Subsection 144-101-I-1.08 - REIMBURSEMENT1.08-1Maximum Amount Unless specified in other Chapters of this Manual, the maximum amount of payment for services rendered shall be the lowest of the following:
A. The MaineCare rate of reimbursement as found in the applicable Chapter of the MBM or as published by the Department;B. The lowest amount allowed by Medicare Part B;C. The usual and customary charges;D. The amount, if any, by which the MaineCare rate of reimbursement for services billed exceeds the amount of the third party payment as set forth in Section 1.07-7. A claim is considered paid in full if the insurance amount received exceeds the MaineCare rate of reimbursement. It is the responsibility of the provider to seek payment from any other resources that are available for payment of the rendered service prior to billing MaineCare.
1.08-2General InformationA. MaineCare members, family members or guardians do not have the authority to prohibit a provider from billing for a MaineCare covered service.B. MaineCare will only reimburse enrolled providers for MaineCare covered services. Under no circumstance can MaineCare reimburse MaineCare members. C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, subsec. 144-101-I-1.08