Updated Billing Instructions: UB-04, CMS 1500, & Dental 

May 17, 2023

We have updated our Billing Instructions to reflect the information below. 

UB-04 Updates 

FL18-28 Condition Codes

• Use condition code AH for State Funded Abortion Services on claims. 

Figures 3-37 - FL76 Attending

• Enter the National Provider Identifier (NPI). This must be a Type 1 NPI. 

• An attending physician name and NPI is not required when the only service on the claim is emergency transportation, singular or Roster billing of Influenza or Pneumococcal Vaccinations and administrations codes. 

• Self-Referred Mammography services can use either a Type 1 or Type 2 NPI when billed as the only services on the claims. 

Attachments and Attachment Uploads

You may provide attachments in any of the following ways: 

i. Attach paper attachment to a paper claim. Use a paper clip when attaching. Do not staple attachments. 

ii. Attachments may be uploaded through the Health PAS Online Portal when submitting claims via Direct Data Entry. 

iii. Attachments may be uploaded through the Portal for claims previously submitted by searching for the matching claim in Claims Status and uploading a scanned attachment directly to the claim. 

1. Acceptable file formats for upload are: PDF, GIF, JPEG/JPG, TIFF, MS Word, and MS Excel. 
2. Attachments must be submitted on the same day. If the appropriate attachment is not present when we are reviewing the claim, the claim will deny. 

CMS 1500 Updates 

Multi-paged claim

a. Page Total - Do not put the total claim amount on any first or intermediate page. 

     i. The total must be placed on the last or final page of the multiple-paged claim. If the total is placed on each page, MaineCare will consider the page a stand-alone claim. 

b. Fill out header information on each page with identical information. This will help ensure that the claim pages are kept together. 

c. Other than Service Lines and Totals, only header information from page 1 will be used for processing the claim. 

     i. Place attachments (e.g., operative notes) for multiple-page claims after the last page of the claim and secure the attachment(s) with a paperclip. Do not staple attachments. 

d. Put page numbering for multi-page claims (in the format page of total pages) in the open area in the upper right-hand area of the claim form. 

Dental Updates 

Multi-paged claim

a. Page Total - Do not put the total claim amount on any first or intermediate page. 

     i. The total must be placed on the last or final page of the multiple-paged claim. If the total is placed on each page, MaineCare will consider the page a stand-alone claim. 

b. Fill out header information on each page with identical information. This will help ensure that the claim pages are kept together. 

c. Other than Service Lines and Totals, only header information from page 1 will be used for processing the claim. 

     i. Place attachments (e.g., operative notes) for multiple-page claims after the last page of the claim and secure the attachment(s) with a paperclip. Do not staple attachments. 

d. Put page numbering for multi-page claims (in the format page of total pages) in the open are in the upper right-hand area of the claim form. 

Please email Provider Services or call 1-866-690-5585. TTY users dial 711.