C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, subsec. 144-101-I-1.10
The following time limits apply unless waived under special circumstances by the Department. Providers have one (1) year from the date services are provided to file a claim correctly with the Department, regardless of when eligibility is verified, except claims for services provided before September 1, 2010 must be filed correctly within one (1) year from the date services are provided or by January 31, 2011, whichever is sooner. Since it is the responsibility of providers to verify eligibility, members may not be billed for covered services that have been denied by the Department for exceeding this time limit for claims submission because the provider did not verify eligibility. The time limit in this paragraph may be exceeded only as follows:
must be filed correctly within one (1) year from the date on the carrier's explanation of benefits.
It is extremely important and necessary that all paper claims be accurate, complete and legible. Only typed original claims or computer generated original claims with information clearly entered within the required information fields are acceptable for processing. All attachments must be on eight and one-half .5) by eleven (11) inch (81/2x11) paper. Providers must follow billing instructions issued by the Department. All claims are computer processed, and any mistakes may substantially delay processing. All claims must be signed and dated by the provider, or by an employee so authorized by the provider. Computer generated authorization or a stamped signature is also acceptable.
The provider must assume full responsibility for the accuracy of the invoice even when submitted by the provider's office. Any claim lacking clear authorization will be rejected (refer to Section 1.11-3) without payment.
Providers may submit claims directly into the claims processing system via a HIPAA-compliant web portal using Direct Data Entry (DDE). When DDE is used, providers will have the ability to identify and correct certain errors at the time the claim is entered, notwithstanding other provisions of this Chapter. Providers can obtain access to this portal at https://mainecare.maine.gov/Default.aspx .
Providers may submit claims using an 837 HIPAA format for submission of electronic claims. Refer to both the Implementation Guide and Companion Guide for MaineCare-specific submittal instructions at https://mainecare.maine.gov/ProviderHomePage.aspx.
C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, subsec. 144-101-I-1.10