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-1.08 - REIMBURSEMENT
Universal Citation: 10 ME Code Rules ยง 144-101-I-1.08
Current through 2024-38, September 18, 2024
1.08-1 Maximum Amount
Unless specified in other Chapters of this Manual, the maximum amount of payment for services rendered shall be the lowest of the following:
A. The MaineCare rate of
reimbursement as found in the applicable Chapter of the MBM or as published by
the Department;
B. The lowest
amount allowed by Medicare Part B;
C. The usual and customary charges;
D. The amount, if any, by which the MaineCare
rate of reimbursement for services billed exceeds the amount of the third party
payment as set forth in Section 1.07-7. A claim is considered paid in full if
the insurance amount received exceeds the MaineCare rate of reimbursement.
It is the responsibility of the provider to seek payment from any other resources that are available for payment of the rendered service prior to billing MaineCare.
1.08-2 General Information
A. MaineCare members, family members or
guardians do not have the authority to prohibit a provider from billing for a
MaineCare covered service.
B.
MaineCare will only reimburse enrolled providers for MaineCare covered
services. Under no circumstance can MaineCare reimburse MaineCare
members.
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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