Provider Homepage

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).

Maine CDC Breast and Cervical Health Program (MBCHP)

 

Provider Training 

Training Videos

Billing for Interpreter Services Training Video - This video demonstrates how to bill MaineCare appropriately for interpreter services. 

Code Request Form Training Video - This video provides detailed instructions about how to complete the Code Request Form for providers who are requesting that MaineCare cover specific codes.

Training Calendar

Health PAS Online Portal Calendar for Online Trainings - You will be redirected to the calendar on the portal. The calendar includes information about upcoming training opportunities.

Training Contact

Contact Lisa Bouchard, Provider Relations Specialist, with training requests.

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. 

Webinar Learning Opportunities

Connecting Patients to Behavioral Health Services Webinar 2024

Community Action Partnership Webinar July 2023

HIV 101 for Primary Care Practitioners May 2024

HIV Treatment Guidelines Update Webinar May 2023

Housing Webinar Materials and Resources 2024

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.                                                                         

Provider Communications

Interpreter Services Guidance

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

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.

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

HIPAA, Privacy, and Security

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.

    Contact Us

    For details about who to call for specific topics, see Contacts for Providers (PDF).

    More Resources