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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.
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.
Effective January 1, 2025, MaineCare updated the PCP rates under Section 90 to align with the Centers for Medicare & Medicaid Services’ (CMS) revision of rates. on February 19, 2025. The updated rates can be found on the Health PAS Online Portal.
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
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.
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:
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).
The final draft rate model and a summary of all comments resulting from both June 2023 and January 2025 forums are available on the Rate System Reform webpage. The comment summary includes the Department’s written responses, with an explanation of whether and how feedback was incorporated into the final draft rates.
On March 31, 2025, the Department will host a virtual “kick off” meeting with interested parties via Zoom. At this meeting, we will provide an overview of the project goals, the scope of this work, and a timeline that includes additional opportunities for interested parties to participate and provide feedback.
Meeting Date/Time
Interpreter Services, Rate Determination Kickoff Meeting
Date/Time: Monday, March 31, 2025, 11:00 AM – 12:30 PM
Registration Link
Effective February 15, 2025, the Center for Medicare and Medicaid Services’ (CMS) quarterly updates are complete in MIHMS.
The following CMS documents provide the details of the APC (CRs 129832 & 129843) updates: