MaineCare Provider Enrollment Update

• By: Angela Westhoff
• On: 11/16/2023 13:02:04
• In: Legislative/Government Affairs

Maine Health Care Association (MHCA) is aware of ongoing delays with MaineCare provider enrollment and we have been in frequent contact with the Office of MaineCare Services. MaineCare is experiencing a high volume of enrollment cases. In addition, their provider enrollment credentialing 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.
 
MaineCare recently shared that Gainwell has hired and trained additional staff. Providers should contact their provider enrollment specialist if their enrollment case has been pending longer than 60 days. Members are also encouraged to contact Angela Westhoff, MHCA President and CEO, if their case is pending longer than 60 days. 

MaineCare also announced system enhancements to automate updates to the licensure of rendering providers in a November 3^rd bulletin. Historically, providers have needed to submit a maintenance case to update the license expiration date for their already enrolled rendering providers. MaineCare's MIHMS system will now automatically update a MaineCare-enrolled rendering provider's license expiration date against the State of Maine's Agency License Management System (ALMS). Providers no longer need to submit maintenance cases to update State of Maine license information for enrolled rendering providers. These licensure updates will occur even if a provider has an open maintenance case.

A maintenance case is still required for some changes. Providers must submit a maintenance case when:

• Adding or removing a rendering provider
• Adding or changing the licensure type of an enrolled rendering provider
• Updating license information from another state
• Updating a facility's license

If a rendering provider's license has not been updated automatically, providers should reach out to their Provider Relations Specialist. Please wait at least two weeks from the date that ALMS has updated the license before contacting the Provider Relations Unit to ensure that MIHMS has had an opportunity to identify and update the license expiration date.

Staff contact: awesthoff@mehca.org