MaineCare Provider Enrollment Update

On Friday, September 15th, the Office of MaineCare Service (OMS) provided an update on the status of provider enrollment case processing timeframes. MaineCare is experiencing a high volume of enrollment cases. In addition, their provider enrollment credentialling vendor, Gainwell Technologies, is experiencing staffing shortages. These challenges are causing provider enrollment cases to take much longer to process than normal, resulting in many pending enrollment cases. Currently, some enrollment cases are taking over 60 days to complete. 

OMS and Gainwell are working diligently to reduce both the number of pending cases and overall case processing time. OMS and Gainwell are investigating the root causes, Gainwell has added staff members, and they continue to evaluate staffing levels. Additionally, they are assessing whether technological upgrades could help automate certain enrollment processes in the mid to longer term. To support timely processing, providers are reminded they should update their enrollment information, such as new licenses, as soon as possible after receiving that update, and well before their license expires. 

If a provider is experiencing hardship as a result of these delays and their enrollment case has remained pending for more than 60 days after submission, they should contact their assigned Provider Relations Specialist. Waiting until your case has remained pending for at least 60 days will assist us in managing this ongoing backlog of cases. A list of the Provider Relations Specialists by service type and their contact information is located on the OMS website here: Provider Relations Specialists 
They understand that these challenges impact your day-to-day operations. They are working hard to implement solutions and to keep enrollment cases processing as quickly as possible. They will follow up regularly to provide status updates. 

MHCA has been in regular communication with Department on this issue and have asked for a timely resolution. 

Staff contact: