Call to Verify Member Eligibility When ‘Emergency Services Only’ Coverage is Displayed
The Office of MaineCare Services (OMS) recently became aware of a system error that changed some MaineCare members’ coverage from full MaineCare to Emergency Services Only. We are working to correct the affected members’ coverage status in the Maine Integrated Health Management Solution (MIHMS), MaineCare’s claims-processing system, and will notify you when the issue is resolved.
In the meantime, if a MaineCare member believes they have full MaineCare coverage, but MIHMS shows Emergency Services Only coverage, please call MaineCare Provider Services at 1-866-690-5585. Provider Services will confirm the member’s eligibility directly with the Office for Family Independence (OFI). If Provider Services confirms the member has full MaineCare coverage, OMS will reimburse for covered services accordingly.
Claims for members with incorrect eligibility displayed in MIHMS may deny until this error is resolved. MaineCare will identify and reprocess affected claims that denied due to the incorrect coverage. Providers do not need to take action on those claims. Please note: if a claim denies for an unrelated reason, providers should correct and resubmit the claim as usual.
If a MaineCare member paid for services that MaineCare would typically cover because MIHMS displayed incorrect coverage, please refund the member. MaineCare cannot reimburse members for payments made directly to providers.
We will provide updates as additional information becomes available. If you have questions, please contact your Provider Relations Specialist or the MaineCare Provider Services call center by email (mainecareprovider@gainwelltechnologies.com) or phone: 1-866-690-5585 (TTY users dial 711).
Thank you for your patience as we resolve this issue and for helping ensure affected members continue to receive covered MaineCare services.