Health PAS Online Portal
Visit the Health PAS Online Portal for:
- Claims and billing instructions, companion guides, user guides, and X12 HIPAA Acknowledgements
- Electronic Visit Verification (EVV) Guides and Manuals
- Enrollment guides and tools
- Trading Partner Guides
- Fee Schedules
- Forms for claims, referrals and authorizations, and other portal submissions
Visit the Primary Care webpage for more details about primary care programs and for the most current Referral Form and Member Education Request Form.
COVID-19 At-Home Tests and Collection Kits
This MaineCare Standing Order (PDF) authorizes Over the Counter (OTC), Direct to Consumer (DTC), and prescription COVID-19 at-home tests and prescription COVID-19 at-home collection kits.
Nicotine Replacement Therapy (NRT) Products
Standing Order for Dispensing Nicotine Replacement Therapy Products to MaineCare Beneficiaries (PDF) - This Standing Order authorizes licensed pharmacists to dispense medically appropriate NRT products to eligible MaineCare members who require the products for help with smoking cessation or vaping cessation.
340B Billing Requirements - July 7, 2021
340B Billing Requirements (PDF) - This document explains the billing requirements for the submission of 340B drug claims to MaineCare for providers and hospitals.
340B Payment Methodology - January 5, 2020
This is a follow up to our December 8th message announcing January 1, 2021 changes to MaineCare’s 340B payment methodology. As we continue to work with the Centers for Medicare and Medicaid Services (CMS) to clarify certain methodology requirements, we are delaying the implementation of this change until further notice. We will share more information as events unfold.
Medications for Addiction Treatment (MAT) Information
See the following documents for guidance about the Prior Authorization (PA) process for Buprenorphine:
- Prior Authorization Form for Buprenorphine and Suboxone (PDF) - July 2021
- Coverage and Prior Authorization (PA) Criteria for Buprenorphine for Treatment of Opioid Use Disorder (PDF) - July 2021
- Frequently Asked Questions: MaineCare / Change Health Care Prior Authorization Processes for Buprenorphine for Treatment of Opioid Use Disorder (PDF) - July 2021
HIPAA, Privacy, and Security
- De-Identification Methods (Health and Human Services webpage) - Explanation of identifiable health information and how to de-identify materials.
- Educational Materials about HIPAA Security (CMS webpage)
- Secure Fax and E-mail Tips
Interpreter Clarification for Providers (PDF) - This document provides details about interpreter services for non-English speaking or limited English speaking members.
Complex Case Unit (CCU) Referrals
CCU provides Maine residents who have disabilities with simple and timely solutions to complex healthcare, financial, and placement issues through integrated provider and community involvement.
The CCU accepts cases based on referrals and prioritizes:
- Maine residents who have complex healthcare, financial and placement issues that the community have been unable to resolve.
- Adults who have been in the Emergency Department more than five days or youth who have been in the Emergency Room more than one day with no possible discharge outcomes.
- Other complex cases sent by the Governor’s or DHHS Commissioner’s Office
Referring a Member to CCU
Please use one of the following referral forms for:
Emergency Department (ED) Collaborative
MaineCare nurses, behavioral health specialists, and care coordinators work with health care providers and MaineCare members to reduce avoidable, non-emergency ED use and improve health outcomes for MaineCare members. See the ED Collaborative (PDF) for more detail about the project and how to participate.
E-Message Sign Up
You can sign up for email notifications on the E-message Subscription Webpage, where you enter your email address, scroll down to “MaineCare Stakeholders,” and select the topics about which you would like to receive updates and information.
See the E-message Topic List (PDF) to ensure you sign up for the topics that relate to the policies under which your organization enrolled with MaineCare. See also the MaineCare Bulletins webpage for past notices.
Policy and Rules RSS Feed Sign Up
MaineCare publishes policy and rule changes through Headline News, our RSS Feed service. To subscribe, click on the topic link below. The link will open a new page where you will click "Subscribe to this feed" to sign up.
- Proposed Rules
- Recently Adopted Rules
- Emergency Rules
- Other Rules (such as chapter 275 and chapter 104)
- Demonstration Waivers