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 Important Updates

MaineCare Prior Authorization (PA) Training 
by spadmin
 10/21/2016 6:17 PM
The MaineCare Provider Relations unit is hosting PA trainings during the week of October 31st, 2016.   See the calendar for dates and locations on this page below.
New Insure Kids Now (IKN) Quarterly Dental Provider Survey  
by spadmin
 10/21/2016 5:12 PM

MaineCare is conducting this quarterly survey of enrolled dental services providers in order to update the information listed on the IKN website for State of Maine Providers. You can help provide much needed services to these children and teens by responding...

New Prior Authorization (PA) Pro-Rate Orthodontic Request Form, CR 60363  
by spadmin
 10/21/2016 5:11 PM

Effective October 11, 2016, you can access the new Orthodontia Pro-Rate Request form by going to the Health PAS Online Portal and following this pathway: Provider Home Page > Provider Documents > Forms > Authorizations and Referrals. It is...

Updated Prior Authorization (PA) Denture Forms, CR 61043 
by spadmin
 10/21/2016 5:10 PM

Effective October 11, 2016, the following denture forms have been updated on the Health PAS Online Portal:

  • Dentures PCP PA Form
  • Supplemental Denture PA Form

If you submit previous versions of the forms, your PA request will be deferred and you...


 Keep in Mind ...

ICD-10 Reminder

ICD-10 codes are required on claims with dates of service on or after 10/1/2015. Failure to do so will delay claims and payment processing. If you have questions regarding ICD-10, please check out MaineCare's ICD-10 webpage for additional resources.

Known Issues
The MIHMS Provider Known Issues List offers information about Change Requests and Trouble Reports that affect MaineCare Providers. You can sort the list by provider type, issue type, or date. E-mail us with issues to add to the list.
Portal Upgrades and Changes
The Health PAS Online Portal is regularly upgraded. As portal upgrades are made, you can see all the changes summarized on the Provider Updates webpage. The date of the upgrade is in the document’s title for easy reference.
Reminder:  Timeframe to Initiate Adjustments for Underpayment
MaineCare Benefits Manual, Chapter I guidelines specify when a provider believes an underpayment has been made for covered services rendered, based upon policy and procedures as described in this manual, the provider should accept and cash the check issued for the services provided. The provider must request a review of payments, using the MaineCare Adjustment Request form, within one hundred and twenty (120) days of the remittance statement date or waive any right to a review of that payment. Please contact your Provider Relations Specialist with questions.
Individuals Excluded by Maine or Federal Government
MaineCare providers are prohibited from employing people who have been excluded by the state or federal government.  Visit the Maine Excluded Providers Database to check for individuals excluded by the State of Maine.  Providers should also check exclusion by the federal government at these two sites:  Office of Inspector General Excluded Providers Database and the System for Award Management.  All potential employees should be checked, including employees who do not provide direct care to MaineCare members.  Employing excluded individuals may result in monetary penalties.  If you have questions, please contact the Program Integrity Unit at 207-287-4660.
Code/Rate Additions, Deletions, and Corrections 
The “Code and Rate Additions, Deletions, and Corrections” spreadsheet has recently been updated. The spreadsheets are used to notify you of code and rate changes. You can view these spreadsheets on the Claims, Billing, and Enrollment webpage.
2016 Primary Care Payment Increase Attestation Form
The 2016 Primary Care Payment Increase Attestation Form has been updated. Please ensure you are using the correct version of the form. The 2016 Primary Care Payment Increase Letter and Attestation Form are available on MaineCare’s Provider Resources webpage.
Please contact Donna Sutter with question at: (207) 629-4280
Using the correct Prior Authorization (PA) form   
The PA forms were updated in February 2014. Some of you are still using old versions of the forms. Please be sure you are using the correct PA forms when submitting requests to avoid delays in the PA process. You can access the newest Prior Authorization Request form on the Health PAS Online Portal by following this pathway: Provider Home page > Provider Forms > Authorizations and Referrals folder.
Keeping the Information You Share with MaineCare Current

MaineCare uses the demographic information you supply through the enrollment process to track our provider networks and to contact you directly when necessary.  To ensure you receive important notices and information, please take a moment to review your address, telephone number, and other demographic information associated with your MaineCare provider file. You must log into your Trading Partner account on the MIHMS Health PAS Online Portal to view your demographic information or to make changes.  If you find we have incorrect information after logging into your trading partner account, please open a provider maintenance case by clicking on “Provider Maintenance – Demographic” under the Provider Enrollment link or by calling Provider Services at 1-866-690-5585. 


By opening a “Provider Maintenance – Demographic” case, you can quickly update the following:


·         Contact name

·         Telephone number

·         Email address

·         Service location address

·         Office hours

·         Patient restrictions

·         Languages spoken

·         Rendering provider address

·         Rendering provider phone number

·         Rendering provider email address

·         Whether a service location or rendering provider is accepting new patients or not


If you need to make any other changes, please open a “Provider Maintenance – Full” case.
Managing Users in Trading Partner Accounts

It is very important for Trading Partners to actively manage user accounts for the MIHMS Health PAS Online Portal.   Managing users can be done by clicking on “Account Maintenance” and then “Manage Users.”  Existing users may be edited, deactivated or reactivated by clicking on the row of the user you would like to manage. The Administrator of the account and users with a security role of “‘R7-User Management” are allowed to use these features. 


Deactivation or managing the security roles of users is essential when access requirements have changed or when access is no longer needed.   Deactivation of individuals no longer working for your organization is imperative as it will help prevent inappropriate access to Protected Health Information (PHI). 
Excel Export
Some survey participants expressed that they were not aware that data could be exported into an Excel spreadsheet or how it is done. You can export MIHMS data into an Excel spreadsheet from the following Health PAS Online Portal status screens:
  • Claims
  • Prior Authorization
  • Referral
  • Certification
  • Payment Status
  • Patient Roster
  • Primary Care Roster
Once you are on the appropriate screen in MIHMS, there is an option to “export” the information to Excel. When you click the export icon, all available records are exported to an Excel spreadsheet. Once exported, you can sort the information as needed and print it for your records.

If you have difficulty exporting to Excel, please contact Provider Services at 866-690-5585. Offices hours are 7:00 AM EST until 6:00 PM EST.
MaineCare Benefit Packages and Covered Services
Some survey participants requested more information about MaineCare benefits and covered services. You can read about specific policies by service and about allowances for services in the MaineCare Benefits Manual, which is the legal document that explains covered services. The MaineCare Member Handbook was designed for MaineCare members and explains the basics of the MaineCare program and gives details about the benefit packages. The MaineCare Eligibility document holds information about MaineCare eligibility in MIHMS as well as the link to the MyHealthPAS Eligibility User Guide which explains how to use the portal in verifying MaineCare eligibility.
Password Protect to Keep Patients’ Information Safe   

Password protecting in a Word or Excel document and attaching it to an email is more secure than adding Protected Health Information (PHI) to the body of the email.


PHI is any information about health status, health care, or payment for health care that can be linked to a specific individual.


PHI consists of:


a.   Names

b.   Street address, city, county, precinct, zip code

c.   All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older

d.   Phone numbers

e.   Fax numbers

f.    E-mail addresses

g.   Social Security numbers

h.   Medical record numbers   

i.    Health plan beneficiary numbers

j.    Account numbers

k.   Certificate/license numbers

l.    Vehicle identifiers and serial numbers, including license plate numbers

m.  Device identifiers and serial numbers

n.   Web Universal Resource Locators (URLs)

o.   Internet Protocol (IP) address numbers

p.   Biometric identifiers, including finger and voice prints

q.   Full face photographic images and any comparable images

r.    Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

s.    Genetic information such as family history and test results


When sending PHI in email, please:

  • Password protect all documents containing PHI
  • Do not include any PHI in the subject line of the email
  • Contact the intended recipient with the password to the secure document. Please do not send the password in an email with the protected document.
  • Do not send the password in an email with the protected document.

For instructions on how to password protect a document or Excel workbook, visit the Microsoft Office Support website. You can search “password protect a document” using the version of Microsoft Office you have in the search.

Fax Protocol to Protect Patient Information 

Sending Protected Health Information (PHI) in a password protected document is more secure than faxing. If you need to fax a document to MaineCare, please do the following:

        ·    Notify the intended recipient that you are sending the fax.

·    Use a fax cover sheet and do not include any PHI on the cover sheet.

·    Identify the intended recipient on the cover sheet.

Old RAs

RAs (Remittance Advices) that are over one (1) year old are archived and removed from the MIHMS Online Portal on a daily basis.

Providers can obtain their archived RAs by contacting Provider Services EDI Helpdesk at 1-866-690-5585, Option 3.
Copy and Paste into Fields
Some survey participants indicated they did not think information can be copied and pasted into fields on the portal but you are able to copy and paste in two ways:
1. Highlight the text you wish to copy and press Ctrl+C.  Then, select the desired field and press Ctrl+V. The information should now be visible in  the field.
2. Highlight the text you wish to copy and right click to select “Copy” from the pop-up menu. Click the cursor in the desired field, right click again, and select “Paste” from the pop-up menu. The information should now be visible in the field.
Depending on the browser you are using, you may only be able to use one of the above options.
Beyond Claims and Billing 
Stay up to date with MaineCare’s current and new initiatives, projects, and programs by visiting MaineCare’s website. Information regarding MaineCare policy changes, contact program leads, public meeting/forums materials, and listserv subscription form can also be found on this site.
PCCM Webpage

Check out the Primary Care Case Management (PCCM) Webpage for information on the PCCM program. This website also has tools for PCCM PCPs and Specialists that will help PCPs know when to submit referrals, and will help Specialists correctly submit PCCM services claim that require a referral.

Contact PCP Network Services with any questions at:

The Office of MaineCare Services sponsors Provider Advisory Group and Technical Advisory Group (“PAG/TAG”) committee meetings in Augusta on dates shown on our calendar. See past PAG/TAG Meetings.
Pharmacy Resources
You can visit MaineCare’s Pharmacy Unit Home Page for Prior Authorization (PA) forms for pharmacy services, Preferred Drug Lists (PDL), Medicare Part D Prescription Drug Plan information, and more.
Forms & User Guides

Downloadable Forms and User Guides change frequently.  To save time, make sure you are using the most up-to-date version.

 Welcome to MIHMS

Explore these valuable documents that will help you use the Maine Integrated Health Management Solution (MIHMS):

Getting Started Provider Enrollment—detailed guides to enroll on-line. Choose between In-State or Out-of-State and type of provider.

Provider Checklist—steps you need to submit claims to the MIHMS

Important IRS Information—your MaineCare payments may be affected if IRS and MIHMS information do not match. Review to ensure compliance with IRS rules.

Trading Partner Registration—step-by-step guides for Trading Partner registration. Applies to billing providers, billing agents, and clearinghouses. Providers can register after enrollment approval; billing agents, after receiving an Enrollment Case Number from at least one associated billing provider; and clearinghouses, anytime.

Provider Maintenance—guides for completing provider maintenance on-line. Provider maintenance is available for approved providers and billing agents registered as Trading Partners.

EDI Testing—test file instructions for Trading Partner approval to submit electronic HIPAA transactions: Health Care Claims (837), Eligibility Requests (270), Claim Status Requests (276) and Prior Authorization/Referrals (278).
Sign in as a Trading Partner to access this feature

EDI Companion Guides—Maine-specific technical guides on how to submit electronic HIPAA transactions

MHP User Guides—The MyHealth PAS User Guides are found on the Left Menu of the Provider Tab under Provider Manuals.

Billing Instructions—field-by-field instructions specific to MaineCare Services—these are useful even if you plan to use DDE (Direct Data Entry) to submit claims or use EDI 837 to upload claim transactions

Prior Authorization Manual—what you need to know about the prior authorization process and requirements

Provider Quick Reference—shows you where to find many commonly used items on the MIHMS and MaineCare websites

Website Maintenance—Maintenance time is used to update the portal, implement changes resulting from change requests and trouble reports, and any other database or system upkeep necessary for the portal to function properly.
The following are the weekly scheduled maintenance times:

9pm Tuesdays6am Wednesdays
6pm Saturdays12-noon Sundays

The website will also occasionally be unavailable throughout the year for extended maintenance. The extended maintenance time is used for large deployments, system disaster planning, and data refresh.

Browser Compatibility—The Health PAS Online Portal currently supports Internet Explorer Versions 8,9,10 and 11 (Windows Only), FireFox 33 and 34 (Windows and Mac), and Chrome 41 with JavaScript and Adobe Flash support. Additional browsers and their versions may be compatible but are not officially supported. Support for these browsers will continue to develop over time. Other that what was required by the supported browser and version, users are not required to have any special software or hardware to gain access to the portal. If you have difficulty with browser compatibility or accessing the portal, please contact Provider Services at 1-866-690-5585. Office hours are 7:00 AM EST until 6:00 PM EST.

Accessibility— The Portal is compliant with Section 508 of the Americans with Disability Act. If you have specific accessibility requirements, call 1-866-690-5585 and we will assist you.

LMS—To learn more on how to use the Online Portal, take online training by visiting the Learning Management System. To access, please log in to your Health PAS Online trading partner account.

 ACA Provider Revalidation

CMS Revalidations Webpage
The Centers for Medicare & Medicaid Services (CMS) has a webpage to help you through the revalidation process. This webpage has valuable information regarding numerous topics that are covered during the revalidation process. Visit the Centers for Medicare and Medicaid Services Revalidations Webpage for more information.
MaineCare's Provider Revalidation Webpage
Have you seen the MaineCare Provider Revalidation Webpage? Check here for news and updates as the initiative moves forward.
Revalidation Notifications
During the MaineCare revalidation process,  you will receive communications such as:
  • Targeted letters that will provide information or request action from you
  • E-messages with information for all providers about the revalidation process
  • Targeted emails generated from your action on the portal
Contact Us
Do you have questions regarding MaineCare's revalidation process? You can reach us by calling Provider Services at 1-866-690-5585, option 7.  Offices hours are between 7:00 AM and 6:00 PM. You can also send an email to the ACA Revalidation email box.

 MaineCare Event Calendar

MachiasUse SHIFT+ENTER to open the menu (new window).
Machias DHHS, 38 Prescott Drive
MaineCare Prior Authorization (PA) Training
HoultonUse SHIFT+ENTER to open the menu (new window).
Houlton DHHS, 11 High Street
MaineCare Prior Authorization (PA) Training
SanfordUse SHIFT+ENTER to open the menu (new window).
Sanford DHHS, 800 Main Street, Suite 208
MaineCare Prior Authorization (PA) Training
PortlandUse SHIFT+ENTER to open the menu (new window).
Portland DHHS, 151 Jetport Blvd, Conference Room 139
MaineCare Prior Authorization (PA) Training
AugustaUse SHIFT+ENTER to open the menu (new window).
Augusta DHHS, 35 Anthony Ave
MaineCare Prior Authorization (PA) Training -- This is a scent-free building. Bell Peppers of any variety (fresh, frozen, cooked or raw whether whole, in pieces or part of a product) are not allowed in this facility.
BangorUse SHIFT+ENTER to open the menu (new window).
Bangor DHHS, 396 Griffin Rd
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