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MaineCare Provider Services

Welcome to the Health PAS Online Portal for MaineCare members and service providers! MaineCare Services coordinates the programs and benefits, assures that they operate under consistent policy in keeping with the Department's goals and federal mandates, and ensures that they are administered effectively and efficiently Office of MaineCare Services (OMS) MaineCare provides health care coverage for Maine's children and adults who are elderly, disabled, or with low incomes MaineCare Member Services. For questions about covered services or to select a Primary Care Provider (PCP) call 1-800-977-6740. TTY users dial 711. You can also email. Pharmacy Help Desk. For prescription drug benefits, medication prior authorizations, and Medicare Part D questions, call 1-866-796-2463. TTY users dial 711

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Current MaineCare members may contact Member Services for information about MaineCare-covered services. Phone: 1-800-977-6740 (TTY 711) Fax: 1-877-314-8775 Email: MaineCareMember@dxc.com Contacts for Providers, Billing Agents, and Clearinghouse Provider Enrollment and Maintenance MaineCareEnroll@dxc.com Provider Services MaineCareProvider@dxc.com For additional contact options including telephone/fax numbers, and email/physical mailing address, click here

Talk with your health care provider or call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711 (Maine Relay). To see if your medication is covered, call the Pharmacy Help Desk at -866-796-2463, TTY: 711 If you have questions about EFT, contact the MaineCare Provider Services at 1-866-690-5585, option 1. Eligibility. How can I see the primary insurance for a member when checking eligibility using the portal? You must first as a Trading Partner to view the secure provider page. Go to Form Entry under the left navigational pane

Attention HIPAA PHI: Special Handling Required. This website contains Protected Health Information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) These services provided by rendering providers will be reimbursed when a provider furnishes these services to a MaineCare member whose physician has prescribed these services. Providers must be appropriately licensed or certified in the state in which he or she practices, practicing within the scope of that licensure or certification, and qualified to deliver treatment under this Section Our providers specialize in a range of MaineCare services designed to support children and adults with intellectual and developmental disabilities. If you need help finding a provider near you, you've come to the right place. Search by county or by service using the search bar above or peruse the list of service providers below

Director, Office of MaineCare Services Voice: (207) 287-2093 Fax: (207) 287-2675. Jill Kingsbury. MaineCare Pharmacy Director, Office of MaineCare Services Voice: (207) 624-6948 Fax: (207) 287-8601. Michael Ouellette, RPh. Utilization & Review Provider Services Manager Voice: (800) 832-1976 Fax: (800) 408-1088. Pharmacy Help Desk. Pharmacy. Office of MaineCare Services, Member Services 11 State House Station Augusta, Maine 04333-0011 Toll Free: (800) 977-6740; TTY: Dial 711 Fax: (800) 314-8775 Janet T. Mills Governor Jeanne M. Lambrew, Ph.D. Commissioner Adult Dental Services Covered by MaineCare Who is eligible for adult dental services? Adult dental services are for members who are Vision service providers must use MaineCare's designated Vision Care Volume Purchase Contractor (the Contractor) as the sole supplier of all eyeglasses for MaineCare members with no Medicare or other third party coverage, except as noted in Section 75.04-4(D). This includes lenses, frames, associated parts and cases In order to provide Behavioral Health Home Organization (BHHO) services, providers must first be approved as meeting the guidelines established by MaineCare and CBHS for provision of Targeted Case Management Services (TCM). Providers may choose to provide TCM or BHHO services, and may also provide both TCM and BHHO services. The following providers have been approved to provide Section 13 TCM services for CBHS, and also may provide Behavioral Health Home services. Click here for the complete.

The Maine Department of Health and Human Services. 4.01-2 Health Care Provider Individual or entity licensed or certified under the laws of the state of Maine to provide medical, behavioral health, and related services to MaineCare Members. Health Care Providers must be enrolled as MaineCare Providers in order to be reimbursed for services MaineCare Services Policy Division 11 State House Station Augusta, Maine 04333-0011 Tel.: (207) 624-4050; Fax: (207) 287-1864 TTY: Dial 711 (Maine Relay) Janet T. Mills Governor Jeanne M. Lambrew, Ph.D. Commissioner MaineCare in Education: Provider Enrollment in MIHMS How a MaineCare provider can access MIHMS MIHMS Provider Checklis Provider Resources Department of Health and Human Services. 13% off Offer Details: MaineCare 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 MaineCare members.See the ED Collaborative (PDF) for more detail about the project and how to participate Section M/N services or other services that are appropriate. This period begins on the first day that the new Sections 65M/N policies become MaineCare approved final rules, and ends on the 90th calendar day from that date. Uncovered Days of Service: Days of service provided for which there was no authorization an MaineCare Guidance Relating to Telehealth and COVID-19 As we respond to COVID-19, we encourage MaineCare providers to consider utilizing telehealth services for the delivery of MaineCare-covered services when appropriate and necessary. MaineCare has long had a robust telehealth policy and has recently created additional flexibility for its usage

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MAINECARE/MEDICAID PROVIDER AGREEMENT This is a Provider Agreement for participation in the MaineCare/Medicaid program. This Agreement is made by and between the State of Maine Department of Health and Human Services (Department), 11 State House Station, Augusta, ME 04333-0011, an ASO MaineCare Funded Service Grid May 13th, 2019 Prior Authorization Review: Requires clinical review Initial Section 28 ‐ Rehabilitative and Community Support Services (OCFS‐Based Providers) Services for Children with Cognitive Impairments and Functional Limitations ‐ 1:1 H2021 HI 15 Min XXX30 40 180. Maine Department of Health and Human Services Office of MaineCare Services - Pharmacy Unit 11 State House Station Augusta, Maine 04333- 0011 Toll Free: (866) 796-2463; TTY: Dial 711 (Maine Relay) Fax: (207) 287-8601 Janet T. Mills Governor Jeanne M. Lambrew, Ph.D. Commissioner To: MaineCare Providers From: Jill Kingsbury, Director of Pharmac With this methodology change, MaineCare will reimburse 340B providers for physician-administered drugs purchased through the federal 340B program at the 340B actual acquisition cost (AAC) instead of at the usual and customary charge amount.This change will also apply to payment for physician-administered specialty drugs However, MaineCare enrollees do not need a referral from their primary health care provider to get treated for their addiction or to receive mental health services. Alcohol And Drug Treatment Maine Medicaid covers inpatient drug rehab and outpatient treatment , as well as prescription drugs related to treatment

Important Information for MaineCare Members MaineCare COVID-19 activities effective Wednesday, March 18, 2020 In response to the COVID-19 emergency and to ensure that MaineCare members are able to access to the medications they need, the Office of MaineCare Services (OMS) is implementing changes at the point of sale, effective March 18, 2020 on: Early Refills, Co-pays and Prior Authorizations Maine Department of Health and Human Services Office of MaineCare Services - Pharmacy Unit 11 State House Station Augusta, Maine 04333- 0011 Toll Free: (866) 796-2463; TTY: Dial 711 (Maine Relay) Fax: (207) 287-8601 Janet T. Mills Governor Jeanne M. Lambrew, Ph.D. Commissioner To: MaineCare Providers From: Jan Wright, Interim Director o

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  1. Only providers who hold a valid contract to deliver covered services as described under this Section will be enrolled or continue to be enrolled as MaineCare providers of substance abuse treatment services including services for members with co-occurring mental health and substance abuse diagnoses
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Engagement summary Maine State DHHS. Our team is supporting a multi-year Organizational Effectiveness transformation for the Office of MaineCare Services (OMS). The Lean Healthcare East team has supported a half-dozen Lean Six Sigma improvement project teams and is working with approximately 25 functional teams within OMS to support improvement.. Lean East Lean Government Services MaineCare Provider. Examples of what the CIS program can support you with: Identifying and accessing community resources. Finding or maintaining housing. Maintaining optimal mental health by staying connected with providers, strengthening coping skills, relapse prevention planning and by creating wellness plans to decrease crisis situations OBH/OCFS/OMS FAQs for BH providers - Updated 5.6.2020; Office of MaineCare Services COVID-19 page. Contact COVID-19 email box for COVID questions. Guidance from OADS for Children's PNMI Providers Regarding Testing in Congregate Care; Office of Child and Family Services COVID-19 page. Office of Behavioral Health Services COVID-19 page

If an individual pays family members for personal care in order to remain at home and then applies for MaineCare long-term care benefits within the next sixty months, the payments will be treated as gifts unless (1) there was a pre-existing written agreement for services between the applicant and the provider; (2) the agreement recites the type, frequency, and duration of the services and the. The budget proposal proposed to consolidate MaineCare's General Fund appropriations from 13 to 4 accounts and add 1 Federal appropriation account. There is no impact on service delivery or the MaineCare providers and the Department is proposing $3 million of annual savings as a result of the consolidation Instead I offer the option to self-pay for my services and I will provide the documentation you need to request reimbursement from your insurance for out-of-network services. MaineCare, Anthem/BCBS, MMC, Maine Community Health Options, EBPA, and Self-pay. Paula Urbach Psychiatric Nurse Practitioner MaineCare (Medicaid) Services. MaineCare (Medicaid) benefits provide health care and dental care coverage to eligible children and adults. Contact the OFI at a regional DHHS office to find out if you are eligible for MaineCare. Contact the Department of Health and Human Services if you have been approved for MaineCare (Medicaid) benefits and.

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Get a bill from a provider; Need help finding a provider enrolled in MaineCare; Need help finding a transportation provider; MaineCare Member Services office hours are Monday and Wednesday from 8 a.m. to 6 p.m. and Tuesday, Thursday and Friday from 8 a.m. to 5 p.m. The number is 800.977.6740, option 3 mainecare waiver services ALLTECH is pleased to provide Assistive Technology (AT) Assessments to individuals under MaineCare Waiver Sections 21 and 29 in the areas of communication, computer access, and access to technology

The Office of MaineCare Services Comprehensive Rate System Evaluation Update March 16, 2021. 2 Background and quality of care, and are sufficient to provide access to the general population. 3 Federal Medicaid Payment Requirements Maine Department of Health and Human Services •To change the way they pay Medicaid providers, state Eligibility and service delivery for this program are governed by Section 96 of the MaineCare Benefits Manual - ages 21 and over or under 21 years old if accessing the Family Provider Service Option under PDN level 4 only telehealth services, unless in-person service also requires prior authorization Yes Yes Yes Providers can use all telehealth modalities to deliver services (live video, store-and-forward, remote patient monitoring) No Yes* (MaineCare TH Rules June, 2020) Yes Providers paid for telephone/audio only visits (For Medicare: see AMA Codin MaineCare members can receive services under only one Home and Community Waiver Benefit at any one time. MaineCare Benefits Manual. The Department of Health and Human Services offers several programs that provide supportive services to elderly and disabled adults in order to avoid or delay nursing home placement

Outpatient-MaineCare. List of providers. Children/youth that show need for mental health assessment and treatment. Services may include individual counseling and/or family therapy. Address any symptoms and promote emotional and behavioral stability. Medication Management-MaineCare. List of Providers clarify Mainecare's role in any effort to provide all Mainers with health insur-ance. one question he does not ask, however, is how the difficult relationship between Mainecare and the health care provider community—hospitals, physi-cians, and other providers who are paid by Mainecare for services provided t School administrative units who contract with a provider to provide special education related services for MaineCare eligible students with an IEP/IFSP should be aware of certain requirements concerning billing. First, the contracted provider must be enrolled as a MaineCare school-based provider. Second, the contracted provider must bill MaineCare according to the MaineCare school-based.

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MaineCare provider by an audit or post-payment review. 10-144 C.M.R. ch. 101, ch. I, § 1.16 (emphasis added).6 [¶14] More specifically, the Manual requires that records must be retained for a period of not less than five (5) years from the date of service or longer if necessary to meet other statutory requirements Providers must also submit a copy of the cost report without supporting documentation to the Division of Financial Services at the Office of MaineCare Services. 3300 UNIFORM COST REPORTS (cont.) 3300.6 Cents are omitted in the preparation of all schedules except when inclusion is required to properly reflect per diem costs or rates

At the time of the services, the services must have been recommended, in writing and signed by the applicant's physician, as necessary to prevent the applicant from residing in an assisted living facility or nursing home; and The agreement must show the type, frequency and duration of the services being provided and the amount of consideration (money or property) being received by the provider. MaineCare Benefits Manual. Providers who are planning to re-open must follow all applicable guidance on how to do so safely during the pandemic. DOE Framework to Reopening OCFS Guidance to Behavioral Health Service Providers MaineCare COVID-19 Provider Guidance and Policy Updates 7 MaineCare members who already use a non-emergency transportation broker to arrange rides to their MaineCare-covered services should call that same broker for rides to vaccination clinics. This program is for MaineCare members who are ineligible for non-emergency transportation, as well as any other Maine resident who does not have access to reliable transportation to get to their vaccination.

Parents and kids who are eligible for free MaineCare can get medical bills paid back to 3 months before the application. Kids eligible for Low-cost CHIP can get medical bills paid back to the first day of the month of their application. To get back bills paid, you must have been eligible for MaineCare or CHIP at the time you received the services summaryThis bill requires that services under MaineCare that are provided through telehealth be reimbursed at the same rates as those services that are not provided through telehealth. The bill also requires the Department of Health and Human Services to amend its rule relating to MaineCare coverage for services delivered through telehealth There are some services, equipment, and medications that need Prior Authorization (PA) from MaineCare before you can acquire them. For such situations, the provider will send a form to MaineCare asking for PA. MaineCare will then send a letter to you and to the provider to inform you if you have PA for a certain medical equipment, service, or. KEPRO is an Administrative Services Organization (ASO). We were hired by the Department of Health and Human Services (DHHS) to review most behavioral health (mental health), intellectual disabilities, and substance abuse services. We do not provide services like a mental health agency. KEPRO does not refer you for services

MaineCare Member Services Call MaineCare Member Services if you: •Have questions about your benefits. •Have questions about co-payments, or get a bill from a provider. •Need help finding a provider who takes MaineCare. •Need help finding transportation to a provider. MaineCare Member Services' number is 1-800-977-6740, Option 3 A specialist will help you fill out the forms or can help you apply for MaineCare online. If it is hard for you to leave your house, someone might be able to come to your home to help you apply for MaineCare. You can also call or visit your local Department of Health and Human Services office and ask to talk to an eligibility specialist

Island Commons goal is to provide services regardless of our elders' financial means and ability to pay. As a MaineCare provider, we rely on donations from generous supporters like you. Thank you for helping our elders to age in place on the island they love! Island Commons Resource Center is a registered 501(c)(3) nonprofit organization Information on elder and adult services issues in Maine. New Admit For MAINECARE Members only If not a MaineCare Member, DO NOT COMPLETE THIS FOR

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Primary Care Case MaineCare. Management (PCCM) program, which began in 1999. The program requires that low-income adults, children, and families, and children and adults with disabilities around the state for primary care, case choose a PCCM provider management, and referrals to specialists KEPRO Provider Manual Appendix C - Service Specific Instructions V8-1-16 8 Baxter Fund Services The following KEPRO processes are required for: 1. Baxter Fund Services - Outpatient Therapy 2. Baxter Fund Services - Group Therapy 3. Baxter Fund Services - Medication Management 4. Baxter Fund/MaineCare - Outpatient Therapy 5 Prepare the MaineCare application and be your liaison with the Department of Health and Human Services Protect your home and other important assets from Maine's estate recovery program Provide planning and guidance for asset protection for the spouse once MaineCare benefits are receive Transfer Forms for MaineCare members only. If not a MaineCare Member, DO NOT COMPLETE THESE FORMS. If you need to contact someone regarding Transfer Forms, call the Office of Aging and Disability Services at: 1-800-262-2232 8am to 5pm TTY (800)606-0215 (Toll Free Nationwide & Canada Transportation service for MaineCare covered reimbursement and rides is available, but must be arranged through the broker service by calling 1-855-608-5176. This includes self-driver friends and family reimbursement. DCP has contracted with the broker to provide rides, but we are no longer able to book your MaineCare trip for you

Mainecare Pdl 2020 Health - healthgolds.com. Health Details: MaineCare PDL - Welcome to the State of Maine Pharmacy .Health Details: In response to the COVID-19 emergency and to ensure that MaineCare members are able to access to the medications they need, the Office of MaineCare Services (OMS) is implementing changes at the point of sale, effective March 18, 2020 on: Early Refills, Co-pays. Schedule Your MaineCare Covered Trip Effective August 1, 2014, KVCAP is working with Penquis, the MaineCare transportation broker for Kennebec and Somerset Counties. Please call 1-844-736-7847 to arrange your MaineCare transportation. KVCAP will continue to be a transportation provider and may b. The state announced Monday that it has terminated its MaineCare contract with a Biddeford-based provider following the death of an adult with developmental disabilities in August.. Maine's Department of Health and Human Services says it has already transitioned several adults into alternative housing, and is working to place 65 more within a month In Maine, Medicaid is called MaineCare. Medicaid is a health insurance program that provides insurance to people who have limited income and assets. Medicaid is run by the federal and state governments. Eligibility for MaineCare is based on age and income. Sometimes you have to be medically eligible as well Providers . Atrezzo; Provider Directory Questionnaire; Provider Manual and Forms; Provider Relations; Provider Training; Quality Improvement; Services . Adult Services. Behavioral Health Services; Behavioral Health Homes; Community Support Services; Home Supports; Hospital Services; Opioid Health Homes; Private Non-Medical Institutions; Targeted Case Management; Children Services

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In Hancock County, the primary MaineCare provider is Washington-Hancock Community Agency, 877-374-8396. To arrange a MaineCare ride, call Logisticare at 1-855-608-5176. view the website; Penobscot county. The Lynx; In Penobscot County, the primary MaineCare provider is The Lynx, operated by Penquis, 866-853-5969 Legal Services for the Elderly. If you are a Maine resident who is 60 or older and you have been denied MaineCare or received a reduction in your services, call the Legal Services for the Elderly Helpline at: 1-800-750-5353 to talk to an attorney for free. Area Agency on Aging MaineCare has numerous programs to provide medical coverage to impoverished individuals. Each program has its own set of financial criteria. To qualify for eligibility, an individual must demonstrate that he meets certain asset and income limitations. Essentially, he must prove to the State that he is poor enough to be eligible for coverage Program Description. Consumer Directed Attendant Services (CDAS) is a Medicaid entitlement program though Maine's state Medicaid program. (Medicaid in Maine is more commonly referred to as MaineCare)

Subsection 144-101-II-90

When an insured is eligible under the MaineCare program for the medical costs of injury, disease, disability or similar occurrence for which an insurer is liable, and the insured's claim is payable to a health care provider as provided or permitted by the terms of a health insurance policy or pursuant to an assignment of rights by an insured, the insurer shall directly reimburse the health care provider to the extent that the claim is honored Browse Maine Administrative Code | Chapter 332 - MAINECARE ELIGIBILITY MANUAL for free on Casetext DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL. Chapter 332 - MAINECARE ELIGIBILITY MANUAL. Chapter 332 Casetext, Inc. and Casetext are not a law firm and do not provide legal advice.. Maine is somewhat unique in that entities are reimbursed but every dental hygienist who works for an enrolled entity must also enroll as a Medicaid provider. Dental hygiene services shall be reimbursed to entities enrolled as MaineCare providers employing or sponsoring licensed dental hygienist services allowed under public health supervision Interpreter services are available for those with limited English proficiency to help navigate this process. Any agent can assist in securing an interpreter at no cost to you. TTY users can call Maine relay 711; You can also email DHHS using the Request Assistance For

MaineCare ride provider has history of problems - Portland16 Easy Ways to Protect Your Wordpress Website From Hackers

Details: This application is for MaineCare providers who plan to serve MaineCare members and/or uninsured individuals. The OHH program requires providers to deliver services through a team-based model of care, as stated in MaineCare Benefits Manual, Chapter II, Section 93, Opioid Health Home Services or in a MaineCare issued OHH contract To get help applying for MaineCare, or if you have questions about your MaineCare benefits, call your local Area Agency on Aging at: 1-877-353-8771 Legal Services for the Elderly If you are a Maine resident who is 60 or older and you are worried about Estate Recovery, call the Legal Services for the Elderly Helpline at 1-800-750-5353 to talk to an attorney for free 14. 20 Day Medicare/MaineCare 15. Medicare to MaineCare 16. 20-day Co-pay to NF 17. 30 Day Community MaineCare 18. Adv to MaineCare update 19. Adv. Medicare to Pvt P ay . 20. Cont. Stay Review 21. Ext Ordinary Circum to NF. 23. PDN IV (FPSO) 25. TBI-Brain Injury NF. 29. Consumer Directed HBC (SCA only) 31.Residential Care 32. MFP-Homeward Bound 33. ORC-Other Relate Find MaineCare Therapists, Psychologists and MaineCare Counseling in Maine, get help for MaineCare in Maine Continuum Health Services is always interested in communicating with qualified health professionals. We work diligently to provide our residents with the best and most talented staff available in the industry. If you are interested in being considered for employment by CHS, please upload your resume. We will retain your submission for a minimum of.

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