Further Guidance on January 1, 2023, Rate Study Increases

As noted in our message issued December 30, 2022, the Department has posted State Plan methodology notices detailing the rate changes for Sections 13, 17, 26, 28, 65, and 92 on our State Plan Methodology page. The new rates will be effective retroactive to January 1, 2023, but they are not available to bill immediately.  

MaineCare aims to issue further guidance by the end of this week or early next week with specific billing instructions and implementation timing on a section-by-section and, where necessary, a service-by-service level, including regarding services that will have a change in billing unit or that will require modifiers. In the meantime, we ask providers to hold their claims. We recognize that holding claims may be difficult for some providers. We will endeavor to make any hold periods as brief as possible. If, upon learning about further service-specific implementation timing, a provider has financial concerns regarding their ability to hold claims, we ask that you contact your Provider Relations Specialist and we will work with you on a solution.  

As noted in last Friday’s message, MaineCare will update our claims system with these rate changes in the coming days and weeks and will send additional messages when the system updates are complete for each section.  

For questions, please contact your Provider Relations Specialist.