• Read more about 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.

• Read more about 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.

• Read more about 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"

• Read more about 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.

• Read more about 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.

• Read more about Maine Center for Disease Control (CDC) Children & Youth with Special Health Care Needs Webinar Learning Series – Women, Infant & Children (WIC) 101

Maine CDC Children & Youth with Special Health Care Needs invites you to join us for an insightful webinar about the basics of WIC. This webinar will provide a general overview of the services offered by WIC and how they can be accessed.  

At the end of this presentation, participants will:

• Understand who is eligible for WIC services
• Be able to identify the four WIC services
• Know the difference between WIC and Farmers Market Nutrition Program (FMNP) 

When: April 1, 2025, 3:30 - 4:30 PM

• Read more about Section 4, Ambulatory Surgical Center (ASC) Rates Implemented, CR 129907

We implemented new rates for Section 4, ASCs retroactively to January 1, 2025.

You may view the updated fee schedule on the rate setting page of the Health PAS Online Portal.

Adjusting Claims   

• Read more about Anesthesiology Rate Updates: Section 14, Advance Practice Registered Nurses (APRNs) and Section 90, Physicians, CR 129353

Effective January 1, 2025, MaineCare updated the Anesthesiology conversion factors for Sections 14 and 90 of the MaineCare Benefits Manual. You may view the updated fee schedules on the rate setting wepage of the Health PAS Online Portal.                                                 

• Read more about Revised Rates: Sections 68, 85 and 109, CRs 129558, 129513, 129352

We implemented new rates for Sections 68, 85 and 109 retroactively to January 1, 2025.

You may view the updated fee schedules on the rate setting page of the Health PAS Online Portal.

Adjusting Claims

• Read more about MaineCare Rate Reform Expert Technical Advisory Panel (TAP) Consultation: Draft CY2025 Rate Determination Schedule Presented Materials and Proposed Schedule

On March 14, 2025, we held the Annual Draft Rate Determination Schedule Consultation with the TAP which was open to the public.