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All MaineCare enrolled providers are requirement to provide at least a 30-day notice to the Office of MaineCare Services (OMS) if they are closing one of their programs or their agency. This requirement is listed in the MaineCare Benefits Manual (MBM) Chapter I Section 1.03-6.
The Office of MaineCare Services (OMS) provides the following guidance to service providers and interested parties in accordance with LD 346, which requires OMS to reimburse parents providing Home Health Aide (HHA) services to eligible minor children under MaineCare Benefits Manual (MBM), Section 40, Home Health Services.
Effective January 1, 2025, the Department updated the rates for Section 97, Appendices E & F, to remove the Service Provider Tax (SPT).
Rate letters are accessible on the secure Health PAS Online Portal. To view them, log into your Trading Partner Account and follow this pathway: File Exchange > Reports > Rate Setting Letters.
Jan 1, 2025
The following is a broad overview of some of the General Fund investments outlined in the Governor's FY26-27 biennial budget and the cost-saving measures proposed through the Department of Health and Human Services (DHHS) budget.
MaineCare has identified some Section 28 claim lines submitted with service code H2021 that denied for Benefit Restriction Group Validation Failed due to a system error. This error has been corrected. We will reprocess the affected claims. No action is required by providers.
The Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) are as follows.
CARC 96: Non-covered charge(s).
RARC N130: Consult plan benefit documents/guidelines for information about restrictions for this service.
Request to Hold January 2025 Claims
The Department is working to implement billing changes reflecting NF rate reform presented at the October 23, 2024 public forum and we expect these changes to be operational by February 1, 2025.
Please hold claims for services delivered in January 2025 until these changes are implemented and announced in a future notice.
On January 9, 2025, the Department held an online public meeting to present revisions to the previously proposed Section 107, PRTF rates and model. Interested parties had the opportunity to provide public comments.
Join us for the Dental Service Provider Forum on January 22, 2025,12:00 – 1:00 PM.
Forum Registration Information
Please register for the virtual forum through the Zoom link.
After registering, you will receive a confirmation email containing a link to join the meeting.
Riverview Psychiatric Center (RPC)
Engagement
Number of Patient Admissions – Aggregation: Sum
Office of the Health Insurance Marketplace (OHIM)
Engagement
Number of Calls to the Consumer Assistance Center