The MaineCare Third Party Liability (TPL) Exemption Request and Attestation Form is Now Available

On August 3, 2026, MaineCare announced claims system updates to support proper TPL reimbursement processes in accordance with MaineCare Benefits Manual (MBM), Chapter I, Section 1.07 TPL rules. The MaineCare TPL Exemption Request and Attestation Form is now available for TPL exemption request submission.  

Requesting TPL Exemption 

In accordance with MBM, Chapter I, Section 1.07 rules, MaineCare may assess the validity of extenuating circumstance or service code TPL exemption requests to bill MaineCare as the primary payer for services delivered to a member with primary, public, or commercial coverage. Providers wishing to apply for TPL exemption to bill MaineCare as the primary payer must complete and submit the MaineCare TPL Exemption Request and Attestation Form to the TPL Medicare Code Exempt Request email box.  

MaineCare will review completed forms with the supporting documentation and provide a decision letter of approval or non-approval via email to the requestor. An exemption request approval letter is valid only for a specific member for a defined duration, no greater than 12 months. The exemption request approval letter must be attached to all applicable MaineCare claims for dates of service during the approved time. Claims without a valid and up-to-date approval letter may result in denials.  

Providers are responsible for maintaining exemption request renewals by submitting a subsequent MaineCare TPL Exemption Request and Attestation Form at least 30 calendar days prior to the expiration date specified in the approval letter.  

Limited Retroactive TPL Exemption Review Period 

For a limited time, MaineCare will consider continuity of care retroactive exemption requests with supporting documentation for claims directly impacted by the system updates announced in the Provider Responsibility Regarding Third Party Liability and Secondary Billing e-message we sent on August 3, 2026.  

After December 31, 2026, retroactive exemption requests may not be accepted for review. Providers who receive retroactive exemption request approvals may resubmit their claims with the applicable approval letter attached for claims processing. 

For questions, please contact your Provider Relations Specialist.