Statutes, codes, and regulations
Maine Administrative Code
Department 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICESDivision 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERALChapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)Chapter II - Specific Policies By Service
Section 144-101-II-3 - AMBULATORY CARE CLINIC SERVICES
Subsection 144-101-II-3.07 - REIMBURSEMENT

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-3, subsec. 144-101-II-3.07

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Current through 2024-51, December 18, 2024
Subsection 144-101-II-3.07 - REIMBURSEMENT

Reimbursement for covered services provided by school health clinics shall be the lowest of the following:

A. The amount listed in the "Allowances for Ambulatory Care Clinic Services", Chapter III, Section 3.
B. The amount allowed by the Medicare Part B carrier.
C. The provider's usual and customary charge.

Reimbursement for services provided by school health clinics is available based on a negotiated rate between the provider and the Office of MaineCare Services, and shall be the lowest of the amounts listed above.

In accordance with Chapter I, it is the responsibility of all Ambulatory Care Clinics to ascertain from each recipient whether there are any other resources (private or group insurance benefits, worker's compensation, etc.) that are available for payment of the rendered service, and to seek payment from such resources prior to billing MaineCare.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-3, subsec. 144-101-II-3.07