• Read more about Section 97, Private Non-Medical Institutions, (PNMI) Appendix E - Clinical Documentation for Continued Stay Reviews

Mar 3, 2025

Maine’s Department of Health and Human Services (DHHS) is committed to providing clear, accurate, and transparent data about its programs and services. As part of this commitment, Maine DHHS recently launched an updated “By the Numbers” data dashboard.

• Read more about Inside the Enhanced ‘By the Numbers’ Dashboard: Greater Insights for Maine DHHS

• Read more about Updated Billing Guidance for Section 28 Providers

This notice clarifies and updates the Department's guidance on December 31, 2024. 

Providers of Specialized Services cannot bill for any time a Board-Certified Behavior Analyst (BCBA) spends delivering services, including, but not limited to, the BCBA Services outlined in MaineCare Benefits Manual (MBM) Section 28.04-3. 

• Read more about Quarter 1, 2025, Section 90 - Physician Drug Rates, CR 129556

Effective January 1, 2025, MaineCare retroactively updated the Physician Drug Rates to align with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update. We implemented these rates on February 19, 2025.

• Read more about 2025 Indian Health Services (IHS) Rate Update, CR 129495

Effective January 1, 2025, the rate for IHS providers increased to $801.00. We implemented this new rate on February 5, 2025.

The Department will reprocess affected claims. No provider action is required. 

Please contact your  Provider Relations Specialist with questions. 

• Read more about REVISED Section 90, Primary Care Provider (PCP) Rates Effective January 1, 2025, CR 129557

• Read more about Attention Providers: Update on Capping of MaineCare Payment Cycles

On February 10, 2025, we shared that, if the Legislature does not pass the Fiscal Year 2025 supplemental budget request to fill the MaineCare shortfall, the Department will not have sufficient funds to pay MaineCare providers in full through the end of the fiscal year and will need to temporarily withhold

• Read more about Seasonal Influenza Activity Remains Elevated in Maine

It's not too late to vaccinate, take steps to prevent illness

AUGUSTA-- Influenza (flu) activity remains high across Maine with hospitals admitting over 900 individuals so far this season. The Maine Center for Disease Control and Prevention (Maine CDC) encourages everyone to take steps to protect themselves and others from getting sick.

• Read more about Attention Providers: AIDS Drug Assistance Program (ADAP) 101 Webinar Available

On March 5, 2025, The Maine Centers for Disease Control (CDC) staff is offering a free 30-minute webinar at 11:30 AM. The webinar covers what health care office staff need to know about the ADAP program, including: 

• Read more about Reminder for Billing Attending Provider on UB-04 and 837I Claims, CR 110840

This is a reminder that the attending provider is required on all UB-04 and 837I claims. MaineCare denies UB-04 and 837I claims submitted without an enrolled attending provider.

The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim/encounter. The attending provider requirement includes all claim submission methods (paper, HealthPAS Online Portal, or 837I).