Current through 2024-51, December 18, 2024
Subsection 144-101-II-40.13 - BILLING APPEALS FOR DUAL MAINECARE/MEDICARE MEMBERSA. 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: 1) Plan of Care not authorized by a physician.2) Information not received.3) No documentation for services billed. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-40, subsec. 144-101-II-40.13