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.
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.