C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-113, subsec. 144-101-II-113.09
Brokers shall collect data on Member and Transporter characteristics, as specified by the Department, and on services furnished to Members through an encounter data system, as may be specified by the Department. The Broker shall submit encounter data to the State's Medicaid Management Information System (MMIS)-Maine Integrated Health Management Information System (MIHMS)-monthly, no later than the 15th of the month, for encounters related to service performed during the previous month. Encounter data shall be submitted in a HIPAA-compliant format (X12N and NCPDP format required by federally mandated timelines in effect at the time of submission).
The Broker shall submit "clean" American National Standards Institute (ANSI) ASC X 12N standard 837P claims encounter transactions as if submitting claims for payments, which document all NET services provided the previous month. The claims must comply with the current billing standards and must have at least the following information:
Documentation must include:
When appropriate to the service provided, Brokers shall report the current Healthcare Common Procedure Coding System (HCPCS) modifiers.
Examples:
Modifier | Description |
D | Diagnostic or therapeutic site other than "P" or "H" when these are used in origin codes |
E | Residential, domiciliary, custodial facility (other than 1819 facility) |
G | Hospital-based ESRD facility |
H | Hospital |
I | Site of transfer (examples: airport or helicopter pad) between modes of ambulance transport |
J | Free standing ESRD facility |
N | Skilled nursing facility (SNF) |
P | Physician's office |
R | Residence |
S | Scene or accident or acute event |
X | Intermediate stop at physician's office on way to hospital (destination code only). Please note that Modifier X can only be used as a destination code in the second position of a modifier. |
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-113, subsec. 144-101-II-113.09