MaineCare Refund Process

March 8, 2011

If you need to send a refund to MaineCare related to a claim, you must use this process:

Refunds for dates of services 9/1/2010 and forward:

1) Use the MaineCare Adjustment Request form on the MIHMS HealthPAS On-line Portal. 2) Follow the directions on the form, complete, and send to the address on the form along with any associated Remittance Advices.

The refund will process as a void or reversal of the claim; therefore, a refund check is not necessary for processing.

Refunds for dates of services 8/31/2010 and prior:

1) Use the MaineCare Adjustment Request for MeCMS on the MaineCare website. 2) Follow the directions on the form, complete, and send along with your refund check and associated Remittance Advices to the address on the form.

It is important to always include a written reason for the refund on the Adjustment Request form. If you need to send multiple refunds on various claims, you may use the Refund Spreadsheet for both pre and post 9/1/2010 refunds. You will need to fill out a separate spreadsheet for each Provider ID number. Please complete one MaineCare Adjustment Request per spreadsheet/Provider ID number.

Please note: If you represent a hospital that receives PIP payments, these credit balances will be cost settled; therefore, a refund check is not necessary.