• Read more about Reminder for Billing Attending Provider on UB-04 and 837I Claims, CR 110840

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).

• Read more about CORRECTION: Biosimilar Preferred Drug List (PDL) 2026 Update

Effective January 1, 2026, the Department will add preferred and non-preferred drugs to the Biosimilar PDL.

Preferred drugs added:

• Q 9996 Ustekinumab-ttwe SubQ
• Q 9997 Ustekinumab-ttwe I.V.
• Q5140 - adalimumab-fkjp
• Q5141 - YUFLYMA, adalimumab-aaty
• Q5142 - SIMLANDI, adalimumad-ryvk 
• Q5143 - CYTEZLO, adalimumab-adbm
• Q5144 - IDACIO, adalimumab-aacf
• Q5145 - ABRILADA, adalimumab-afzb

Change from preferred to non-preferred drug:

• Read more about Maine CDC Alerts Consumers About Recall of ByHeart Whole Nutrition Infant Formula Due to Botulism Risk

Maine parents and caregivers advised not to buy or use ByHeart Whole Nutrition infant formula while the U.S. FDA investigation is ongoing

• Read more about Biosimilar Preferred Drug List (PDL) 2026 Update

Effective January 1, 2026, the Department will add preferred and non-preferred drugs to the Biosimilar PDL.

Preferred drugs added:

• Q 9996 Ustekinumab-ttwe SubQ
• Q 99976 Ustekinumab-ttwe I.V.
• Q5140 - adalimumab-fkjp
• Q5142 -SIMLANDI, adalimumad ryvk

Change from preferred to non-preferred drug:

• Read more about Reminder: Provider Responsibility Regarding Third Party Liability and Secondary Billing

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.

• Read more about Update to Acentra Health Call Center

Effective immediately, Acentra Health made the following update to call center operations:

• Read more about MaineCare Rate Reform Expert Technical Advisory Panel (TAP) Consultation: Draft CY2026 Rate Determination Schedule Presented Materials and Proposed Schedule

On November 14, 2025, the Office of MaineCare Services held the Annual Draft Rate Determination Schedule Consultation with the TAP which was open to the public.

• Read more about Elimination of Mailing Paper Remittance Advice (RA) and Reduction of Paper Checks, CR 132320

Paper Ras

Within the next several weeks, the Office of MaineCare Services (OMS) will eliminate the mailing of all paper RAs to providers. This is a cost-saving initiative for the department. We encourage those receiving paper RAs to reference the electronic PDF versions posted on the Health PAS Online Portal. Advantages of using the PDF version include easier member and claim searching and access to previous RAs.

• Read more about Payment Error Rate Measurement (PERM) Update for Reporting Year (RY) 2027 and PERM RY 2024 Errors

For the PERM RY 2027 cycle, which covers claims for the current state fiscal year, PERM auditors will not be conducting the Medical Review portion of the audit. As a result, the PERM auditors will not outreach providers to collect claims documentation as they usually do. This does not change the documentation requirements as listed in the MaineCare Benefits Manual, but it does mean that this PERM audit will not require provider participation. For the next PERM cycle, covering claims from July 1, 2028, to June 30, 2029, we anticipate that Centers for Medicare and Medicaid Services (CMS) will

• Read more about Section 65, Multi-Dimensional Family Therapy (MDFT): Rate Determination Kickoff Meeting Presented Materials & Survey

On November 10, 2025, MaineCare with our vendor Milliman kicked off a rate determination process for a new MDFT service with interested parties. At this meeting, we introduced the project team and reviewed project goals, work plans, an initial timeline, and a survey.