10-144-103 Me. Code R. § VI-6.1

Current through 2024-51, December 18, 2024

Section 144-103-VI-6.1 - Maine Medical Assistance Manual

The following Maine Medical Assistance Manual (MMAM) provisions apply to Maine Health Program recipients.

1. Provider Participation (MMAM Chapter I, Section 1.03)

2. Recipient Eligibility (MMAM Chapter I, Section 1.04, except 1.04-1)

3. Supplementation By Recipients (MMAM Chapter I, Section 1.05)

4 Services Covered And Non-covered (MMAM Chapter I, Section 1.06, except 1.06-2-C)

5. Third Party Liability (MMAM Chapter I, Section 1.07, except 1.07-23

6. Submittal of Claims (MMAM Chapter I, Section 1.08)

7. Payment Process (MMAM Chapter I, Section 1.09)

8. Claims Adjustments (MMAM Chapter I, Section 1.10)

9. Inquiry Process (MMAM Chapter I, Section 1.11)

10. Audits (MMAM Chapter I, Section 1.123

11. Utilization Review (MMAM Chapter I, Section 1.133

12. Surveillance (MMAM Chapter I, Section 1.14)

13. Prior Authorization (MMAM Chapter I, Section 1.15)

14. Provision of Necessary Transportation to Medical Services (MMAM Chapter I, Section 1.16)

15. Sanctions Against Providers (MMAM Chapter I Section 1.17)

16. Provider Fraud/Abuse (MMAM Chapter I, Section 1.18, except 1.18-2)

17. Provider Appeals (MMAM Chapter I, Section 1.19)

18. Recipient Appeals (MMAM Chapter I, Section 1.20)

19. Enrollee Restriction Program (MMAM Chapter IV, Section 1)

20 Primary Care Case Management (MMAM Chapter VI Section 1 )

10-144 C.M.R. ch. 103, § VI-6.1