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Provider Enrollment

All providers are required to fill out and sign the Provider Enrollment Forms, Agreement Forms and the W9 Form. The Servicing Provider Form is required for each servicing provider being enrolled. The instructions included in the Provider Enrollment download has a sheet detailing who must be enrolled as a servicing provider.

Please download and fill out all required forms and submit as one packet.

   
Provider Enrollment Forms (.doc) (.pdf)
Specialty/Subspecialty Documentation Requirements (.doc) (.pdf)
Servicing Provider Form (a section of the Provider Enrollment Forms document listed above) (.doc) (.pdf)
Special Instructions for Providers Located Outside Maine
Rules and Regulations by Provider Type  
Change of Address or Company Name
  • Form
   (.pdf)
  • Instructions
   (.pdf)
   

 

 

Please be sure to print out a copy of the billing instructions and policy section for your provider specialty. Policy links are listed with the Provider Type.

If you have questions, please call one of the following numbers:

  • Enrollment and Out of State providers: 1-800-321-5557 Option 6 or (207)287-4082.
  • Billing: 1-800-321-5557 option 8 or (207)287-3094.
  • Policy: 1-800-321-5557 option 8 or (207)287-9368. Your call will then be directed to the appropriate provider relations specialist.
To view the current policy for all specialities view the Secretary of State's website.
NOTE: Please check our Rulemaking Site for any policy/rules which are in the process of being revised or updated.