2. Institutional providers that are submitting an application to establish a new practice location must submit the applicable application fee prior to executing a MaineCare Provider Agreement. 3. MaineCare will reject the enrollment application from a newly-enrolling institutional provider, or an institutional provider who is applying to establish a new practice location, that is submitted without the application fee or documentation that CMS has granted the provider a hardship waiver for the application fee. 4. Requests for hardship waivers must be submitted to CMS pursuant to 42 CFR 424.514 D. MaineCare does not reimburse in-state providers, including rendering providers, for services provided to members prior to enrollment approval or after a provider’s enrollment has been terminated (end-dated). E. Once the enrollment application has been submitted online through the Department’s Health PAS portal, notification of MaineCare’s decision will be sent to providers via electronic notification or U.S. mail. The effective enrollment date is the effective date of the Provider Agreement. F. In the case of retroactive enrollment for Federally Qualified Health Centers (FQHCs), the retroactive FQHC enrollment will be effective on the date of the FQHC’s Health Resources and Services Administration (HRSA) or CMS approval, not before. In the case of retroactive enrollment for Rural Health Clinics (RHC), retroactive enrollment will be effective on the date of the Medicare approval. In the case of retroactive enrollment for Indian Health Centers (IHCs), the retroactive IHC enrollment will be effective on the date of the HRSA grant. G. The Department will pay for MaineCare covered services provided only to the following members: Those who are eligible for the specific services on the date the services are actually provided, unless otherwise specified in the MBM; or Those who have been granted retroactive MaineCare eligibility after services have been provided. For more information on retroactive eligibility see Section 1.04-1. H. Certain providers will be required to use rendering provider National Provider Identifier (NPI) in accordance with the appropriate billing instructions. For some of new providers not previously reimbursed under MaineCare, reimbursement rates must be established before the provider may be enrolled and reimbursed for covered services.
2. Institutional providers that are submitting an application to establish a new practice location must submit the applicable application fee prior to executing a MaineCare Provider Agreement. 3. MaineCare will reject the enrollment application from a newly-enrolling institutional provider, or an institutional provider who is applying to establish a new practice location, that is submitted without the application fee or documentation that CMS has granted the provider a hardship waiver for the application fee. 4. Requests for hardship waivers must be submitted to CMS pursuant to 42 CFR 424.514 D. MaineCare does not reimburse in-state providers, including rendering providers, for services provided to members prior to enrollment approval or after a provider’s enrollment has been terminated (end-dated). E. Once the enrollment application has been submitted online through the Department’s Health PAS portal, notification of MaineCare’s decision will be sent to providers via electronic notification or U.S. mail. The effective enrollment date is the effective date of the Provider Agreement. F. In the case of retroactive enrollment for Federally Qualified Health Centers (FQHCs), the retroactive FQHC enrollment will be effective on the date of the FQHC’s Health Resources and Services Administration (HRSA) or CMS approval, not before. In the case of retroactive enrollment for Rural Health Clinics (RHC), retroactive enrollment will be effective on the date of the Medicare approval. In the case of retroactive enrollment for Indian Health Centers (IHCs), the retroactive IHC enrollment will be effective on the date of the HRSA grant. G. The Department will pay for MaineCare covered services provided only to the following members: Those who are eligible for the specific services on the date the services are actually provided, unless otherwise specified in the MBM; or Those who have been granted retroactive MaineCare eligibility after services have been provided. For more information on retroactive eligibility see Section 1.04-1. H. Certain providers will be required to use rendering provider National Provider Identifier (NPI) in accordance with the appropriate billing instructions. For some of new providers not previously reimbursed under MaineCare, reimbursement rates must be established before the provider may be enrolled and reimbursed for covered services.
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