Provider Resources

Health PAS Online Portal

Visit the Health PAS Online Portal for:

  • Claims and billing instructions, companion guides, user guides, and X12 HIPAA Acknowledgements
  • Electronic Visit Verification (EVV) Guides and Manuals
  • Enrollment guides and tools
  • Trading Partner Guides
  • Fee Schedules
  • Forms for claims, referrals and authorizations, and other portal submissions

MaineCare Communications Toolkits

You may request printed materials be sent to you, free of charge, for the below toolkits. To order, go to the Materials for MaineCare Communications Toolkit webpage

MaineCare for Kids

Beginning October 1, 2023, children and young adults under 21 in Maine are now eligible for MaineCare coverage if they are in families who make an annual income up to 300% of the Federal Poverty Level. That translates to an annual salary of about $59,000 for a family of 2 and $90,000 for a family of 4. We have launched a MaineCare for Kids Toolkit (PDF) to provide you with materials you can download and print or include in your digital and social media channels to help reach the families with children and young adults who now may be eligible for MaineCare coverage.

New Coverage Groups

Beginning July 1, 2022, people who are pregnant or are under 21, with or without citizenship, are now eligible for full MaineCare coverage. We have launched a New Coverage Groups Toolkit (PDF) to provides you with materials you can download and print or include in your digital and social media channels to reach the people in your community who may be eligible for this coverage. 

Learning Opportunities

Connecting Patients to Behavioral Health Services Webinar 2024

An introduction to Treatment Connection platform recording for providers seeking services for patients.

Community Action Partnership Webinar July 2023

HIV Treatment Guidelines Update Webinar May 2023

Housing Webinar Materials and Resources 2023

Pharmacy

COVID-19 At-Home Tests and Collection Kits

This MaineCare Standing Order (PDF) authorizes Over the Counter (OTC) COVID-19 at-home tests.

Nicotine Replacement Therapy (NRT) Products

This Standing Order for Dispensing Nicotine Replacement Therapy Products to MaineCare Beneficiaries (PDF) authorizes licensed pharmacists to dispense medically appropriate NRT products to eligible MaineCare members who require the products for help with smoking cessation or vaping cessation.

Naloxone Standing Order

This Standing Order for Prescribing Intranasal and Injectable Naloxone products authorizes licensed pharmacists to create a prescription for and dispense naloxone products to eligible MaineCare members.

Non-Prescription Oral Contraceptive Products Standing Order

This Standing Order authorizes licensed pharmacists to create a prescription for and dispense medically appropriate oral contraceptive products to eligible MaineCare members.

Medications for Addiction Treatment (MAT) Information

See the following documents for guidance about the Prior Authorization (PA) process for Buprenorphine:

340B Guidance

  • 340B Program Overview - January 29, 2024

    • This document provides a general overview of MaineCare's 340B Program

  • 340B Modifier Billing Guidance Update - July 14, 2023

This document gives information about how drug claim lines eligible for rebate collection are identified by the state - 340B Modifier Billing Guidance Update Department of Health and Human Services (maine.gov)

  • General Billing Guidance - May 8, 2023

This document provides general billing guidance for inclusion of National Drug Codes (NDCs) in drug claim lines. Billing Guidance to Include National Drug Codes (NDCs) in Drug Claim Lines Department of Health and Human Services (maine.gov)

  • Guidance to avoid Duplicate Discounts and drug claim line denial reasons - October 12, 2022

This document summarizes the state's actions to avoid duplicate discounts, and reasons why a drug claim line may deny. Attn: Providers Particpating in the 340B Drug Program, CR 112772 Department of Health and Human Services (maine.gov)

  • 340B Provider Enrollment Guidance - October 7, 2022

This document provides general 340B provider enrollment guidance - 340B Provider Enrollment Guidance Department of Health and Human Services (maine.gov))

  • 340B Billing Requirements - July 7, 2021

This document explains the billing requirements for the submission of 340B drug claims to MaineCare for providers and hospitals - 340B-Drug-Claim-Billing-July2021.pdf(maine.gov)

HIPAA, Privacy, and Security

Interpreter Information

Interpreter Clarification for Providers (PDF) - This document provides details about interpreter services for non-English speaking or limited English speaking members.

Complex Case Unit (CCU) Referrals

CCU provides Maine residents who have disabilities with simple and timely solutions to complex healthcare, financial, and placement issues through integrated provider and community involvement. 

The CCU accepts cases based on referrals and prioritizes:

  • Maine residents who have complex healthcare, financial and placement issues that the community have been unable to resolve.
  • Adults who have been in the Emergency Department more than five days or youth who have been in the Emergency Room more than one day with no possible discharge outcomes.
  • Other complex cases sent by the Governor’s or DHHS Commissioner’s Office

Referring a Member to CCU

Complex Case Unit Process for Referrals (PDF)

Please use one of the following referral forms for:

Questions?

Please contact Michele Lane regarding adult referrals or contact Teresa Barrows with questions regarding youth referrals.    

Emergency Department (ED) Collaborative

MaineCare nurses, behavioral health specialists, and care coordinators work with health care providers and MaineCare members to reduce avoidable, non-emergency ED use and improve health outcomes for MaineCare members. See the ED Collaborative (PDF) for more detail about the project and how to participate.

E-Message Sign Up

You can sign up for email notifications on the E-message Subscription Webpage, where you enter your email address, scroll down to “MaineCare Stakeholders,” and select the topics about which you would like to receive updates and information.

See the E-message Topic List (PDF) to ensure you sign up for the topics that relate to the policies under which your organization enrolled with MaineCare. See also the MaineCare Bulletins webpage for past notices.

Policy and Rules RSS Feed Sign Up

MaineCare publishes policy and rule changes through Headline News, our RSS Feed service. To subscribe, click on the topic link below. The link will open a new page where you will click "Subscribe to this feed" to sign up.

YouTube Channel

See MaineCare's YouTube channel by searching @MaineCareCommunications207 for video made for MaineCare service providers, members, and the public.

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