Outpatient Hospital Claims Overpaid Under Ambulatory Payment Classification (APC), CR 119887 

Sep 22, 2023

During the COVID-19 Public Health Emergency (PHE), MaineCare overpaid some outpatient hospital services under APC methodology. MaineCare was responsible for reimbursing COVID-19 vaccine administration codes at 100% of APC during the PHE. MaineCare overpaid claims submitted with a combination of COVID-19 vaccine administration codes and other non-vaccine administration codes. The non-vaccine administration codes paid 100% of APC in error.  

To fix this overpayment, MaineCare will reprocess affected claims and revert to paying 83.7% of APC. Once the claims have reprocessed, MaineCare will reimburse each facility by sending a manual check for the difference owed. Claims affected were between dates of service December 11, 2020, through May 12, 2023.    

Please contract Tiffany.Norton@Maine.gov with questions.