Attention Pharmacy Providers: Announcing Expanded Interim Payments for Certain Pharmacies and Continued Response to Change Healthcare Service Disruption
Announcing Expansion of Interim Payments to include Maine-based Health Systems Pharmacies:
Revalidate with MaineCare to Avoid Claim Denials
Per the Affordable Care Act (ACA), Section 6401, all providers need to revalidate with all states they are enrolled with.
Durable Medical Equipment (DME) providers are required to revalidate their information with MaineCare every three years. The current round of revalidation began in January 2022.
Electronic Visit Verification (EVV) Phase 2 Trainings
The EVV requirements for Home Health providers delivering services under Section 40 were implemented on January 1, 2023.
All trainings are online via Microsoft Teams.
NOTE: The Absorb training system has been updated to allow providers to register for trainings more than once.
EVV Training Schedule
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EVV Phase 2 Training and Aggregator Content – State and Provider Trainings |
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Attention Section 14, Advanced Practice Registered Nursing (APRN) and Section 90, Physician Services: 2024 Anesthesiology Rate Updates, CR 122923
Effective January 1, 2024, MaineCare has updated the Anesthesiology conversion factors for Section 14, APRN Services and Section 90, Physician Services codes. New rates were implemented on February 14, 2024.
Attention Section 2, Adult Family Care Homes (AFCHs) Room and Board Rate Update for January 1, 2024, CR 122824
As part of the Department’s regularly scheduled annual updates, MaineCare has increased the Section 2, AFCH room and board rate, effective January 1, 2024. The new rate of $1,352.00 was implemented on February 7, 2024.
Adjustments for affected claims:
Attention Section 90, Physician and Primary Care Provider Services: Calendar Year 2024 (CY24) Medicare Standardization Rates Implemented, CR 122982 & 122980
In follow up to our January 19, 2024, Medicare Standardization notice, MaineCare has updated Section 90, Physician and Primary Care Provider rates effective January 1, 2024.
Attention Sections 68 & 85, Occupational and Physical Therapy Service Providers: Revised 2023 Rates CR 114862
MaineCare revised rates for Section 68, Occupational Therapy Services and Section 85, Physical Therapy Services, effective January 1, 2023. Rates were implemented on February 8, 2023, and may be viewed on the Health PAS online portal.
Adjustment of affected claims:
REVISED 2023 Quarterly Physician Drug Code Rate Updates Implemented
The Department updated the Physician Drug Rates in alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate updates for 2023. The updated rates can be found on the Health PAS Online Portal and were implemented for billing on the following dates:
Section 4, Ambulatory Surgical Centers Annual Rate Update for Calendar Year 2024 (CY24) CR 123437
MaineCare has updated Section 4, Ambulatory Surgical Center Services, to reflect 100% of the most current year Medicare rates.
Section 90, Physician Services: REVISED 2023 Rates
MaineCare revised Section 90, Physician Services rates in alignment with Medicare reimbursements effective January 1, 2023. New rates were implemented on April 13, 2023. You may view all codes and rates on the Usual, Customary and Reasonable (UCR) fee schedule.
Adjustment of affected claims: