DHHS → node
This is an update to the notice we sent on July 24, 2025, about Health PAS Online Portal downtimes.
The portal will continue to remain down Monday through Friday from 7:00 PM to 7:00 AM and all weekend hours as Gainwell continues to address technical issues.
The portal will remain available from 7:00 AM to 7:00 PM Monday through Friday except for holidays, when state offices are closed.
Notice of Agency Rule-making Adoption
AGENCY: Department of Health and Human Services, Office of MaineCare Services
CHAPTER NUMBER AND TITLE: 10-144 C.M.R. Ch. 101, MaineCare Benefits Manual, Chapter III, Section 45, Principles of Reimbursement for Hospital Services
ADOPTED RULE NUMBER:
CONCISE SUMMARY:
The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.
The Office of MaineCare Services (OMS) is requesting that providers include the taxonomy code on all claims. The taxonomy code is necessary for the Centers for Medicaid and Medicare Services (CMS) to collect data for Transformed Medicaid Statistical Information System (T-MSIS) reporting. This data helps to inform states of their current standing in data quality as compared to other states and is crucial for research and policy on Medicaid and CHIP. The taxonomy is also used by CMS to conduct program oversight, administration, and integrity.
It is important for your TPA administrator to actively manage your user accounts for the Health PAS Online Portal. To manage users, log into the administrator TPA and click on “Account Maintenance” and then “Manage Users.” Edit existing, deactivated or reactivated users by clicking on the row of the user you would like to manage. The Administrator of the account and users with a security role of “R7-User Management” are allowed to use these features.
This is a reminder that the attending provider is required on all UB-04 and 837I claims. MaineCare denies UB-04 and 837I claims submitted without an enrolled attending provider.
The attending provider is the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim/encounter. The attending provider requirement includes all claim submission methods (paper, HealthPAS Online Portal, or 837I).
Effective January 1, 2026, the Department will add preferred and non-preferred drugs to the Biosimilar PDL.
Preferred drugs added:
Change from preferred to non-preferred drug:
Maine parents and caregivers advised not to buy or use ByHeart Whole Nutrition infant formula while the U.S. FDA investigation is ongoing
Effective January 1, 2026, the Department will add preferred and non-preferred drugs to the Biosimilar PDL.
Preferred drugs added:
Change from preferred to non-preferred drug:
Per federal requirements, MaineCare is the payor of last resort, with only limited exceptions. The Office of MaineCare Services continuously refines policies and claims processing procedures to ensure that primary insurance coverage is leveraged, whenever possible. This includes reviewing Medicare and commercial coverage policies for service coverage changes in all areas, including, but not limited to, behavioral health, durable medical equipment, and physician services.