Provider Resources

Health PAS Online Portal

Visit the Health PAS Online Portal for:

  • Claims and billing instructions, companion guides, user guides, and X12 HIPAA Acknowledgements
  • Electronic Visit Verification (EVV) Guides and Manuals
  • Enrollment guides and tools
  • Trading Partner Guides
  • Fee Schedules
  • Forms for claims, referrals and authorizations, and other portal submissions

Checking MaineCare Member Eligibility

You should always check a patient’s eligibility for MaineCare before providing a service. You can check eligibility by logging into your secure account on the Health PAS Online Portal and searching by the member. 

You can also call the automated Interactive Voice Response (IVR) to check member eligibility. See the IVR Eligibility Check Instructions (PDF). 

Adjusting Claims for Retro Rate Increases

For guidance about adjusting verses straight reversing claims and instructions on how to do each, see the How to Adjust Claims for Retro Rate Increases (PDF).

HIV Program

HIV Testing Now Recommended Quarterly by Maine CDC. A Health Alert Network notice issued on April 19, 2024, describes the current situation in the state and recommends quarterly testing for certain people. These Fast Facts for providers on HIV Screening summarize the testing recommendation. 

Providing Cabenuva to MaineCare Members

    340B Guidance

    340B Program Overview - January 29, 2024

    This document provides a general overview of MaineCare's 340B Program

    340B Modifier Billing Guidance Update - July 14, 2023

    This document gives information about how drug claim lines eligible for rebate collection are identified by the state - 340B Modifier Billing Guidance Update Department of Health and Human Services (maine.gov)

    General Billing Guidance - May 8, 2023           

    This document provides general billing guidance for inclusion of National Drug Codes (NDCs) in drug claim lines. Billing Guidance to Include National Drug Codes (NDCs) in Drug Claim Lines Department of Health and Human Services (maine.gov)

    Guidance to avoid Duplicate Discounts and drug claim line denial reasons - October 12, 2022

    This document summarizes the state's actions to avoid duplicate discounts, and reasons why a drug claim line may deny. Attn: Providers Particpating in the 340B Drug Program, CR 112772 Department of Health and Human Services (maine.gov)

    340B Provider Enrollment Guidance - October 7, 2022

    This document provides general 340B provider enrollment guidance - 340B Provider Enrollment Guidance Department of Health and Human Services (maine.gov))

    340B Billing Requirements - July 7, 2021

    This document explains the billing requirements for the submission of 340B drug claims to MaineCare for providers and hospitals - 340B-Drug-Claim-Billing-July2021.pdf(maine.gov.                                                   

      Maine CDC Breast and Cervical Health Program (MBCHP)

      Complex Case Unit (CCU) Referrals

      CCU provides Maine residents who have disabilities with simple and timely solutions to complex healthcare, financial, and placement issues through integrated provider and community involvement. 

      The CCU accepts cases based on referrals and prioritizes:

      • Maine residents who have complex healthcare, financial and placement issues that the community have been unable to resolve.
      • Adults who have been in the Emergency Department more than five days or youth who have been in the Emergency Room more than one day with no possible discharge outcomes.
      • Other complex cases sent by the Governor’s or DHHS Commissioner’s Office

      Referring a Member to CCU

      Complex Case Unit Process for Referrals (PDF)

      Please use one of the following referral forms for:

      Questions?

      Please contact Michele Lane regarding adult referrals or contact Cassie Antonelli with questions regarding youth referrals.    

      Emergency Department (ED) Collaborative

      Nurses, behavioral health specialists, and care coordinators work with health care providers and MaineCare members to reduce avoidable, non-emergency ED use and improve health outcomes for members. See the ED Collaborative (PDF) for more detail about the project and how to participate.

        HIPAA, Privacy, and Security

        Contact Us

        For details about who to call for specific topics, see Contacts for Providers (PDF).

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