NEW! Critical Communications to Providers
Subscribe to the MaineCare - Critical Communications topic list where we will share information when circumstances disrupt provider operations. See the e-message that describes the importance of this new list. Don’t miss critical information from MaineCare!
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
Checking MaineCare Member Eligibility
You should always check a patient’s eligibility for MaineCare before providing a service. You can check eligibility by logging into your secure account on the Health PAS Online Portal and searching by the member.
You can also call the automated Interactive Voice Response (IVR) to check member eligibility. See the IVR Eligibility Check Instructions (PDF).
Adjusting Claims for Retro Rate Increases
For guidance about adjusting verses straight reversing claims and instructions on how to do each, see the How to Adjust Claims for Retro Rate Increases (PDF).
HIV Program
HIV Testing Now Recommended Quarterly by Maine CDC. A Health Alert Network notice issued on April 19, 2024, describes the current situation in the state and recommends quarterly testing for certain people. These Fast Facts for providers on HIV Screening summarize the testing recommendation.
Providing Cabenuva to MaineCare Members
AIDS Drug Assistance Program (ADAP) 101 for Health Practitioners - 30-minute webinar, March 2025
Hepatitis C and HIV Clinical Guidance Package
- HIV and HCV Clinical Guidance Package (PDF)
- HIV and HCV Clinical Guidance Package Overview (PowerPoint deck)
- HIV and HCV Clinical Guidance Package Meeting Recording
340B Guidance
340B Modifier Billing Guidance Update - December 23, 2024
This notice gives information about how drug claim lines eligible for rebate collection are identified by the state - 340B Modifier Billing Guidance Update
340B Program Overview - January 29, 2024
This notice provides a general overview of MaineCare's 340B Program.
340B Modifier Billing Guidance Update - July 14, 2023
This notice 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 notice 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 notice 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 notice 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 notice 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.
Maine CDC Breast and Cervical Health Program (MBCHP)
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 Cassie Antonelli with questions regarding youth referrals.
Emergency Department (ED) Collaborative
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 members. See the ED Collaborative (PDF) for more detail about the project and how to participate.
HIPAA, Privacy, and Security
- De-Identification Methods (Health and Human Services webpage) - Explanation of identifiable health information and how to de-identify materials.
- Educational Materials about HIPAA Security (CMS webpage)
Contact Us
For details about who to call for specific topics, see Contacts for Providers (PDF).
- For MIHMS and Health PAS Online Portal questions, email Provider Services or call 1-866-690-5585. TTY users dial 711.
- Call your Provider Relations Specialist (PDF) for policy-related questions.