Skip Maine state header navigation

Agencies | Online Services | Help

Skip First Level Navigation | Skip All Navigation

Home > Provider > Provider Enrollment

Provider Enrollment

NOTE: Current MaineCare providers need to re-enroll in MIHMS, the system that will begin operations in early 2010. To re-enroll, please visit the MIHMS re-enrollment portal. New providers should enroll using the forms and information below.

 

All providers are required to fill out and sign the Provider Enrollment Forms, Agreement Forms and the W9 Form. The Servicing Provider Form is required for each servicing provider being enrolled. The instructions included in the Provider Enrollment download have a sheet detailing who must be enrolled as a servicing provider.

Please download and fill out all required forms and submit as one packet.

Provider Forms Word PDF
Provider Enrollment Forms (.doc) (.pdf)
Specialty/Subspecialty Documentation Requirements (.doc) (.pdf)
Provider Type/Specialty/Subspecialty Sheets - Rules and Regulations by Provider Type    
Servicing Provider Form (a section of the Provider Enrollment Forms document listed above) (.doc) (.pdf)
Special Instructions for Providers Located Outside Maine (.doc) (.pdf)
Change of Address or Company Name
  Form   (.pdf)
  Instructions   (.pdf)

 

Please be sure to print out a copy of the billing instructions and policy section for your provider specialty. Policy links are listed with the Provider Type.

If you have questions, please call one of the following numbers:

  • Enrollment and Out of State providers: 1-800-321-5557 Option 6 or (207)287-4082.
  • Billing: 1-800-321-5557 option 8 or (207)287-3094.
  • Policy: 1-800-321-5557 option 8 or (207)287-9368. Your call will then be directed to the appropriate provider relations specialist.>
To view the current policy for all specialities view the Secretary of State's website.
NOTE: Please check our Rulemaking Site for any policy/rules which are in the process of being revised or updated.