C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-7, subsec. 144-101-II-7.09

Current through 2024-51, December 18, 2024
Subsection 144-101-II-7.09 - BILLING INSTRUCTIONS

All of the following conditions must be met for provider reimbursement under this section.

A. Providers must use the Department's approved billing form, in accordance with the Department's billing instructions available at http://www.maine.gov/dhhs/oms/providerfiles/billing_instructions.html
B. Providers must bill dialysis services on a monthly basis for each member. All services provided during the same month must be submitted on the same claim form for MaineCare reimbursement.
C. Providers must document appropriate and current diagnostic codes. These codes must accurately describe the clinical diagnosis of members receiving medically necessary treatment.
D. In order to receive full MaineCare reimbursement for claims submitted for a service that is defined as an exemption to Chapter I, refer to the billing instructions distributed by the Department in Chapter I, General Administrative Policies and Procedures.
E. Providers must provide all necessary services that are covered under the facility composite rate. Failure to provide an item or service covered under the composite rate will result in non-payment of the composite rate for that service.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-7, subsec. 144-101-II-7.09