Service Billing Determination - High Level

 

Breakout

 

Mainecare client?

Yes

 

No

 
 

Is the billing location in Kennebec or Somerset County?

Yes

 

No

 
 

Is the billing program participating in CCBHC?

Yes

 

No

 
 

Is the service a CCBHC service?

Yes

 

No

 
 

Is there a T1041 authorization in place?

Yes

 

No

 
 

Is there an authorization service level component in place for service delivered?

Yes

 

No

 
 

Does this service yield a PPS triggering CPT?

Yes

 

No

 
 

Pass T1041 compliance checks?

Yes

 

No

 
 

Bill PPS Rate

 

The service is now a Failed Activity.

This service will continue to fail until it passes validation, compliance, and authorization checks.

 

 

How did I get here? 🛑

 

Fee for Service

Does it pass validation, compliance, and authorization checks?

Yes

 

No

 
 

Bill Fee for Service

 

The service is now a Failed Activity.

This service will continue to fail until it passes validation, compliance, and authorization checks.

 

 

Fee for Service

Does it pass validation, compliance, and authorization checks?

Yes

 

No

 
 

Bill Fee for Service

 

The service is now a Failed Activity.

This service will continue to fail until it passes validation, compliance, and authorization checks.

 

 

Fee for Service

Does it pass validation, compliance, and authorization checks?

Yes

 

No

 
 

Bill Fee for Service

 

The service is now a Failed Activity.

This service will continue to fail until it passes validation, compliance, and authorization checks.

 

Fee for Service

Does it pass validation, compliance, and authorization checks?

No

 
 
 

The service is now a Failed Activity.

This service will continue to fail until it passes validation, compliance, and authorization checks.

 

Fee for Service

Does it pass validation, compliance, and authorization checks?

Yes

 

No

 
 

Bill Fee for Service

 

The service is now a Failed Activity.

This service will continue to fail until it passes validation, compliance, and authorization checks.

 

 

Fee for Service

Does it pass validation, compliance, and authorization checks?

 

Yes

 

No

 
 

Bill Fee for Service

 

The service is now a Failed Activity.

This service will continue to fail until it passes validation, compliance, and authorization checks.
 

 

Written By Amanda Griffin (Super Administrator)

Updated at January 28th, 2025


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