Maine Independent Dispute Resolution

The Bureau has contracted with Maximus Federal Services to resolve certain disputes involving bills for covered emergency services rendered by out-of-network medical service providers. Independent dispute resolutions apply to out-of-network bills for emergency medical services rendered on or after October 1, 2020.

Who can request an independent dispute resolution?

  • An uninsured patient
  • A person covered under a self-insured/ERISA plan
  • An out-of-network health care provider

What types of bills can I dispute?

  • A bill for covered emergency services by an out-of-network provider to a person covered by a health plan.
  • Bills totaling $750 or more received by an uninsured person for emergency health services for a single visit regardless of the number of providers.

How do I start a dispute?

  • Click on the link https://dispute.maximus.com/me/indexME
  • Create your account. 
  • Log in and activate your newly created account within 3 calendar days.
  • Complete the dispute resolution application electronically for a patient or provider. If you do not have an email address or do not want to create an account electronically, please contact Maximus at (888) 866-6205.
  • Gather and submit relevant documents such as:
    • Copy of bill(s)
    • Claim form(s), if you have it.
    • Copy of Explanation of Benefits (EOB) if you have it.
    • Relevant communication between patient, provider, and/or carrier.
    • A dollar figure you will accept as the amount for the dispute.

What happens after I submit my application?

  • MAXIMUS reviews it to confirm it’s complete.
  • Maximus assigns an arbitrator to your case.
  • The arbitrator notifies the other party of the dispute and requests them to submit their response.
  • The arbitrator requests information from the parties as needed.
  • Parties can check case status any time.

 When will I hear back from Maximus about my dispute?

  • The arbitrator will issue a written decision within 30 calendar days after receiving a completed application.

How much does this cost and who pays?

  • In a dispute between an uninsured patient and the provider, the provider always pays.
  • In a dispute between the provider and the insurance company, the losing party pays the fee or if it’s settled, the fee is divided between the parties.

For what the law says on independent dispute resolutions, click here:

https://www.maine.gov/pfr/insurance/legal/rules/pdf/365_final_rule.pdf

http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP1501&item=5&snum=129

Carrier Form for Out-of-Network Emergency Services Provider Notice

Contact US
MAXIMUS Federal
Attn: State Appeals/ME IDR
3750 Monroe Avenue, Suite 705
Pittsford, NY 14534
Phone: (888)866-6205
img MEdisputes@maximus.com
Fax: (585) 425-5296