Rounding Rule Information for Providers of Section 25, Dental Services

Apr 03, 2023

On May 29, 2022, MaineCare adopted changes to the rounding rule in Chapter I, Section 1.03-8(J), effective January 1, 2023, which the Department will not enforce until May 1, 2023. MaineCare provided a future effective date and delayed enforcement of the rule to give providers time to make necessary system changes to bill for partial units of service.

The rounding rule applies to all units of service that are measured in minutes, which means it affects Section 25 providers billing for anesthesia services and behavior management.

Providers that cannot make the necessary system changes to bill for partial units by May 1, 2023, may submit claims with partial units through direct data entry on the Health PAS Online Portal. Effective April 1, 2023, MaineCare  made changes to the Portal so that it will accept partial units in the quantity box for dental claims.

If you deliver and bill for anesthesia services and behavior management and you have questions about the rounding rule or concerns regarding your ability to comply, please view these Frequently Asked Questions or contact your Provider Relations Specialist, Jane Brann.