Provider Billing Requirements in Chapter I, Section 1: General Administrative Policies and Procedures - Reminder

Sep 09, 2025

Providers who are enrolled with MaineCare may not request payment from MaineCare members for covered services.  

As stated in Section 1.06-4(A), MaineCare will not reimburse for non-covered services. Providers may bill members for non-covered services only if, prior to the provision of the service, the provider has clearly explained to the member that MaineCare does not cover the service and that the member will be responsible for the payment. Providers must document in the member’s record that the member was told, prior to provision, that the service was not a MaineCare covered service and that the member is responsible for the payment. 

Additionally, providers should not tell members to seek reimbursement from MaineCare for covered services. As a reminder, Section 1.08-2(B) says that MaineCare will only reimburse enrolled providers for MaineCare covered services. Under no circumstance can MaineCare reimburse MaineCare members.  

Please see the MaineCare Benefits Manual, including Section 1.05 Supplementation by Members, for more information. For questions, please call your Provider Relations Specialist.