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-1.13 - INQUIRY PROCESS
Current through 2024-38, September 18, 2024
There are two (2) options available to providers to check member eligibility, co-pay information, claim status, third party payment insurance, and eligibility for MaineCare managed care benefits. These options are a web based system and an Interactive Voice Response System. These options are available twenty-four (24) hours a day, seven (7) days a week and allow unlimited inquiries. Providers will be required to furnish the MaineCare provider ID number, the member's name, date of birth, and the member's ID number or Social Security Number before any information can be given. Providers should attempt to resolve questions via the web based system or the Interactive Voice Response System, or other means made available by the Department, prior to calling the Provider Services Unit.
When a provider is in need of an immediate resolution to a policy and/or procedural question, the Provider Relations Unit may be contacted by telephone, or by submitting an e-mail inquiry.
Written inquiries regarding the payment or nonpayment of claims should be mailed or faxed to:
Provider Services
MaineCare Services
11 State House Station
Augusta, Maine 04333-0011
Priority will be given to written inquiries that contain copies of claims, Remittance Advices and any other pertinent documents, because these documents expedite issue resolution.
1.13-1 Unpaid Claims
When a provider does not receive information regarding the payment of a specific claim from the Department, he or she may use the web-based system or call the Interactive Voice Response System, or use other means made available by the Department, regarding the status of the claim before rebilling. The web based system and Voice Response System will let the providerknow if the claim has been paid or denied and on what date. If there is no information on file, it means the claim was not received and should be resubmitted.
1.13-2 Re-evaluation of Charges
If a provider questions the payment he or she has received for a service, a written inquiry must be made within one hundred and twenty (120) calendar days from the date of the Remittance Advice. The provider must comply with the most current procedures made available by the Department.
