinar. You can register Here. 

 
Learning Objectives: 
1. Learners will develop an understanding of resilience and the core capabilities that support it. 
2. Learners will develop strategies that support regulation in clients and patients.  
3. Learners will develop strategies that support regulation and resilience in providers. 

 

Billing Guidance and Implementation Timing for the Updated Payment Methodology for Section 31, Federally Qualified Health Centers (FQHCs), Including Changes When Providing Services Now Outside the Encounter Rate

The Office of MaineCare Services (OMS) previously announced that we will submit a State Plan Amendment to add an Alternative Payment Methodology (APM) option for FQHCs, effective March 1, 2023. This APM is based on costs and visits from fiscal years 2018 and 2019 for all State Plan covered services, with the exceptions identified in the lists below, consistent with federal requirements. 

MaineCare Benefits Manual, Section 65, Behavioral Health Services

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED:  Chapter 101, MaineCare Benefits Manual, Section 65, Behavioral Health Services

NATURE OF PROPOSED CHANGES: The Department plans to update reimbursement for Healthcare Common Procedure Coding System (HCPCS) code H2030 (clubhouse services) from $7.31 to $8.67 effective May 1, 2023.

National Diabetes Prevention Program (NDPP): Rate Determination Comment & Response Summary

On December 16, 2022, the Office of MaineCare Services initiated a rate determination for the NDPP, a new service that will be the Proposed MaineCare Benefits Manual (MBM), Chapter II, Section 71. MaineCare held a public forum on February 6, 2023, to present the draft service, rates, and methodologies to interested stakeholders and accept public comment.

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