Maine Medicaid — MaineCare (Maine Medicaid)
| Program name | MaineCare (Maine Medicaid) |
|---|---|
| Provider portal | https://www.maine.gov/dhhs/oms |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Maine Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Maine
The Blue Cross Blue Shield Association licensee in Maine is Anthem Blue Cross and Blue Shield Maine (Elevance Health). See the Anthem (Elevance Health) payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Maine
The dominant commercial insurers operating in Maine, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Maine
Maine Medicaid MCO data has not yet been populated in the registry.
Medicare contractor and active LCDs in Maine
Wellpoint Federal is the Medicare A/B MAC for Maine: Part A and Part B fee-for-service claims from Maine go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by Wellpoint Federal. In the current Medicare Coverage Database export, 147 active LCDs from these contractors apply to Maine claims.
- Wellpoint Federal
A/B MAC (Part A and Part B claims); Home health and hospice MAC
- Noridian Healthcare Solutions, LLC
DME MAC (durable medical equipment and supplies)
Selected active Wellpoint Federal policies for Maine
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L33627 Non-Invasive Vascular Studies
- L33394 Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
- L35936 Facet Joint Interventions for Pain Management
- L39036 Epidural Steroid Injections for Pain Management
- L35000 Molecular Pathology Procedures
- L33577 Transthoracic Echocardiography (TTE)
- L33631 Outpatient Physical and Occupational Therapy Services
- L33632 Psychiatry and Psychology Services
- L33557 Cardiac Catheterization and Coronary Angiography
- L33569 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
- L33636 Routine Foot Care and Debridement of Nails
- L33622 Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts
Equipment, home health and hospice policies that apply in Maine
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33393 Hospice - Determining Terminal Status
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Maine billing
- 24-A MRS §2039 (Maine Balance Billing / Surprise Bill — LD 1403, 2019)
- 24-A MRS §4303 (prompt pay — 30 days electronic clean claim)
- 22 MRS §1716 (hospital financial assistance / free care guidelines)
Provider licensing & enrollment in Maine
Providers enroll via MaineCare Provider Portal (MIHMS). CAQH ProView accepted for MaineCare and commercial credentialing.
Major health systems headquartered in Maine
| Health system | Headquarters |
|---|---|
| MaineHealth (Maine Medical Center) | Portland, ME |
| Northern Light Health (Eastern Maine Medical Center) | Bangor, ME |
| Central Maine Healthcare | Lewiston, ME |
| MaineGeneral Health | Augusta, ME |
| Mid Coast–Parkview Health (MaineHealth) | Brunswick, ME |
Frequently asked questions — Maine billing
What is the Maine Medicaid program called?
Maine's Medicaid program is known as MaineCare (Maine Medicaid). Providers enroll and manage claims through the provider portal at https://www.maine.gov/dhhs/oms.
What is the Maine Medicaid timely filing limit?
MaineCare (Maine Medicaid) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Maine's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Maine Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for MaineCare (Maine Medicaid). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Maine?
The dominant commercial payers in Maine include Anthem (Elevance Health), Harvard Pilgrim, Aetna, UnitedHealthcare, Cigna, along with the BCBS licensee Anthem Blue Cross and Blue Shield Maine (Elevance Health). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Maine?
Maine Medicaid MCO data has not yet been populated in the registry. Consult the state Medicaid portal for the current MCO roster.
What state-specific billing regulations apply in Maine?
Maine has 3 tracked state-level statutes that affect medical billing and RCM: 24-A MRS §2039 (Maine Balance Billing / Surprise Bill — LD 1403, 2019); 24-A MRS §4303 (prompt pay — 30 days electronic clean claim); 22 MRS §1716 (hospital financial assistance / free care guidelines). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Maine with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to MaineCare (Maine Medicaid) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Maine Medicaid and the member ID card before submission.