Enrolling with MaineCare
See the Enrollment Folder on the Health PAS Online Portal for details about how to enroll in Maine Integrated Health Management Solution (MIHMS). To enroll, you must have a trading partner account, as described in the MIHMS Enrollment Guide (PDF). See the Provider Enrollment Process Questions and Answers (PDF) for more information.
See the Enrollment Frequently Missed Information (PDF) for details about common new enrollment and maintenance case errors.
All applications, including initial enrollments and maintenance cases, have enrollment screening requirements. These screening requirements are based on categorical risk level.
Categorical Risk Levels
The ACA mandates that State Medicaid agencies establish categorical risk levels of limited, moderate, or high for initial applications or new practice locations. For provider types that are not recognized by Medicare, states must assess the appropriate categorical risk level by provider type A full listing of the criteria can be found in the Risk Category Assignments (PDF). For additional information , please see CMS's Frequently Asked Questions.
National Provider Identifier (NPI) Information
- Healthcare Provider Taxonomy Code Set - Visit CMS’ Taxonomy webpage for a link to the taxonomy code set when applying for an National Provider Identifier (NPI).
- National Plan and Provider Enumeration System (NPPES) Home Page - See NPPES for information required during the MaineCare enrollment process.
- NPI Application Help Page - Go to this webpage for help with the CMS application for the NPPES registration process.
Fees and Surety Bonds
Providers who are newly enrolling, revalidating, or adding new practice locations with MaineCare must pay an application fee. This fee varies from year to year.
Home Health Agencies (HHA) and Durable Medical Equipment (DME) providers are required to provide surety bonds when enrolling as a new provider, revalidating, or adding a new service location.
See the Application Fee and Surety Bond (PDF) for more detail. See the 2019 Application Fee Spreadsheet (PDF) for a list of provider types that require an application fee.
Non-billing, Ordering, Prescribing, and Referring (NOPR) Providers
Billing providers must provide the NPI of an enrolled MaineCare practitioner who is ordering, prescribing, or referring on their claims to avoid claim denials. These practitioners are known as NOPRs and must enroll in MaineCare independently or as part of an organization. For more detail about NOPR requirements, please see Non-billing, Ordering, Prescribing, and Referring Provider Requirements (PDF).
Effective April 1, 2021, all prescribing providers must either be enrolled as a MaineCare provider or, where applicable, be added as a NOPR provider under their organization’s MaineCare provider enrollment to prevent disruption of pharmacy services for MaineCare members. See the NOPR Not Enrolled Letter (PDF) for more detail about this requirement.
Revalidating your Enrollment Application
Providers must revalidate their information with MaineCare every 5 years, or 3 years for Durable Medical Equipment (DME) providers. For more detail about Revalidation see the Revalidate as a Current Provider (PDF).
See the following documents for guidance:
Medicare Bad Debt Enrollment
Providers who are a provider type not recognized by MaineCare but who wish to enroll in MaineCare for the sole purpose of processing claims to determine Medicare cost sharing, pursuant to 42 C.F.R. Section 455.410(d), should contact the Provider Enrollment Manager, Kenneth Jamison to discuss the process and requirements for that type of enrollment.
- MaineCare Enrollment email box
- Provider Services Call Center: 1-866-690-5585, Option 2 for Enrollment Questions. TTY users dial 711.
- Provider Services Call Center: 1-866-690-5585, Option 7 for Revalidation Questions. TTY users dial 711.