​UPDATED Billing Guidance and Claims Reimbursement for Distinct Psychiatric and Substance Use Disorder (SUD) Units

Sep 29, 2023

On September 19, 2023, the Office of MaineCare Services (OMS) sent a notice advising hospitals with distinct psychiatric and SUD units that our systems will update to reimburse claims to such units on October 1, 2023, as described in the proposed MBM, Chapter II, Section 45, Hospital Services rule. Please be advised that our systems are updated and will process claims billed in accordance with the guidance email sent on June 27, 2023, by Provider Relation Specialist Cheryl Rood.     

As a reminder, OMS will reprocess claims billed on or after July 1, 2023, through 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 that 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. We will send an updated message 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.