Attention Section 31, Federally Qualified Health Centers (FQHCs): Update on Rate Rebasing Efforts, CR 117105

Aug 04, 2023

As noticed in our previous e-message, new rates resulting from the Department’s rate determination for Section 31, FQHCs are available for billing in MIHMS. The new rates are retroactive to March 1, 2023.   

In May, the Department provided billing guidance to FQHCs to prepare them for the updated payment methodology and rates, including how to bill for services that are now outside the encounter rate and to allow for easier adjustment of claims by providers and the Department after implementation. Please see below for an update on process and timeline for MaineCare adjustments of claims submitted between March 1, 2023, and May 10, 2023.  

MaineCare Adjustment Process: MaineCare is processing adjustments for all impacted claims and is prioritizing these adjustments. Providers should see claims adjusted each week until all of their impacted claims have been adjusted. We estimate that these claims adjustments should be completed by mid-September, 2023.  

NOTE: Providers should NOT adjust affected claims themselves. If they do, and if MaineCare is simultaneously adjusting them, those claims will fail. If providers attempt to adjust their own claims, there will be delays in the reprocessing, and the mid-September target completion date will be in jeopardy.  

Please contact Shannon Beggs, Provider Relations Specialist, with any questions.