MaineCare Medicare Part C Update

March 22, 2011

Please note: this will apply to physician claims only until further notice

For members who are MaineCare or QMB eligible with Medicare Part C as primary, claims are currently paid by determining what MaineCare would pay as primary and subtracting the amount paid. If there is a balance due, that amount is paid; otherwise the claim pays at zero.

In the near future, MaineCare will be updating this reimbursement method to align with how Medicare Part A and B are processed.

We will provide more details about the new reimbursement method and how these claims will be reconciled once there is more information available.