Attention Section 18, 21, and 29 Providers: Evergreen Electronic Data Interchange (EDI) 837 Prior Authorization (PA) Issue Resolved, CR 123785

Apr 19, 2024

Evergreen PAs, with the prefix “LTS” issued prior to March 16, 2024, were created with 17-character IDs. EDI claims submitted with those PAs were being denied with the “UM not found” edit because the EDI 837 file was developed with a maximum of 15 characters for PA IDs. 

The Department implemented a fix for this issue, and the system was updated to reflect the changes on April 16, 2024.

Providers are now able to submit EDI claims as normal with the 17-character LTS authorization IDs. The system will recognize the entire PA ID and no longer deny for the “UM not found” edit.

As a reminder: Starting Monday, April 22, 2024, the Office of MaineCare Services will no longer reprocess denied claims for this issue. With the fix now in place, please rebill any previously denied EDI 837 claims as you normally would be reimbursed.

Please reach out to your Provider Relations Specialist, Olivia Hardman with any questions, or to report any issues with this fix.  

Please report Evergreen authorization issues to ResourceCoordinatorOADS@maine.gov.