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-7 - FREE-STANDING DIALYSIS SERVICES
Subsection 144-101-II-7.09 - BILLING INSTRUCTIONS
Current through 2024-38, September 18, 2024
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.
