Providers of Section 17 Services - Telehealth Clarification
Effective January 1, 2025, the Department exercises enforcement discretion permitting providers to utilize telehealth for Section 17 services in line with the following guidance.
Prior Authorization (PA) Requests for Dentures
PA requests for complete dentures must include ALL of the following:
- The MaineCare Removeable Prosthodontics PA Form, found on the Health PAS Online Portal
- A treatment plan, completed by providers within their scope of service
- A radiographic or photographic image(s)
We will defer PA requests that do not include appropriate documentation and send a letter to the provider.
Application Fee for 2025 Reminder, CR 128480
Effective January 1, 2025, in accordance with the Centers for Medicare & Medicaid Services (CMS) application fee requirements, MaineCare’s provider enrollment application fee will increase to $730 per enrollment application. This increase will apply to new, reactivating, or revalidating providers, or when adding new service locations to an existing enrollment. You can pay the application fee by credit or debit card at the time of application submission.
Updates to Service Provider Tax (SPT) Repeal Frequently Asked Questions (FAQ)
In response to MaineCare provider inquiries regarding SPT repeal, the Department updated the FAQs originally published and shared in the
UPDATE: Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment
UPDATE: Notice of MaineCare 1115 Waiver Application: Substance Use Disorder Care Initiative Amendment
AGENCY: Department of Health and Human Services, Office of MaineCare Services
NATURE OF PROPOSED CHANGES: The state is requesting a budget neutrality projection adjustment for two components of the current 1115 Waiver Substance Use Disorder (SUD) Care Initiative.
Training Opportunity Available for Family and Caregivers of Adults Receiving Services Within Section 12, 19, and 96 Programs
The Office of Aging and Disability Services (OADS), in collaboration with the National Alliance on Mental Illness (NAMI) Maine is excited to announce a virtual training De-Escalation opportunity scheduled for Tuesday, December 10, 2024, from 3:00 PM – 5:00 PM.
This training is available for caregivers providing care to Section 12, 19, and 96 members. Caregivers can include personal support staff, attendants, home health aides, nurses or other natural and family supports.
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).
Taxonomy Code Requested on Claim Submissions – Portal Claims
The Office of MaineCare Services (OMS) is requesting that providers include the taxonomy code on all claims. The taxonomy code is necessary for the Centers for Medicaid and Medicare Services (CMS) to collect data for Transformed Medicaid Statistical Information System (T-MSIS) reporting. This data helps to inform states of their current standing in data quality as compared to other states and is crucial for research and policy on Medicaid and CHIP. The taxonomy is also used by CMS to conduct program oversight, administration, and integrity.
Revalidate with MaineCare to Avoid Claim Denials
Per the Affordable Care Act (ACA), Section 6401, all providers need to revalidate with all states they are enrolled with.
Durable Medical Equipment (DME) providers are required to revalidate their information with MaineCare every three years. The current round of revalidation began in January 2022.
Rescheduled: Section 107, Psychiatric Residential Treatment Facilities (PRTFs): Revised Draft Rates Public Review and Comment Forum
The PRTF public review and comment forum has been rescheduled to December 17, 2024.
MEETING DATE & TIME:
Tuesday, December 17, 2024, 11:30AM – 1:00PM
ZOOM Information:
https://mainestate.zoom.us/j/89397750850
Meeting ID: 893 9775 0850
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