Attention Section 18, 21, and 29 Providers: Evergreen Users Billing 837 Claims

Mar 08, 2024

With the new Evergreen system rollout, previous authorizations with a prefix of “EIS” have been replaced by new authorizations with a prefix of “LTS.”   

Our current Electronic Data Interchange (EDI) 837 file was developed with a max of 15 characters for authorization IDs. The new LTS authorization IDs have a max of 17 characters. When submitting 837 claims, providers are reporting that the last two characters of the authorization ID are getting cut off, resulting in denied claims with the “UM not found” edit.   

MaineCare is aware of this issue and is currently researching a fix to accommodate these longer LTS authorizations. At this time, we are asking providers to submit their 837 claims without authorization IDs, allowing the system to auto-match for the claims to pay.   

If your EDI system will not allow you to submit a claim without an authorization ID, we recommend you:

1. Submit the claim with the authorization ID number.
2. Edit the claim in the Health PAS Online Portal to re-add the last 2 characters of the authorization ID that were dropped.
3. Resubmit the claim for processing.  

Providers also have the option to submit claims directly on the Health PAS Online Portal, which allows a max of 30 characters for the authorization ID. With this option, providers can enter the full LTS authorization ID or leave the authorization field blank and let the system auto-match.   

MaineCare will pull a claims report weekly and reprocess any claims that have been denied for this issue. Claims reprocessing started this week and will continue until the issue is resolved.   

Additional guidance for providers using new Evergreen authorizations. 

In EIS, most Prior Authorizations (PAs) contained a specific rate. When translated into the Health PAS Online Portal, that amount displayed as the “Manual Price.” In Evergreen, most PAs will not contain a specific rate. As a result, the Health PAS Online Portal may not display anything, or it may display $0.00 as the “Manual Price”. When a provider bills, the system pays at the contracted price listed on the most current provider fee schedule. A benefit of this change is that future rate changes will be faster, without the need to price the authorizations with every rate change.

There are some authorizations for services that will have a specific rate. Examples of these services include T2016/T2016 SC in Section 21, Specialized Medical Equipment, and Individual Goods & Services.

You can find the most current fee schedules corresponding to your section of policy in the Provider Fee Schedules. 

Please reach out to your Provider Relations Specialist, Olivia Hardman with any questions.   

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