Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter I - Specific Policies By Service
Sec2 144-101-I-1 - GENERAL ADMINISTRATIVE POLICIES AND PROCEDURES
- Subsection 144-101-I-1.01 - INTRODUCTION AND STATUTORY AUTHORITY
- Subsection 144-101-I-1.02 - MAINECARE ADMINISTRATION
- Subsection 144-101-I-1.03 - PROVIDER PARTICIPATION
- Subsection 144-101-I-1.04 - MEMBER PARTICIPATION
- Subsection 144-101-I-1.05 - SUPPLEMENTATION BY MEMBERS
- Subsection 144-101-I-1.06 - COVERED AND NON-COVERED SERVICES
- Subsection 144-101-I-1.07 - THIRD PARTY LIABILITY
- Subsection 144-101-I-1.08 - REIMBURSEMENT
- Subsection 144-101-I-1.09 - COPAYMENT
- Subsection 144-101-I-1.10 - SUBMISSION OF CLAIMS
- Subsection 144-101-I-1.11 - PAYMENT PROCESS
- Subsection 144-101-I-1.12 - CLAIM ADJUSTMENTS
- Subsection 144-101-I-1.13 - INQUIRY PROCESS
- Subsection 144-101-I-1.14 - PRIOR AUTHORIZATION
- Subsection 144-101-I-1.15 - PROVISION OF NECESSARY TRANSPORTATION TO MEDICAL SERVICES
- Subsection 144-101-I-1.16 - AUDITS
- Subsection 144-101-I-1.17 - UTILIZATION REVIEW
- Subsection 144-101-I-1.18 - PROGRAM INTEGRITY
- Subsection 144-101-I-1.19 - TERMINATION FROM PARTICIPATION IN MAINECARE
- Subsection 144-101-I-1.20 - SANCTIONS/RECOUPMENTS
- Subsection 144-101-I-1.21 - REINSTATEMENT FROM TERMINATION OR EXCLUSION
- Subsection 144-101-I-1.22 - FRAUD/ABUSE BY A PROVIDER, INDIVIDUAL OR ENTITY, AND SUSPENSION OF PAYMENTS
- Subsection 144-101-I-1.23 - PROVIDER AND PROVIDER APPLICANT APPEALS
- Subsection 144-101-I-1.24 - MEMBER APPEALS
- Subsection 144-101-I-1.25 - MAINECARE ADVISORY COMMITTEE
- Appendix 144-101-I-1-1 - CODE OF ETHICS FOR INTERPRETERS*
- Appendix 144-101-I-1-2 - PERTINENT SECTION S FOR REQUIRED COMPLIANCE UNDER THE FALSE CLAIMS ACT
Current through 2024-38, September 18, 2024
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