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 II - Specific Policies By Service
Section 144-101-II-40 - Home Health Services
Subsection 144-101-II-40.13 - BILLING APPEALS FOR DUAL MAINECARE/MEDICARE MEMBERS
Current through 2024-38, September 18, 2024
A. An agency document must be on file signed by the MaineCare member or guardian noting that services are denied Medicare coverage and all claims will be submitted to MaineCare.
B. The agency will obtain and keep on file a signed departmental "Authorization to Represent" form on all MaineCare members. This form will be provided by the Department. The agency will present this form to the Department or its designee when an Initial Determination and/or Reconsideration or Administrative Law Judge is requested.
C. The Department will find the Home Health Agency liable for the cost of services following an adverse decision by Medicare in response to a Department appeal detailing a technical denial. Examples of a technical denial shall include but not be limited to:
