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The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the propo
As of May 20, 2022, we have updated Prior Authorizations (PAs) issued prior to May 3, 2022, for Section 21 Home Support- Agency Per Diem (T2016 or T2016 SC) rate adjustments effective January 1, 2022, associated with Part AAAA of P.L. 2021, ch 398. Providers may now adjust claims for these services retroactively to January 1, 2022. Providers have 120 days from the date of this notice to adjust claims; please focus on the oldest dates of service first.
Effective immediately, all providers submitting claims for Individuals with Disabilities Education Act (IDEA) services must include the TL or TM modifier on the claim line to indicate if the service was provided pursuant to an Individualized Education Program (IEP) or Individual Family Service Plan (IFSP), respectively.
TL and TM modifiers must now be included for claims submitted for any and all services delivered under MaineCare Sections 28 and 96 of MBM.
Through adoption of MaineCare Benefits Manual Chapter II, Section 90.04-7(B), Biosimilar Preferred Drug List, and pursuant to P.L. 2021, Ch. 398, Sec. A-17, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023, the Department is implementing a Biosimilar Preferred Drug List (PDL).
Please review and download the MaineCare in Education 2022 School Health-Related Services Billing Guide. The guide is available on the
We have added enteral nutrition and supply codes to the Diabetic Supply Service Group to correct an issue that was causing claims to deny.
Enteral nutrition and supply codes that were submitted with overlapping dates, paid by Medicare, and crossed over to MaineCare in the Medicare claim file were denying as duplicates. We have corrected this issue by adding the codes to the Diabetic Supply Service Group. We will adjust affected claims, and no provider action is necessary.
The State of Maine has completed the process of a federally mandated PERM audit for Reporting Year 2021. The information below will help you avoid errors that could result in the need to pay MaineCare back.
This audit covered randomly selected paid claims with payments dated July 1, 2019, through June 30, 2020. See the e-message from February 6, 2020, that notified providers about the audit.
Claims Submission
Earlier this week at a provider association meeting, an official from the Centers for Medicare and Medicaid Services (CMS) indicated that CMS is likely to give states the option to request additional time to comply with some aspects of the federal HCBS Settings Rule. The Department has received questions about what this means for Maine’s current compliance efforts.
PCPlus is an adopted MaineCare policy that supports primary care practices in delivering high-quality primary care. We anticipate that this policy will have a future effective date of July 1, 2022.