Evergreen Users Billing 837 Claims

Apr 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With the new Evergreen system rollout, previous authorizations with a prefix of “EIS” have been replaced by new authorizations with a prefix of “LTS.”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. Some LTS authorization IDs were generated with a max of 17 characters. When submitting 837 claims, providers are reporting that the last two characters of the 17-character authorization ID are getting cut off, resulting in denied claims with the “UM not found” edit.    

The Department’s Evergreen system has been updated to address the issue, and going forward, new Prior Authorizations (PAs) issued starting March 16, 2024, have been updated to a 15-character format to accommodate our current EDI 837 file. Providers can bill these newly issued authorizations as they normally would using their Electronic Claims system, and claims should no longer deny for the ‘UM not found” edit.  

PAs issued prior to March 16, 2024, will continue to have the 17-character format. MaineCare is still researching and working on a system fix to accommodate these longer PAs.  

At this time, we are asking providers who are billing the 17-character PAs to continue utilizing the previously issued workarounds until a system fix is in place: 

Submit EDI claims without authorization IDs to allow the system to auto-match for 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 continue to 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 to the authorization on file.    

Please note: Beginning on Monday, April 22, 2024, the Office of MaineCare Services will no longer be reprocessing denied claims for this issue. As of that date, Providers will be responsible for utilizing the above workarounds and adjust any claims that have been denied for this issue.  

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

Please report Evergreen authorization issues to ResourceCoordinatorOADS@maine.gov