Maine Integrated Health Management Solution Project _MIHMS_

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					                                                                                           Provider Types and Re-Enrollment Schedule
       Providers will receive a notice to re-enroll in the Maine Integrated Health Management Solution (MIHMS) three to four weeks prior to their scheduled
       training dates. This notice will contain details and specific timeframes for re-enrollment. Please note, providers with multiple provider types enroll in the
       Third Cycle, not when their separate provider types are listed.
                                                                                                          Provider Agreements
       Following this re-enrollment period, provider agreements will be renewed every three (3) years. In order to stagger renewal dates to avoid all provider
       agreements being renewed in the same year, the first set of provider agreements will be scheduled for renewal as listed below. One month following the
       closure of the third re-enrollment cycle, all provider renewal lengths will be scheduled for three (3) years, with the exception of out-of state emergency
       providers and Intermediate Care Facility for Persons with Mental Retardation (ICF-MR), which will be issued for one (1) year and renewed annually.
                                                                           National Provider Identifier (NPI) Enumeration Guidance
       Healthcare providers will be re-enrolling in MIHMS using National Provider Identifiers (NPIs). A provider can only re-enroll one provider type (as listed in
       the table below) per location. Providers with more than one provider type at the same address need to obtain an additional NPI for each provider type.
       The new “provider type NPI” can be used to re-enroll that provider type for any location the provider may have.
       Atypical providers (Free Standing Day Habilitation, Fiscal Employer Agent, and Transportation Services) do not require an NPI although some of these
       providers have obtained NPIs. If they have not done so, an Atypical Provider Identifier (API) will be assigned by MIHMS once their application for re-
       enrollment is approved. In either case, atypical services must be re-enrolled separately from typical healthcare provider types.
       And lastly, one NPI can be used to re-enroll different provider types at different locations in one enrollment application. For example, a provider has three
       locations as follows:
                                            LOCATION                                       PROVIDER TYPE                             ENROLLMENT NPI/API
                                                                                           Mental Health Clinics                     NPI #1
                                            56 State Street                                Group Home ICF-MR Facilities              NPI #2
                                                                                           Free Standing Day Habilitation Services   API #1 (Or NPI #3)
                                                                                           Mental Health Clinics                     NPI #1
                                            200 Capitol Street                             Substance Abuse Providers                 NPI #2 (Or NPI #4)
                                                                                           Free Standing Day Habilitation Services   API #1 (Or NPI #3)
                                            36 Main Street                                 Private Non-Medical Institutions (PNMI)   NPI #2 (Or NPI #5)
                                                                                           Mental Health Clinic                      NPI #1

       All three Mental Health Clinics will enroll under NPI #1. The two atypical Free Standing Day Habilitation Services will enroll separately under NPI #3 or will
       be assigned an API #1 upon approval of their application. The other three provider types can all be enrolled under NPI #2 even though they are different
       provider types, because they are located at different addresses. Alternatively, the provider could elect to obtain an NPI for each provider type, therefore
       enrolling the Substance Abuse provider type under NPI #4 and the PNMI under NPI #5. Each NPI would be re-enrolled separately.
       Providers that submit claims to Medicare and MaineCare should enroll Medicare reimbursable Provider Types in MIHMS using the same NPI enumeration
       as with Medicare.
                                                                                                                    Training
       Training sessions will be provided throughout the state to coincide with the enrollment cycles listed below. Separate sessions will be provided for
       “Individual Enrollment,” “Group Enrollment,” and “Facility, Agency, or Organization (FAO) Enrollment.” Training schedules will be available in the near
       future and will be posted at http://www.maine.gov/bms/providerfiles/provider_training.htm.


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                                                                                                             Clearinghouses
       A clearinghouse provides connectivity and often serves as a “middleman” between providers and billing entities, payers and other health care partners for
       transmission and translation of claims information (primarily electronic) into the specific format required by payers. These organizations will sign Trading
       Partner Agreements (TPAs) and register as Trading Partners with Unisys. Upon receipt of their Trading Partner ID, Clearinghouses will be able to submit
       electronic claims on any provider’s behalf. Clearinghouses are “covered entities” under the Privacy Rule of the Health Insurance Portability and
       Accountability Act (HIPAA) and, as such, are required by law to protect health information when conducting health care transactions electronically.

         Clearinghouses                                                                                                                                         Registration Period
         Register as Trading Partners and sign Trading Partner Agreements (TPA)                                                                               June 2009 and On-Going

                                                                                  Provider Re-Enrollment Information and Schedule
       Individual practitioners who have enumerated with both an individual NPI and a private practice organizational NPI are considered to be “Groups” in
       MIHMS and must enroll as “Groups” in the Second Cycle. They should attend “Group Enrollment” training, not the “Individual Enrollment” training.
       Providers with Multiple Provider Types, for example group practices and an FAO, should plan to attend training sessions for each. Please note,
       providers with multiple provider types will enroll in the Third Cycle, not when their separate provider types are listed.
       Trading Partners must register to be granted access to the secured portions of the MIHMS portal. This includes providers wishing to submit electronic
       claims, conduct eligibility verifications electronically or access claims information on the portal. Providers will receive notification of approval of their re-
       enrollment application. Upon approval, providers will be eligible to register as a Trading Partner. Providers will be required to enter one pay-to provider ID
       (either an NPI or API) and their Tax ID for authentication purposes. Providers will be able to associate additional provider records with their trading partner
       account after registration.
                          First Cycle Provider Types                                                 MaineCare Chapter 2 Section       Provider   Training Period       Enrollment
                                                                                                                                      Agreement                           Period
                                                                                                                                       Renewal

          Pilot Providers (TBD)                                                            N/A                                         4 Years         May                 July
          Adult Day Health Facilities                                                      26: Day Health Services                     4 Years         June                July

          Adult Family Care Services - Alternative                                         2: Adult Family Care Services               4 Years         June                July
          Residential Facilities
          Advanced Practice Registered Nurses: Certified
          Clinical Nurse Specialists, Certified Nurse                                      14: Advanced Practice Registered Nursing
          Midwives, Certified Nurse Practitioners, Certified                               Services                                    4 Years         June                July
          Registered Nurse Anesthetists (Individual Enrollee
          Only)
          Ambulance Services                                                               5: Ambulance Services                       4 Years         June                July

          Assisted Living Services Provider                                                6: Assisted Living Services                 4 Years         June                July

          Audiologists (Individual Enrollee Only)                                          109: Speech and Hearing Services            4 Years         June                July

          Behavioral Health Clinicians: Licensed Clinical
          Professional Counselors (LCPC), Licensed Clinical
          Social Workers (LCSW), Licensed Marriage and                                     65: Behavioral Health Services              4 Years         June                July
          Family Therapists (LMFT), Psychologists,
          Psychological Examiners (Individual Enrollee Only)

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                          First Cycle Provider Types                                                 MaineCare Chapter 2 Section                Provider   Training Period   Enrollment
                                                                                                                                               Agreement                       Period
                                                                                                                                                Renewal

          Chiropractors (Individual Enrollee Only)                                         15: Chiropractic Services                            4 Years         June            July

          Dental Hygienists (Individual Enrollee Only)                                     25: Dental Services                                  4 Years         June            July

          Dentists (Individual Enrollee Only)                                              25: Dental Services                                  4 Years         June            July

          Denturists (Individual Enrollee Only)                                            25: Dental Services                                  4 Years         June            July

          Durable Medical Equipment Suppliers (DME)                                        60: Medical Supplies and Durable Medical
          including Hearing Aids, Orthotic and Prosthetic                                  Equipment                                            4 Years         June            July
          Devices                                                                          35: Hearing Aids and Services
          Early Intervention Practitioner (Individual Enrollee                             Section 27: Early Intervention Services              4 Years         June            July
          Only)
          Education Related Services Providers: Early                                      Section 41: Day Treatment Services
          Intervention Services, Day Treatment, School-                                    Section 27: Early Intervention Services              4 Years         June            July
          Based Rehabilitation                                                             Section 104: School Based Rehabilitative Services
                                                                                           Section 62: Genetic Testing and Clinical Genetic
                                                                                           Services
          Laboratory/Radiology Services                                                                                                         4 Years         June            July
                                                                                           Section 55: Laboratory Services
                                                                                           Section 101: Medical Imaging Services
          Non-Hospital Affiliated Clinics (VD Clinics)                                     Section 150: V.D. Screening Clinic Services          4 Years         June            July

          Occupational Therapists (Individual Enrollee Only)                               Section 68: Occupational Therapy Services            4 Years         June            July

          Opticians (Individual Enrollee Only)                                             Section 75: Vision Services                          4 Years         June            July

          Optometrists (Individual Enrollee Only)                                          Section 75: Vision Services                          4 Years         June            July
          Pharmacies – Free Standing (Pharmacological and                                  Section 35: Hearing Aids and Services
          DME)                                                                             Section 60: Medical Supplies and Durable Medical
          Pharmacies located in Canada may not enroll as                                                                                        4 Years         June            July
                                                                                           Equipment
          MaineCare providers.
                                                                                           Section 80: Pharmacy Services
          Physical Therapists (Individual Enrollee Only)                                   Section 85: Physical Therapy Services                4 Years         June            July

          Physicians – (Individual Enrollee Only)                                          Section 90: Physician Services                       4 Years         June            July

          Podiatrists (Individual Enrollee Only)                                           Section 95: Podiatric Services                       4 Years         June            July

          School Health Centers                                                            Section 3: Ambulatory Care Clinic Services           4 Years         June            July
          Speech Language Pathologists (Individual Enrollee                                Section 109: Speech and Hearing Services             4 Years         June            July
          Only)
          Transportation Agencies: Full Service and                                        Section 113: Transportation Services                 4 Years         June            July
          Wheelchair Van
          Vision Centers                                                                   Section 75: Vision Services                          4 Years         June            July

          Waiver Services Providers - Members with Mental                                  Section 21: Home and Community Benefits for          4 Years         June            July

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                          First Cycle Provider Types                                                 MaineCare Chapter 2 Section                Provider   Training Period   Enrollment
                                                                                                                                               Agreement                       Period
                                                                                                                                                Renewal

          Retardation and Autistic Disorders                                               Members with Mental Retardation or Autistic
                                                                                           Disorder
                                                                                           Section 29: Community Support Benefits for
                                                                                           Members with Mental Retardation and Autistic
                                                                                           Disorder



                        Second Cycle Provider Types                                                  MaineCare Chapter 2 Section                Provider   Training Period   Enrollment
                                                                                                                                               Agreement                       Period
                                                                                                                                                Renewal

                                                                                           Section 14: Advanced Practice Registered Nursing     3 Years         July           August
          Advanced Practice Registered Nursing Group                                       Services

          Audiology Group                                                                  Section 109: Speech and Hearing Services             3 Years         July           August

          Behavioral Health Clinician Group                                                Section 65: Behavioral Health Services               3 Years         July           August

          Boarding Homes: Cost Reimbursed Case Mix,                                        Section 97: Private Non-Medical Institution          3 Years         July           August
          Cost Reimbursed Non-Case Mix and Flat Rate                                       Services

          Case Management Service Providers Free-                                          Section 13: Targeted Case Management Services        3 Years         July           August
          Standing Only
          Chiropractic Group                                                               Section 15: Chiropractic Services                    3 Years         July           August
          Dental Group                                                                     Section 25: Dental Services                          3 Years         July           August
          Dental Hygienists Group                                                          Section 25: Dental Services                          3 Years         July           August
          Denturist Group                                                                  Section 25: Dental Services                          3 Years         July           August

          Family Planning Agencies                                                         Section 30: Family Planning Agency Services          3 Years         July           August
                                                                                           Section 24: Day Habilitation Services for Persons    3 Years         July           August
          Free Standing Day Habilitation                                                   with Mental Retardation
          Group Home ICF-MR Facilities                                                     Section 50: ICF-MR Services                           1 Year         July           August
          Home Health Agencies                                                             Section 40: Home Health Services                     3 Years         July           August
          Hospices                                                                         Section 43: Hospice Services                         3 Years         July           August
                                                                                           Section 50: ICF-MR Services                          3 Years
          Nursing Homes: Skilled Nursing Facilities (SNF),                                                                                     (Non ICF-
          Intermediate Care Facility for Persons with Mental                               Section 67: Nursing Facility Services
                                                                                                                                                  MR)           July           August
          Retardation (ICF/MR), Cost Reimbursed Boarding                                   Section 97: Private Non-Medical Institution           1 Year
          Homes and Brain Injury Facility                                                  Services                                            (ICF-MR)

          Occupational/Physical Therapy Group                                              Section 68: Occupational Therapy Services            3 Years         July           August

          Physicians Groups - Non-Hospital Based                                           Section 90: Physician Services                       3 Years         July           August

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                        Second Cycle Provider Types                                                  MaineCare Chapter 2 Section               Provider   Training Period    Enrollment
                                                                                                                                              Agreement                        Period
                                                                                                                                               Renewal

          Podiatry Group                                                                   Section 95: Podiatric Services                      3 Years          July           August
          Private Non-Medical Institutions (PNMI): Addiction                               Section 97: Private Non-Medical Institution
          Services, Mental Health, Supervisory Care Homes                                                                                      3 Years          July           August
                                                                                           Services
          formerly known as Child Care Facilities
          Rehabilitation Centers                                                           Section 102: Rehabilitative Services                3 Years          July           August

          Speech Language Pathology Group                                                  Section 109: Speech and Hearing Services            3 Years          July           August

          Speech/Hearing Therapist Group                                                   Section 109: Speech and Hearing Services            3 Years          July           August

                                                                                           Section 13: Targeted Case Management Services
                                                                                           Section 17: Community Support Services
          State Agency (ACT, ICM, Case Management,                                         Section 21: Home and Community Benefits for
          Community Support Services, Residential                                          Members with Mental Retardation or Autistic         3 Years          July           August
          Training, Dentist-Public Health)                                                 Disorder
                                                                                           Section 25: Dental Services
                                                                                           Section 65: Behavioral Health Services

          Vision Services Provider Group                                                   Section 75: Vision Services                         3 Years          July           August



                          Third Cycle Provider Types                                                 MaineCare Chapter 2 Section               Provider   Training Period    Enrollment
                                                                                                                                              Agreement                        Period
                                                                                                                                               Renewal

          Ambulatory Surgical Centers                                                      Section 4: Ambulatory Surgical Center Services      2 Years    August/September   September

          Dialysis Center – Free Standing                                                  Policy in Development                               2 Years    August/September   September
          Hospital-Based Professionals                                                     Section 90: Physician Services                      2 Years    August/September   September
          Hospitals Including Critical Access Hospitals                                    Section 45: Hospital Services                       2 Years    August/September   September
          Psychiatric Hospitals                                                            Section 46: Psychiatric Hospital Services           2 Years    August/September   September
                                                                                           Section 12: Consumer Directed Attendant Services
                                                                                           Section 19: Home and Community-Based Benefits
          Attendant Care: Consumer Directed Services                                       for the Elderly and for Adults with Disabilities
          Agency, Family Provider Service Option Agency,                                                                                       2 Years    August/September   September
                                                                                           Section 22: Home and Community Benefits for the
          Personal Care Attendant Agency, Physically
                                                                                           Physically Disabled
          Disabled Waiver Agency.
                                                                                           Section 96: Private Duty Nursing and Personal
                                                                                           Care Services
                                                                                           Section 31: Federally Qualified Health Center
          Community Health Center: Federally Qualified                                     Services                                            2 Years    August/September   September
          Health Centers, Rural Health Center
                                                                                           Section 103: Rural Health Clinic Services
                                                                                           Section 96: Private Duty Nursing and Personal       2 Years    August/September   September
          Fiscal/Employer Agent
                                                                                           Care Services
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                          Third Cycle Provider Types                                                 MaineCare Chapter 2 Section               Provider     Training Period      Enrollment
                                                                                                                                              Agreement                            Period
                                                                                                                                               Renewal

          Indian Health Centers                                                            Section 3: Ambulatory Care Clinic Services          2 Years      August/September      September

          Mental Health Clinics: Behavioral Health,                                        Section 65: Behavioral Health Services
          Community Support, Assertive Community                                                                                               2 Years      August/September      September
          Treatment (ACT), Intensive Case Management
          (ICM)
          Non-Medicaid Providers                                                           MaineCare Policy Does Not Apply                     2 Years      August/September      September
                                                                                           All Sections as defined in this Table              Varies from
          Out of State Providers                                                                                                               1 Year to    August/September      September
                                                                                                                                                Special
                                                                                           Section 96: Private Duty Nursing and Personal       2 Years      August/September      September
          Private Duty Nurse Provider Agencies
                                                                                           Care Services
          Private Duty Nurses: Registered Nurses (RN) and                                  Section 96: Private Duty Nursing and Personal      Individual
          Licensed Practical Nurses (LPN) (Individual                                      Care Services                                      Agreement
                                                                                                                                               2 Years      August/September      September
          Practitioner)                                                                                                                        Lengths

          Providers enrolled in MeCMS Post 02/28/2009                                      All Sections as defined in this Table               2 Years      August/September      September

          Providers with Multiple Provider Types                                           All Sections as defined in this Table               2 Years      August/September      September
          Substance Abuse Providers                                                        Section 65: Behavioral Health Services              2 Years      August/September      September
          Waiver Services Provider - Elderly and Adults with                               Section 19: Home and Community-Based Benefits       2 Years      August/September      September
          Disabilities Waiver                                                              for the Elderly and for Adults with Disabilities


       Billing Agents are defined in MIHMS as entities contracted by providers to create and manage the submission of providers’ claims and related
       transactions. These entities are typically hired by provider organizations to perform medical claim coding services. They will not re-enroll in MIHMS as they
       enrolled in MeCMS. These organizations will sign Trading Partner Agreements (TPAs) and register as Trading Partners with Unisys. Upon receipt of their
       Trading Partner ID, they will be able to submit electronic claims on behalf of those providers who have authorized these services. Billing agents will be
       required to enter the pay-to provider ID (either an NPI or API) and the Tax ID of the providers for whom they will be billing for authentication purposes.
       Providers are reminded to ensure that a Business Associates Agreement (BAA) is in place when employing a billing agent. For more information on BAAs,
       please visit the Office for Civil Rights’ web site at http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/businessassociates.html.

          Billing Agents                                                                                                                                                  Registration Period
          Register as Trading Partners and sign Trading Partner Agreements (TPA)                                                                                          September/October


          Maintenance: On-Going
          Providers are reminded to conduct on-going maintenance of data in MIHMS in preparation for Full Implementation.


                                           Please call 1(800)321-5557, Option 8, or e-mail MaineCare2010.DHHS@maine.gov if you have any questions.



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