MaineCare
Administered by Maine Department of Health and Human Services (Maine DHHS) through MIHMS (MaineCare Integrated Health Management Solution).
Maine Revenue Cycle Management
Medical billing for Maine practices — MaineCare, Medicare, and commercial payers.
Maine's Medicaid billing runs through Maine Department of Health and Human Services (Maine DHHS), and every managed-care plan has its own rules. We bill MaineCare, Medicare, and Maine's commercial payers correctly the first time — and follow every denial through to resolution.
The Maine payer landscape
Managed-care plans
- MaineCare fee-for-service
- MaineCare Health Homes
- MaineCare behavioral health homes [VERIFY]
Dominant commercial payers
- Anthem BCBS of Maine
- Harvard Pilgrim Health Care
- Community Health Options [VERIFY]
Why Maine claims get denied
- MaineCare eligibility lapsed mid-month and wasn't re-verified before the visit
- MIHMS claim rejected for a missing or mismatched NPI-to-taxonomy pairing [VERIFY]
- Behavioral health home enrollment not on file for a client billed under that model
- Prior authorization missing for a service MIHMS flags as requiring review
- Rural telehealth claims denied for originating-site or modifier errors
Maine behavioral health billing
Maine runs behavioral health through MaineCare's health home model rather than a separate managed-care carve-out, so claims for the same client can span physical and behavioral health homes — we track which home is active before submitting so claims aren't rejected for a home mismatch [VERIFY].
Credentialing comes first
MaineCare provider enrollment through MIHMS runs alongside CAQH and Medicare PECOS credentialing — see our Maine credentialing page for the full timeline.
See Maine Credentialing →Billing and books together
Your Maine claims and your bookkeeping are handled by the same team, so collections, denials, and adjustments always tie back to your financials without a reconciliation gap between separate vendors.
Clearinghouses and EHRs we work in
AvailityOffice AllyWaystarTebraAdvancedMDSimplePracticeKipuTheraNestAveaICANotesBestNotes
5–7% of collections · $950/mo minimum — the same in every state.
Free analysis
Free Maine Revenue Leakage Analysis
Send a recent AR aging report and denial summary. We'll show you denial patterns by MaineCare plan, days in AR, and the fixes we'd make first.
Send de-identified reports only — we sign a Business Associate Agreement before any PHI is exchanged.