C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-103, subsec. 144-101-II-103.09
In accordance with Chapter I, Section 1, of the MaineCare Benefits Manual, it is the responsibility of the provider to ascertain from each member whether there are any other resources (private or group insurance benefits, worker's compensation, etc.) that are available to pay for the rendered service, and to seek payment from such resources prior to billing MaineCare.
If a member has third party coverage other than MaineCare, and if that third party carrier requires a co-pay but makes no fee-for-service payment in order to cover Rural Health Clinic Services, MaineCare reimbursement will be limited to the amount of the co-pay alone.
Providers billing for RHC services must bill using standard CPT and HCPC procedure codes as detailed in Chapter III, Section 103, Table 1. For Core Services, as described under Covered Services-Section 103.04, providers must bill the code T1015 and include the appropriate revenue codes. When billing, providers must use a UB 04 claim form. Effective October 1, 2010, in addition to billing the code T1015 for Core and Ambulatory Services, providers must also report all services provided including all procedures with the standard CPT and HCPCS codes on the UB 04 claims form for reporting purposes.
RHCs have the option of obtaining a separate MaineCare provider billing number for the limited purpose of fee-for-service billing and reimbursement for such services as X-ray, EKG, inpatient hospital visits and other Medicare defined non-RHC Services that are billable under Medicare PartB.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-103, subsec. 144-101-II-103.09