Attention Providers: Supporting MaineCare Members During Temporary Provider Payment Holds

MaineCare is receiving reports regarding increased member concern about the status of their MaineCare coverage as a result of the temporary hold on certain provider payments. The temporary holds on provider payments do not affect MaineCare coverage for members.

MaineCare sent this electronic message to our member list serv on March 10, 2025, regarding impact on members.

Attaching an Explanation of Benefits (EOB) to Secondary Claims

When billing MaineCare secondary claims, you must attach an EOB to all claims regardless of the submission type listed below:

  • Direct Data Entry (DDE)
  • Paper
  • Electronic Data Interchange (EDI)

When submitting electronically, upload the EOB after the claim is in MIHMS. The charges billed on the claim lines must match the charges billed on the EOB, or the claim will be denied.

Maine Center for Disease Control (CDC) Children & Youth with Special Health Care Needs Webinar Learning Series – Women, Infant & Children (WIC) 101

Maine CDC Children & Youth with Special Health Care Needs invites you to join us for an insightful webinar about the basics of WIC. This webinar will provide a general overview of the services offered by WIC and how they can be accessed.  

At the end of this presentation, participants will:

  • Understand who is eligible for WIC services
  • Be able to identify the four WIC services
  • Know the difference between WIC and Farmers Market Nutrition Program (FMNP) 

When: April 1, 2025, 3:30 - 4:30 PM

Anesthesiology Rate Updates: Section 14, Advance Practice Registered Nurses (APRNs) and Section 90, Physicians, CR 129353

Effective January 1, 2025, MaineCare updated the Anesthesiology conversion factors for Sections 14 and 90 of the MaineCare Benefits Manual. You may view the updated fee schedules on the rate setting wepage of the Health PAS Online Portal.                                                 

Clone of Division of Licensing and Certification

The Division of Licensing & Certification (DLC) provides regulatory oversight of medical and long-term care facilities in Maine. This includes oversight of the CNA registry, criminal background checks for employers to ensure staff are safe to care for our vulnerable citizens, and investigations into allegations of unsafe practices/events in facilities as diverse as hospitals, nursing homes, assisted living facilities, and group homes.

10-144 C.M.R. Chapter 332; MaineCare Eligibility Manual – Part 9: LIMITED BENEFIT GROUPS and Chart 3.8: Premiums for Special Benefits Waiver [Maine Section 1115 Health Care Reform Demonstration for Individuals with HIV/AIDS] MaineCare Rule #312P – Part 9

10-144 C.M.R. Chapter 332; MaineCare Eligibility Manual – Part 9: LIMITED BENEFIT GROUPS and Chart 3.8: Premiums for Special Benefits Waiver [Maine Section 1115 Health Care Reform Demonstration for Individuals with HIV/AIDS]

MaineCare Rule #312P – Part 9 and Chart 3.8 Premium Updates

10-144 C.M.R. Chapter 331; Public Assistance Manual Temporary Assistance for Needy Families (TANF) Manual, Chapter II TANF Rule #124 – COFA Update

10-144 C.M.R. Chapter 331; Public Assistance Manual Temporary Assistance for Needy Families (TANF) Manual, Chapter II

TANF Rule #124 – COFA Update

PRINCIPAL REASON(S) OR PURPOSE FOR PROPOSING THIS RULE: 

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