Cycle 4 Revalidation Providers and School-Based Services Guide and Reminders

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Attention Cycle 4 Providers: MaineCare Provider Revalidation Training Reminder

Cycle 4 providers may start revalidation efforts by July 2, 2018 and must submit by August 30, 2018.  

To ensure a successful revalidation and enrollment process for providers, MaineCare is conducting multiple webinar trainings prior to each of the thirteen revalidation cycles. These trainings include an overview of provider revalidation as well as a live demonstration of entering a revalidation application or enrollment through the Provider Enrollment Application (PEA) on the Health PAS Online Portal. MaineCare will be conducting training webinars to assist providers prior to each cycle. For the schedule of trainings, see the Event Calendar on the Health PAS Online Portal. We will offer these free trainings through the Learning Management System (LMS).

  • If you have not registered with the LMS, see the First Time User Guide for assistance. To access the guide, go to the Health PAS Online Portal and log into your Trading Partner Account (TPA). Click on the section called "Trading Partner User Training" and you will see the link to the LMS First Time User Guide.
  • For assistance with registering or any other training related topic, please email the Medicaid Training Center.

Please review these important time-sensitive reminders:

  • Application deadlines must be met. If you are required to revalidate with MaineCare during this Cycle 4, you must initiate your revalidation application on or after July 2, 2018 and complete and submit by August 30, 2018. Failure to meet this deadline will impact your claims being processed for payment.
  • Open maintenance cases can cause delays in the revalidation process. To allow ample time to complete the revalidation application during your assigned cycle, we recommend you complete all maintenance cases two weeks prior to the beginning of your revalidation cycle. An open maintenance case could delay the initiation of your revalidation application.
  • Visit our website to stay informed and meet your revalidation deadlines. If you are unsure which cycle you have been assigned to, please see the MaineCare provider revalidation schedule currently posted under the “Revalidate as a Current Provider” section of the MaineCare Provider Enrollment and Revalidation webpage.

The following resources are available to assist you with the revalidation process:

MaineCare School-Based Services Guide and Reminders

MaineCare School-Based Services Billing Guide

Please review the MaineCare in Education 2018 School-Based Services Billing Guide. The guide has been updated and is available on MaineCare’s School-based webpage. Included in this update are instructions regarding enrollment and revalidation.

School-Based Services Provider Reminders 

All services categorized as School-Based Services must meet the following minimum requirements:

  1. Be medically necessary;
  2. Be ordered, prescribed, or recommended by a physician or other licensed practitioner;
  3. Be included in the member’s Individualized Education Program (IEP) or Individualized Family Service plan (IFSP); and
  4. Be medical in nature (rather than educational).

It is the provider’s responsibility to verify a member’s eligibility for MaineCare prior to providing services, as described in Chapter 1, Section 1 of the MaineCare Benefits Manual.

All questions about MaineCare School-Based Services can be directed to the MaineCare In Education email box.