Out-of-State Lab Services and Lab Processing

September 20, 2013

This message is a reminder to providers that you should have lab services and lab processing for MaineCare members done in Maine whenever available as stated in the MaineCare Benefits Manual, Chapter I, Section 3.

Below, are exceptions for members to receive out-of-state lab services:

  • Emergency Services for members that have emergencies while travelling out-of-state or;
  • Service and equipment provided to a member who is residing out-of-state or;
  • A provider who is the sole provider of a type of cost-effective medically necessary item or service may be enrolled only for the purpose of providing that item or service with prior authorization. An example would be an out-of-state laboratory that conducts a test, or a manufacturer of a highly specialized item, not provided by any in-state provider or; An out-of-state provider of services to a MaineCare member who is eligible for services as a Qualified Medicare Beneficiary (QMB) may enroll as a MaineCare provider only for the purpose of billing Medicare coinsurance and deductibles.