Billing Guidance and Claims Reimbursement for Distinct Psychiatric and Substance Use Disorder Units

On October 1, 2023, the Office of MaineCare (OMS) systems will update and prepare to reimburse claims under the new methodology for distinct psychiatric and substance use disorder units as described in the proposed MBM, Chapter II, Section 45, Hospitals Services rule.

On June 27, 2023, OMS Provider Relation Specialist Cheryl Rood emailed hospitals identified as having distinct psychiatric and/or distinct substance use disorder units billing guidance for claims billed on or after July 1, 2023. MaineCare will reprocess claims billed in accordance with this guidance between July 1, 2023, and September 30, 2023 to pay under the new reimbursement methodology. Hospitals that have not billed claims according to the provided guidance will need to correct and resubmit their claims for proper reimbursement. The HealthPAS portal will be updated with this guidance as soon as administratively possible. Hospitals who require the guidance to be resent to them in the interim may reach out to Cheryl Rood.

We are aware that some claims processing secondary to third party liability (TPL) carriers may not process correctly when this update goes live on October 1, 2023. We are working to correct this issue as soon as possible. An updated message will be sent once this issue has been resolved. At this time, please do not hold claims.

Please contact your Provider Relations Specialist Tiffany Norton with any other questions.