Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter I - Specific Policies By Service
Sec2 144-101-I-1 - GENERAL ADMINISTRATIVE POLICIES AND PROCEDURES
Subsection 144-101-I-1.11 - PAYMENT PROCESS

1.11-1 Payments

The Office of the State Treasurer issues all payments. A Remittance Advice (RA) is generated with each payment showing the payment or denial of specific claims. Payment will be made by Electronic Fund Transfer (EFT), unless the provider is unable to accept payment in this manner. In those cases the Office of the State Treasurer shall provide an alternative method of payment.

1.11-2 National Correct Coding Initiative Edits

1.11-3 Rejected Invoices

If the claim is rejected due to invalid or incomplete information, no reimbursement is made. Rejected claims will be identified either during the claim submission process or on the RA and will include a reason for the rejection. A correct claim must be resubmitted within the time limits previously stated in Section 1.10-2 before payment will be considered.

If a covered service was denied payment, or an incorrect amount was paid due to a billing or processing error, providers must follow appropriate billing instructions issued by the Department (see Section 1.12).

1.11-4 Payments and Denials for all Third Party Payers, Including Medicare

Providers shall bill the appropriate third party payer, including Medicare, for those MaineCare members also covered by the third party payer. Providers are to comply with the most current billing instructions as made available by the Department.