Specifications include, but are not limited to: Eligibility Determination Requirements
Ensure Client eligibility is determined in accordance with MaineCare Benefits Manual (MBM) 10-144 C.M.R. Ch. 101, Ch. II , § § 13.03-4.B . and more specifically to women who:
Are eighteen (18) years of age and older;
Are pregnant and/or have a dependent child(ren) ages seventeen (17) or younger; and
Have a Substance Use Disorder (SUD) and/or Co-occurring conditions.
Client Health Insurance Coverage Screening and Billing Methods
Determine if eligible Clients have either private health insurance or are MaineCare Members prior to providing Case Management Services.
Provide assistance to Clients without MaineCare or private insurance in applying for MaineCare benefits within fourteen (14) days calendar of the date services are initiated.
Submit claims to MaineCare for Clients who are MaineCare Members, ensuring:
Claims are limited to the standard terms of MaineCare/Medicare reimbursement.