• Read more about MaineCare in Education: New Modifier Guidance for Sections 28 and 96 

Effective immediately, all providers submitting claims for Individuals with Disabilities Education Act (IDEA) services must include the TL or TM modifier on the claim line to indicate if the service was provided pursuant to an Individualized Education Program (IEP) or Individual Family Service Plan (IFSP), respectively.

TL and TM modifiers must now be included for claims submitted for any and all services delivered under MaineCare Sections 28 and 96 of MBM.

• Read more about Biosimilar Preferred Drug List (PDL) 

Through adoption of MaineCare Benefits Manual Chapter II, Section 90.04-7(B), Biosimilar Preferred Drug List, and pursuant to P.L. 2021, Ch. 398, Sec. A-17, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023, the Department is implementing a Biosimilar Preferred Drug List (PDL).

• Read more about Updated MaineCare in Education 2022 Guide

Please review and download the MaineCare in Education 2022 School Health-Related Services Billing Guide. The guide is available on the

• Read more about Enteral Nutrition and Supply Codes Added to the Diabetic Supply Service Group, CR 107707 

We have added enteral nutrition and supply codes to the Diabetic Supply Service Group to correct an issue that was causing claims to deny.

Enteral nutrition and supply codes that were submitted with overlapping dates, paid by Medicare, and crossed over to MaineCare in the Medicare claim file were denying as duplicates. We have corrected this issue by adding the codes to the Diabetic Supply Service Group. We will adjust affected claims, and no provider action is necessary. 

• Read more about Attention All Providers: Payment Error Rate Measurement (PERM) Audit

The State of Maine has completed the process of a federally mandated PERM audit for Reporting Year 2021. The information below will help you avoid errors that could result in the need to pay MaineCare back.

This audit covered randomly selected paid claims with payments dated July 1, 2019, through June 30, 2020. See the e-message from February 6, 2020, that notified providers about the audit.

Claims Submission 

• Read more about Status of Home and Community Based Services (HCBS) Settings Rule Requirements 

Earlier this week at a provider association meeting, an official from the Centers for Medicare and Medicaid Services (CMS) indicated that CMS is likely to give states the option to request additional time to comply with some aspects of the federal HCBS Settings Rule. The Department has received questions about what this means for Maine’s current compliance efforts. 

• Read more about Reminder: Primary Care Plus (PCPlus) Application Closes Today 

PCPlus is an adopted MaineCare policy that supports primary care practices in delivering high-quality primary care. We anticipate that this policy will have a future effective date of July 1, 2022.   

• Read more about Reminder: Primary Care Plus (PCPlus) Application Closes Today 

PCPlus<

• Read more about Instructions to Apply for Retainer Payments for Providers of MaineCare Benefits Manual (MBM), Sections 18, 20, 21, and 29 Services 

This is a follow up to the August 30, 2021 e-message and September 24, 2021 e-message regarding Home and Community Based Services (HCBS) Retainer

• Read more about Attention All MaineCare Providers: Updated Alternative Settings Guidance  

Under the Department’s approved Section 1135 waiver, the Centers for Medicare & Medicaid Services (CMS) has granted us the ability to waive certain federal Medicaid requirements during the COVID-19 federal public health emergency.