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- General
- Provider
Welcome to the Partner Portal for MaineCare members and service providers!
MaineCare Services coordinates the programs and benefits, assures that they operate under consistent policy in keeping with the Department’s goals and federal mandates, and ensures that they are administered effectively and efficiently.
By doing so, MaineCare Services assures the highest quality outcomes for its members through measurement, a well-informed workforce and an efficient, sustainable, and integrated health delivery system.
Members
MaineCare Members:
- MaineCare members should visit MaineCare.gov and the Member Resources webpage for information about the MaineCare program and how to access a letter of creditable coverage and claims history report.
Providers / Trading Partners
Log in to the provider secure portal to:
- View Medicaid eligibility and history
- Submit claims
- Submit authorization requests
- Check document status
- Resume provider enrollment application
- Check provider enrollment application status
Event Calendar
Keep in Mind
1. Reminder: Adjustment of Medicaid Expansion Claims
For MaineCare to properly identify claims for Medicaid expansion members, if member eligibility information changes after the claim has been submitted, we may adjust the claims for those members. When members' eligibility changes, claims paid prior to the updates may be re-processed, claims that denied previously may pay, and others will have no payment impact but will be updated for tracking and fund allocation purposes. No provider action is needed.
2. Home Health Agencies (HHA) and Durable Medical Equipment (DME): Surety Bonds
All HHA and DME providers are required to provide surety bonds to MaineCare when enrolling as a new provider, revalidating enrollment, or adding a new service location. The surety bond must name the DME or HHA provider as Principal, MaineCare as the Obligee, and the surety company as Surety. The surety's name, street address or post office box number, city, state, and zip code must be included. The bond must also contain the service location name and address.
The bond must contain appropriate guarantees for payment to MaineCare to cover uncollected overpayments and liability for unpaid claims that are identified during the term of the bond, regardless of when the overpayments took place.
The bond must be in the amount of:
- HHA providers: The greater of $50,000 or 15% of Annual Medicaid Payment based on previous fiscal year per service location.
- DME providers: An amount of no less than $50,000 per National Provider Identifier (NPI). An additional $50,000 bond is required for each adverse legal action you've had within the past 10 years.
Surety bonds that do not meet these requirements established by the Affordable Care Act (ACA) could delay the initiation of your revalidation application.
3. Encounter Services Required When Billing T1015 Reminder
This is a reminder that RHC, FQHC, Indian Health, and School Health Center providers who bill T1015 are required to provide all encounter services related to the claim. Claims submitted with T1015 and no encounter services will be denied. The claim will also deny if all encounter services on the claim are not covered by MaineCare.
4. Dental Services Providers Enrolling Dentists/Physicians, CR 82105
A new provider type/specialty combination has been created called 51 Physician/029 Dentist-General. This combination must be used whenever a licensed dentist, who is also a licensed physician, is enrolled in MIHMS as a provider. The combination should be used when enrolling Pay-To providers; rendering providers; and Non-billing Ordering, Prescribing, and Referring (NOPR) providers. The change will allow the dentist/physician to submit claims for both dental and physician services. Selecting a dental provider type to enroll a dentist/physician will result in incorrect reimbursement.
5. Enrollment Backdate Requests
Effective November 1, 2020, providers will have 180 days from when they complete their enrollment to clear up any backdated items that were not in effect on the requested date during the enrollment submission process. For example, if a specific effective date of August 3, 2020 had been requested at the onset of enrollment, but the system did not set the date as requested in the initial case submission, providers will have 180 days from the enrollment case completion date to request a correction to the date of August 3, 2020 to match the initial request within the case. If this does not occur within 180 days, the request will not be honored.
6. Attention All Providers: Updating Your License Under Title 5
The Office of MaineCare Services (OMS) has recently updated the online Provider Enrollment Application (PEA) to allow the use of a Title 5 License Extension to update expired licenses.
Providers whose license is under a Title 5 review may use their Title 5 notice to extend their enrollment with MaineCare in MIHMS by six months and for every six months thereafter until the Title 5 issue is resolved. This update can be completed by a maintenance case via the MaineCare Partner Portal. Please select the "Title 5 License Extension" from the licensing board drop-down menu and complete the maintenance case as usual. Dates to be used are as follows: if you are enrolling and today's date is January 17, 2020, use that date as your "Begin Date," add six months and enter the "Term Date" as January 16, 2020. This process must be repeated every six months until the Title 5 review has been finalized and submitted as soon as you are notified by your licensing board that your license termination date will not be extended.
Providers that have not yet revalidated their enrollment, please be sure to renew your license with your licensing board before the license termination date. Gainwell will follow the internal process to update licenses for providers who have not yet revalidated. Failure to renew your license prior to its expiration will result in no reimbursement for services provided to MaineCare members.
7. Family Planning Codes and FP Modifier Usage Requirement, CR 97225
Effective November 1, 2020, the Office of MaineCare Services will require providers to bill the FP modifier in conjunction with the family planning procedure codes listed below. This affects MaineCare Benefits Manual Sections 30, 31, 45, 90, 103, and Limited Family Planning.
Claim lines billed with any of the codes below that do not include the FP modifier for dates of service on or after November 1, 2020, will deny. The FP modifier must be the first modifier listed if more than one modifier is required for the claim line.
We recognize that some providers may need to make changes in their billing system to accommodate the use of the FP modifier. While those changes are being made, providers may utilize direct data entry into the MaineCare Partner Portal as an alternative so that claims can still be submitted and processed as appropriate.
Codes that require an FP modifier:
11976
57170
58300
58301
A4266
A4267
A4268
A4269
J1050
J7300
J7301
J7303
J7304
J7307
J7296
J7297
J7298
S4993
8. Avoid Invalid NDC Code Claim Rejections
There has been an increase in claim rejections for invalid NDC codes. The following information will assist in identifying NDC codes that are not valid.
If you submit an 837 EDI transaction with an invalid NDC code, it will reject the entire claim. You will need to review your rejections on the BRR report to know which NDC code is invalid. A claim with invalid NCD code can be submitted successfully on the MaineCare Partner Portal, but the claim lines with the invalid NDC codes will deny.
NDC codes should be 11 digits long and have a 5 4 2 format (example: 00703-5145-01). When adding NDC codes to your claims, hyphens are not needed, but 11 digits are required.
There are two Medicare crosswalks to validate NDC codes that are used to edit claims in MIHMS. If the code combinations are not on either of these crosswalks, then the claim will not process accurately.
Please see the links for the Medicare crosswalks:
There will be occasions when the HCPC/NDC combination is on one list but not the other. There will always be a delay with keeping both lists current so, the MaineCare uses both lists to validate these combinations. These codes are Date of Service sensitive; therefore, the relationship start and end dates on the PDAC crosswalk matters. When using the Medicare ASP Crosswalk, choose the quarter that includes the Date of Service.
If claims are denied due to the invalid NDC/HCPCS codes, you can request the combination to be reviewed, and possibly added by using the NDC-J Code Combination Request Form and by emailing the information to MaineCareNDCrequest.DHHS@maine.gov
9. MaineCare Partner Portal Browser Compatibility
Browser Compatibility—The MaineCare Partner Portal currently supports these web browser versions:
- Microsoft Edge Chromium 79 or higher
- Chrome version 38 and newer
- Safari 10 and newer