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See the Supplemental Billing Instructions on the Health PAS Online Portal which explains how to bill Patient Driven Payment Model (PDPM) services.
For questions, please contact Bruce Cosgrove, Provider Relations Specialist.
On February 26, 2025, we announced that, absent emergency action by the Legislature, the Department would need to temporarily hold certain provider payments beginning with the payment cycle that will run on March 12, 2025. As of the time of this message, the Legislature has not approved the necessary funding to avoid these measures.
Effective January 1, 2025, we implemented new rates for Section 101, Medical Imaging Services.
The Office of Aging and Disability Services (OADS) is excited to announce a statewide marketing effort to increase awareness of Adult Day Services.
The marketing plan includes digital, broadcast and cable television, and streaming segments as well as a refresh to the OADS Adult Day Services webpage.
As of May 1, 2025, providers of Section 97 appendix E (PNMI E) must submit clinical documentation supporting medical necessity.
Providers must submit this clinical documentation into the Atrezzo system every 90 days as part of each member’s continued stay review. The documentation must include all of the following:
The member’s diagnosis
Level of care utilization system (LOCUS) score
Treatment plan
Mar 3, 2025
Maine’s Department of Health and Human Services (DHHS) is committed to providing clear, accurate, and transparent data about its programs and services. As part of this commitment, Maine DHHS recently launched an updated “By the Numbers” data dashboard.
This notice clarifies and updates the Department's guidance on December 31, 2024.
Providers of Specialized Services cannot bill for any time a Board-Certified Behavior Analyst (BCBA) spends delivering services, including, but not limited to, the BCBA Services outlined in MaineCare Benefits Manual (MBM) Section 28.04-3.
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.