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On October 19, 2022, the Office of MaineCare Services (OMS) issued a bulletin informing providers that MaineCare will no longer require a PA for crowns provided in conjunction with endodontic therapy when a qualifying diagnosis was included on the dental claim. The list of qualifying diagnosis inadvertently listed ICD-10-CM code K04.0-Pulpitis.
The Office of MaineCare Services has updated the MaineCare in Education web page.
You are invited to:
The Office of MaineCare Services (OMS), Office of the State Controller, and Gainwell have resolved the issue with claims going to a PEND status for a Missing Vendor Code (Edit 6037), noted in the May 1, 2024 e-message.
Please note that Gainwell is mass adjudicating all the claims affected and there should be no impact on next week’s payment.
In alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update, the Department has retroactively updated the Physician Drug Rates Effective January 1, 2024. These new rates were implemented for billing on May 1, 2024.
In coordination with the Centers for Medicare & Medicaid Services, (CMS) revision of rates effective March 9, 2024, MaineCare has updated its Section 90 rates. These rates were implemented on May 1, 2024. You may view all codes and rates on the Usual, Customary and Reasonable (UCR) fee schedule.
As caterpillars become more active, take precautions to protect your health
AUGUSTA – The Maine Center for Disease Control and Prevention (Maine CDC) and Maine Forest Service (MFS) remind Maine residents and visitors to take precautions to reduce exposure to browntail moth caterpillars, as they become more active this spring.
The Office of MaineCare Services (OMS) has become aware of a vendor code issue that began this morning, May 1, 2024, impacting certain provider’s claims and causing those claims to go into a PEND status for a Missing Vendor Code (Edit 6037). This issue is being investigated and addressed by multiple entities including: OMS, Gainwell Technologies, and the Office of the State Controller. OMS will update all providers as this issue progresses.
Please note that this issue will NOT impact any provider’s payments issued this week.
The public review and comment forum that was scheduled for May 7, 2024, to present the draft rates and methodologies for Section 45 services has been postponed. We appreciate your ongoing patience and apologize for any inconvenience. The Department will reschedule this forum and send notice of the new date and time. Please watch for future noticing.
For questions, please contact Jessica Levesque, MaineCare’s Rate Reform Project Manager.
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until t
Notice of Agency Major Substantive Rulemaking Adoption
AGENCY: Department of Health and Human Services, MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual, Chapter III, Section 29, Allowances for Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder
PROPOSED RULE NUMBER: 2023-P173
CONCISE SUMMARY: