Sections 2, 13, 17, 26, 28, and 65: Implementation of Cost-of-Living Adjustments (COLAs) Effective January 1, 2024

Aug 05, 2024

On December 1, 2023, MaineCare provided notice that it would increase reimbursement for certain eligible services through a 2.54% COLA, to be effective January 1, 2024. The notice indicated a status of “pending approval of appropriations” for several eligible services (under Sections 2, 13, 17, 26, 28, and 65).

After a 90-day waiting period that began with the adjournment of the Legislature on May 10, 2024, the funding for these COLAs will be made available to the Department, and rates implemented for billing on August 9, 2024.

These new rates will be funded retroactively to January 1, 2024, and will reflect a 2.54% COLA. The updated fee schedules will be available for viewing on the Rate Setting page of the Health PAS online portal shortly after August 9, 2024.

Adjustment of Claims with Dates of Service January 1, 2024, through August 8, 2024

Providers will be responsible for adjusting claims for the above date span, as is deemed appropriate by the provider. The Department urges providers to consider the following billing guidance carefully prior to adjusting claims. Following this guidance should prevent common billing errors that result in denials and additional edits, which ultimately delay reimbursements and may cause financial hardships.

• For providers who submitted claims with charges at, above, or below the new rates: the Department recommends adjusting claims starting with the oldest dates first. 

Exception to the 120 Day Adjustment Timely Filing Edit: The Department will override the 120-day timely filing edit for all adjustments submitted for the new COLA rate update for one year from the date of service, beginning with date of service January 1, 2024, through date of service August 8, 2024.

Adjustment Denials

When an adjustment is denied, the original claim payment will be reversed, and a new claim will need to be submitted within one year from the date of service. Please ensure that adjustment denials are tracked to prevent financial hardships.

Providers may choose to Reverse and Rebill (also called Straight Reversal) versus Adjust: It is important to plan for the financial impacts of reversing claims. When claims are reversed, those payments are deducted from your current claims payments and will typically appear on the next Remittance Advice (RA) cycle. Reversed funds should be tracked and accounted for until the new claim processes and pays on a later remittance statement. Important: The reversal and new payment will not be on the same statement. Providers must determine the appropriate volume of claims to be reversed and consider the timing of the reversals and new payments to prevent financial hardship. Providers must wait for the reversal claim to be in a ‘reversed’ status and appear on the remittance advice statement (RA/835), prior to submitting the new claim. Timely Filing for reverse and rebills: Providers have one year from the date of service to submit a new claim after reversing the original. Please work the oldest dates first to avoid timely filing denials.

Processing times for Adjustments or Straight Reversals Submitted by Providers: Depending on the volume of claims being reviewed by the Department, providers can expect delays in processing times as the Department will need to manually override the 120-day timely filing edits on each claim.

Claims with Prior Authorizations (PA):

The Department recommends that claims with PAs be adjusted to reduce the risk of financial hardship to the provider. To prevent denials, please first consider the number of units on the PA before submitting the adjustment. If you prefer to reverse and rebill, please ensure the reversal has processed to a “reversed” status before the new claim is submitted to allow the units to be available for the new claim and to avoid duplicate denials.  

For additional billing guidance when adjusting or reversing claims, please see the How to Adjust Claims for Retro Rate Increases (PDF) document.

For questions, please contact your Provider Relations Specialist.