Non-Emergent - Emergency Department Claims Not Pricing Correctly

Jun 26, 2024

MaineCare discovered that some hospital non-emergency claims failed to price correctly and were overpaid. This occurred when there was more than one emergency room service on the claim, for claims submitted for Dates of Service from January 1, 2022, and March 31, 2024. MaineCare reimburses differently in cases where non emergent use of the emergency room is determined.

No provider action is required as MaineCare will re-process these claims.

For questions, please contact Tiffany Norton, Provider Relations Specialist for Section 45.