Mainecare Insurance Form

Mailing address for facility claim mainecare insurance if you are a nursing facility or an icf mr mail your completed claim form to this address.

Mainecare insurance form. To submit a request. Learn more about emergency assistance here. Mainecare helps to ensure that all maine people are able to access the critical health services both preventative and emergency that help them stay healthy and safe. Fax the completed form to us at 1 888 879 6938.

Select and print the proper form from the list below. Private health insurance premium phip application pdf use this application if you are mainecare member seeking help paying for private health insurance premiums. Emergency assistance ea application pdf use this application to apply for emergency assistance. There are also additional options for people with disabilities and certain health conditions young adults who have been in foster care and those who need long term care.

Mainecare provides free and low cost health insurance to mainers who meet certain requirements based on household composition and income. Mainecare preferred drug list. To open and read word documents doc docx from this site. Mainecare claims processing m 400 augusta me 04333 cms 1500 claim form and ub 04 form instruction and guide.

Download word to open and read word documents doc docx from this site. Listed below are all the pa forms you will need in order to request drugs that require prior authorization. With the expansion of mainecare in 2019 more individuals are now eligible.