Medical Billing Services in Maine
Billing, coding, credentialing and denial management for Maine practices, with Medicare claims through National Government Services (Jurisdiction JK) and Maine Medicaid handled by people who know the rules.
Medical billing for Maine practices
Maine is one of the few states that still runs Medicaid without managed care plans. MaineCare pays claims directly, so practices deal with one state fee schedule and one set of billing rules for Medicaid. Maine also has one of the oldest populations in the country, which makes Medicare and Medicare Advantage a large share of revenue for primary care and specialty practices from Portland to Aroostook County.
SFA Solutions works with Maine practices remotely. We bill Medicare Part B through National Government Services, submit and follow up on MaineCare claims, and work Anthem, Harvard Pilgrim, Community Health Options and Martin's Point. We also track MaineCare's move from the HealthPAS Online Portal to the new MaineCare Partner Portal to help keep enrollment and claim access uninterrupted.
Maine at a glance
| Medicare contractor | National Government Services, Jurisdiction JK |
|---|---|
| Medicaid timely filing | Generally 12 months from the date of service under the MaineCare Benefits Manual, Chapter I; check the manual for exceptions such as retroactive eligibility and Medicare crossovers |
| NP practice authority | Full |
| Cities we serve | Portland, Lewiston, Bangor, South Portland, Auburn, Biddeford, Sanford, Augusta, Saco, Westbrook |
What Maine billing involves
These are the programs and rules our team works with for Maine claims.
Medicare
National Government Services · JKMaine Part B claims are processed by National Government Services in Jurisdiction JK. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Maine Medicaid
MaineCare, administered by the Maine Department of Health and Human Services Office of MaineCare Services
Portal: MaineCare Partner Portal, part of the upgraded MIHMS system, scheduled to replace the HealthPAS Online Portal in late September 2026 for enrollment, eligibility and claims; Gainwell Technologies runs MaineCare Provider Services
Medicaid managed care
MaineCare does not use Medicaid managed care plans. Claims are paid fee-for-service, with value-based programs such as Accountable Communities, Health Homes and primary care payment models layered on top.
Timely filing
Generally 12 months from the date of service under the MaineCare Benefits Manual, Chapter I; check the manual for exceptions such as retroactive eligibility and Medicare crossovers.
Commercial and Medicare Advantage
Anthem Blue Cross and Blue Shield is the largest commercial carrier in Maine, with Harvard Pilgrim, Community Health Options, Aetna and Cigna also active. Martin's Point, UnitedHealthcare, Anthem and Humana carry most Medicare Advantage members.
Prompt pay law
Under 24-A M.R.S. 2436, insurers must pay undisputed claims within 30 days after receiving proof of loss. If the insurer asks in writing for more information, the 30 days restart when it arrives. Undisputed claims paid late accrue interest at 1.5% per month.
Nurse practitioners
Full practiceMaine NPs practice independently after completing at least 24 months of practice under a licensed physician or a supervising nurse practitioner, or as an employee of a clinic or hospital with a physician medical director (32 M.R.S. 2102). Payers may ask for proof of that period when an NP opens an independent practice.
Credentialing
MaineCare enrollment and revalidation are handled through the MaineCare provider portal, and with no Medicaid MCOs, state enrollment is the only Medicaid credentialing step. Anthem, Harvard Pilgrim and most commercial carriers use CAQH ProView, so keep that profile attested every 120 days. With the new MaineCare Partner Portal, each user needs a unique email address for account migration.
Billing challenges Maine practices face
Portal transition
MaineCare is moving providers from the HealthPAS Online Portal to the new MaineCare Partner Portal. Accounts that share an email address cannot be migrated, so practices that miss setup steps can lose access to eligibility checks and remittances. We track the rollout and help keep your access in place.
Heavy Medicare Advantage mix
Maine's older population means many patients are in Medicare Advantage plans with their own prior authorization and referral rules. Billing these patients as traditional Medicare, or missing a plan's authorization, leads to denials. We verify coverage before visits and track authorizations.
Chronic care and annual wellness billing
With an older patient base, Medicare annual wellness visits (G0438, G0439), chronic care management (99490) and transitional care management (99495, 99496) add real revenue when documented and billed correctly. We review documentation requirements and bill these services consistently.
Our services in Maine
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Maine
Maine medical billing questions
Does Maine use Medicaid managed care plans?
No. MaineCare pays claims directly on a fee-for-service basis, with no Medicaid managed care organizations. Practices bill MaineCare itself and follow the MaineCare Benefits Manual.
What is the timely filing limit for MaineCare?
MaineCare generally requires claims within 12 months of the date of service under Chapter I of the MaineCare Benefits Manual. Exceptions apply in situations such as retroactive eligibility, so check the manual for your claim type.
Who is the Medicare contractor for Maine?
National Government Services (NGS) is the Jurisdiction K (JK) A/B MAC for Maine and the rest of New England and New York. Enrollment changes go through PECOS.
How fast must Maine insurers pay claims?
24-A M.R.S. 2436 requires insurers to pay an undisputed claim within 30 days after receiving proof of loss. If the insurer requests more information in writing, the clock restarts when it is received. Late undisputed claims accrue interest at 1.5% per month.
Get a free billing audit for your Maine practice
We will review your recent claims and denials against Maine payer rules and show you what can be recovered.
Nearby states
Primary sources
- Maine DHHS Office of MaineCare Services: Provider Resources
- MaineCare: Action Needed, New Online Portal Coming September 2026
- 24-A M.R.S. 2436 Prompt payment of insurance claims
- MaineCare Benefits Manual (Maine Secretary of State)
- 32 M.R.S. 2102 Definitions (nurse practitioner supervised practice)
- CMS: Who Are the MACs
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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