MaineCare as a Secondary Payer

Jul 22, 2024

Many MaineCare members are dually eligible for both Medicare and full MaineCare. These members may have Medicare Advantage plans that have different coverage from traditional Medicare. Many Medicare Advantage plans cover some dental services, so it is important to verify the members’ coverage with their primary insurance before providing services.  

As a provider, it is your responsibility to take all reasonable and necessary measures to obtain payment from the primary insurance provider. This includes verifying that you are either in network with the primary insurance carrier, or that the carrier will reimburse out of network providers prior to providing services. MaineCare requires members and providers to follow the rules of the primary insurance carrier to receive reimbursement for services.  

In accordance with MaineCare Benefits Manual (MBM), Chapter 1, Section 1.07 Third Party Liability, the Office of MaineCare Services (OMS) is the payer of last resort, except in circumstances involving Indian Health Services (IHS) claims, where they are the payer of last resort. 

For questions regarding reimbursement from MaineCare as a secondary payer, please contact your Provider Relations Specialist, Shannon Beggs.