Section 90, Physician Services Rate Update, CR 129756
Effective January 1, 2025, MaineCare updated Section 90, Physician Service rates. You may view the updated fee schedule on the rate setting page of the Health PAS Online Portal.
Primary Care Providers (PCPlus) Quality Measure Webinar: Cervical Cancer Screening
PCPlus providers are invited to a webinar series about best practices regarding quality measures in the PCPlus program. This series is intended to educate practices on how to optimize their performance, and payment, while aligning with industry best practices for population and patient health. We will host approximately one webinar a month during 2025.
Attention Primary Care Plus (PCPlus) Practices: PCPlus Application and Recertification to Open in April
MaineCare Services is excited to notify you that in April, the PCPlus application will open for new and recertifying primary care practice applicants. During the open application period, primary care practices that are not currently participating in PCPlus will have an opportunity to apply to participate. MaineCare will send another notification once the application for PCPlus is open.
Notice of MaineCare 1115 Waiver Renewal Application, “Maine Substance Use Disorder (SUD) Care Initiative”
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
Attention Primary Care Practices: Primary Care Plus (PCPlus) Program Reorientation Meeting
Please join us on March 28, 2025, for a PCPlus Program Reorientation Meeting on the following topics:
- Structure and goals of the current service model
- Status of the program
- Aims of MaineCare’s upcoming work to evolve and advance the program and its Alternative Payment Model (APM)
Date: March 28, 2025
Time: 12:00 to 1:00 PM
Registration link: Please register prior to the meeting.
Attention MaineCare Providers: Status of Temporary MaineCare Payment Holds
On March 5, 2025, MaineCare announced the Department would need to temporarily hold certain provider payments beginning with the payment cycle that ran on March 12, 2025. As of the time of this message, the Legislature has not approved the necessary funding, by way of an emergency supplemental budget, to avoid these measures.
MaineCare Notice of Agency 1115 Waiver Renewal Application, "Maine Substance Use Disorder (SUD) Care Initiative"
Notice of Agency Waiver Renewal
AGENCY: Department of Health and Human Services (DHHS), Office of MaineCare Services
RULE TITLE OR SUBJECT: 1115 Waiver Renewal Application
WAIVER: Section 1115(a) waiver demonstration, “Maine Substance Use Disorder (SUD) Care Initiative"
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.