MaineCare's Electronic Media Claims
Downloads
Below, you will find various documents to download, beginning with the provider agreement letter.
Provider Agreement Letter
Fax the completed provider agreement letter to:
Attn: EMC Enrollment
207-287-8450
Note: The Provider ID must be filled out, or we cannot complete your EMC enrollment.
Y2K EMC Records Layout
Notes:
- All records must be follow by a carriage return (hex 0d) and line feed (hex 0a) regardless of type of claim use.
- Depending on how your browser is set, when you click on a link the browser may automatic open the file. In this case to download a file, right click on link and select 'Save Target As'.
For HCFA-1500 and Dental claims, download the HCFA 1500 document, HCFA 1500.
For Hospital, Nursing Facility, Home Health, Boarding Home claims, download the UB92 Version 5 PDF and the UB92 Addendum document.
UB92 Version 5
UB92 Addendum
Note: The UB92 Version 5.0 Flat-File is in PDF (Portable Document Format) and can be accessed using Adobe Acrobat Reader 3.0 or higher. If you do not already have Adobe Acrobat Reader 3.0 or higher, click Download Now. |
