DHHS → node
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.
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:
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.
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.
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.
The Office of MaineCare Services has updated the MaineCare in Education web page.
You are invited to:
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.
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.
In coordination with the Centers for Medicare & Medicaid Services, (CMS) revision of rates effective March 9, 2024, MaineCare has updated its Section 90 rates. These rates were implemented on May 1, 2024. You may view all codes and rates on the Usual, Customary and Reasonable (UCR) fee schedule.
As caterpillars become more active, take precautions to protect your health
AUGUSTA – The Maine Center for Disease Control and Prevention (Maine CDC) and Maine Forest Service (MFS) remind Maine residents and visitors to take precautions to reduce exposure to browntail moth caterpillars, as they become more active this spring.