Provider Enrollment & Revalidation

Enrolling with MaineCare

See the Enrollment Folder on the Health PAS Online Portal for details about how to enroll in Maine Integrated Health Management Solution (MIHMS). To enroll, you must have a trading partner account, as described in the MIHMS Enrollment Guide (PDF). Please visit the Enrollment Questions and Answers (PDF) for more information.

See the Enrollment Frequently Missed Information (PDF) for details about common new enrollment and maintenance case errors.

Enrollment Requirements

All applications, including initial enrollments and maintenance cases, have enrollment screening requirements. These screening requirements are based on categorical risk level.

Categorical Risk Levels

The ACA mandates that State Medicaid agencies establish categorical risk levels of limited, moderate, or high for initial applications or new practice locations. For provider types that are not recognized by Medicare, states must assess the appropriate categorical risk level by provider type A full listing of the criteria can be found in the Risk Category Assignments (PDF). For additional information , please see CMS's Frequently Asked Questions.

National Provider Identifier (NPI) Information

Fees and Surety Bonds

Providers who are newly enrolling, revalidating, or adding new practice locations with MaineCare must pay an application fee. This fee varies from year to year.

Home Health Agencies (HHA) and Durable Medical Equipment (DME) providers are required to provide surety bonds when enrolling as a new provider, revalidating, or adding a new service location.

See the Application Fee and Surety Bond (PDF) for more detail. See the 2019 Application Fee Spreadsheet (PDF) for a list of provider types that require an application fee.

Non-billing, Ordering, Prescribing, and Referring (NOPR) Providers

Billing providers must provide the NPI of an enrolled MaineCare practitioner who is ordering, prescribing, or referring on their claims to avoid claim denials. These practitioners are known as NOPRs and must enroll in MaineCare independently or as part of an organization. For more detail about NOPR requirements, please see Non-billing, Ordering, Prescribing, and Referring Provider Requirements (PDF).

Effective April 1, 2021, all prescribing providers must either be enrolled as a MaineCare provider or, where applicable, be added as a NOPR provider under their organization’s MaineCare provider enrollment to prevent disruption of pharmacy services for MaineCare members. See the NOPR Not Enrolled Letter (PDF) for more detail about this requirement.

Revalidating your Enrollment Application

Providers enrolled prior to January 1, 2017 must revalidate their information. For more detail about Revalidation see the Revalidate as a Current Provider (PDF).

See the following documents for guidance: