• Read more about Governor Mills Announces Health and Human Services Commissioner Jeanne Lambrew to Step Down at End of May

Under Lambrew’s leadership, Maine expanded affordable health care to more than 100,000 people, led the nation in COVID-19 response, made historic investments in health and human services, and rebuilt the Department

Governor Janet Mills announced today that Jeanne Lambrew, Ph.D., will step down from her position as Commissioner of the Department of Health and Human Services, effective May 31, 2024, to accept a position leading national health policy development and to teach at Harvard University.

• Read more about UPDATE - Claims Pending for Missing Vendor Code​

The Office of MaineCare Services (OMS), Office of the State Controller, and Gainwell have resolved the issues with claims going to a PEND status for a Missing Vendor Code (Edit 6037), that occurred twice last week. 

Please note that Gainwell is mass adjudicating all the claims affected and there should be no impact on next week’s payment. 

• Read more about Attention Pharmacy Providers: Updated Technical Instructions for Processing Backlogged Claims​

Pharmacy claims resumed processing on March 27, 2024. MaineCare continues to work with Optum to review outstanding rejected claims with dates of service during the system outage. The guidance below applies to claims with dates of service from February 21, 2024, through March 26, 2024.

• Read more about EVV Providers – Update to Latest Version of the Sandata Mobile Connect (SMC) App

EVV Providers who are currently using the SMC app through their phone, tablet, or other mobile device should update to the latest version of the app using the Apple Store, or Google Play. The current version of the app is being phased out as of July 1, 2024. To avoid any interruption of visit record keeping, you should now download the latest version of the app. 

Please contact Provider Services with questions:  

• EVV email box  

• 1-866-690-5585, option 3.

• Read more about ​Utilizing the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program for Children and Youth​

The goal of the EPSDT program is to ensure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting. 

MaineCare’s EPSDT program allows MaineCare members under the age of 21 to receive services that are not typically covered due to limits on the type, frequency, or duration of the service. These services can include preventive, dental, developmental, behavioral and/or mental health, and specialty services.   

• Read more about UPDATE May 3, 2024 - Claims Pending for Missing Vendor Code

The Office of MaineCare Services (OMS) has become aware that after the issue was resolved regarding the Missing Vendor Code (Edit 6037) from the May 1, 2024 e-message, the same issue occurred during the overnight process on May 2, 2024. This issue is being investigated and addressed by multiple entities including: OMS, Gainwell Technologies, and the Office of the State Controller.  

• Read more about Update: Crown Prior Authorization (PA) Exception for Endodontic Therapy

On October 19, 2022, the Office of MaineCare Services (OMS) issued a bulletin informing providers that MaineCare will no longer require a PA for crowns provided in conjunction with endodontic therapy when a qualifying diagnosis was included on the dental claim. The list of qualifying diagnosis inadvertently listed ICD-10-CM code K04.0-Pulpitis.

• Read more about MaineCare in Education: New Resources and Updated MaineCare in Education 2024 Guide

The Office of MaineCare Services has updated the MaineCare in Education web page.     

You are invited to:  

• Read more about UPDATE - Claims Pending for Missing Vendor Code​

The Office of MaineCare Services (OMS), Office of the State Controller, and Gainwell have resolved the issue with claims going to a PEND status for a Missing Vendor Code (Edit 6037), noted in the May 1, 2024 e-message. 

Please note that Gainwell is mass adjudicating all the claims affected and there should be no impact on next week’s payment. 

• Read more about Quarterly Physician Drug Codes Update: QTR 1, CR 122400

In alignment with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update, the Department has retroactively updated the Physician Drug Rates Effective January 1, 2024. These new rates were implemented for billing on May 1, 2024.