Skip to main content

Provider Resources

New COVID-19 Payer Policies & Information

Below are the links to payer information including coding, waivers for member cost shares on diagnostic testing and telemedicine visits, opening crisis response lines and expanding 24/7 access to nurse medical lines.

 

 Aetna: Payer link  Centers for Medicare & Medicaid Services (CMS): Payer link  Martin's Point USFHP: Payer link
 Anthem: Payer link  Harvard Pilgrim: Payer link  United Healthcare: Payer link

 Beacon: Payer link

 Humana: Payer link
 WellCare: Payer link
 Cigna: Payer link  Medicaid (MaineCare) and the Children’s Health Insurance Program (CHIP): Payer link  
 Community Health OptionsPayer link  Martin's Point Generations Advantage: Payer link  

Resource Topics

Providers are eligible to participate in the ACO who are a MD, DO or Primary Care NP and a member of the medical staff of Franklin Memorial Hospital, LincolnHealth, Maine Medical Center, Memorial Hospital, Mid Coast Hospital, Pen Bay Medical Center, Southern Maine Health Care, Stephens Memorial Hospital, St. Mary’s Regional Medical Center or Waldo County General Hospital. To begin the process of joining the MaineHealth ACO, please email us to request an application packet.

Participants 

Conditions of Participation

Clinical Documentation Improvement Training (webpage)

Annual Compliance Training (PDF)

Code of Ethical Conduct (PDF)

COPD Resources

 

Colorectal Cancer Resources 

 

Diabetes Resources

 

End-of-Life Resources

 

Heart Failure Resources

 

Hypertension Resources

 

Adolescent & Pediatric Resources

 

Tobacco Resources

 

Practices that participate in the ACO's MSSP contract are automatically enrolled in a special MIPS payment model created for ACO participants called the MIPS APM. Because the ACO reports some categories of data on behalf of its participants, this model places a reduced reporting burden on practices, compared to those enrolled in the standard MIPS model. 

Promoting Interoperability (PI) - Each ACO participant TIN (tax ID number) is required to report for the Promoting Interoperability (PI) category, or apply for and receive a hardship exception from CMS. 2015 Edition CEHRT EHR is required to report for the PI category. 

Participants must submit collected data for specific measures from each of the 4 objectives (unless an exclusion is claimed) for 90 continuous days or more during 2020:

  1. e-Prescribing
  2. Health Information Exchange
  3. Provider to Patient Exchange
  4. Public Health and Clinical Data Exchange 

A Security Risk Analysis measure is required but not scored for 2020. 

Specifications for each required measure are below:

HARP (HCQIS access roles and profile system) Account Information: The Quality Payment Program Portal requires you to have a login and password. If you already possess a HARP account / QPP login you may continue to use it. However, if you do not have an account, please follow the process outlined in the documents below.
  1. Before You Begin
  2. Register for a HARP Account
  3. Connect to an Organization
  4. Connect as a Clinician
  5. Security Officials Manage Access

If you have any questions, please contact Susan Whittaker at swhittaker@healthcentricadvisors.org or (207) 406-3970.

A series of Best Practice Frameworks designed to provide a standard set of strategies and tools specific to help you improve care provided in the ambulatory environment.

Best Practice Frameworks (Webpage)

The MaineHealth ACO Skilled Nursing Facility Index assesses how effectively individual facilities provide high value, patient-centered care that is compatible with MaineHealth ACO and MaineHealth system priorities. Specifically, the Index measures facilities’ engagement with endorsed protocols, care pathways, and quality improvement activities that enhance patient care and reduce the potential for avoidable readmissions and emergency department transfers. The Index is based on a unique set of measures and is meant to complement other sources of data and measurement. It is not intended to replace other quality data sources such as the CMS Nursing Home Compare star ratings, nor is it intended to be a blanket endorsement of the clinical care provided by participating facilities. Discharge planners and patients should consult all resources available to them when making a decision about post-acute care.

The 2020 Index reflects performance during 2019. 31 skilled nursing facilities that are members of the MaineHealth Senior Living Collaborative participated. Facilities received points for performance on 16 metrics. Points earned were applied to a level designation using the following framework:

 

Designation

Points Received

Gold

34-46 (maximum)

Silver

27-33

Bronze

18-26

Standard

17 or fewer

 

2020 Designations:

 

GOLD

Cedars Nursing Care Center

Portland, Maine

RiverRidge Center

Kennebunk, Maine

Sandy River Center

Farmington, Maine

Seaside Healthcare and Rehabilitation

Portland, Maine

Springbrook Center

Westbrook, Maine

 

SILVER

Cove's Edge

Damariscotta, Maine

Falmouth by the Sea

Falmouth, Maine

Gorham House

Gorham, Maine

Harbor Hill Center

Belfast, Maine

Hawthorne House

Freeport, Maine

Kennebunk Center for Health & Rehabilitation

Kennebunk, Maine

Knox Center for Long Term Care

Rockland, Maine

Maine Veteran's Home - Scarborough

Scarborough, Maine

Quarry Hill (The Gardens)

Camden, Maine

Seal Rock Healthcare

Saco, Maine

St. Joseph's Rehabilitation & Residence

Portland, Maine

 

 

 

 

BRONZE

Augusta Center for Health & Rehabilitation

Augusta, Maine

Brentwood Center for Health & Rehabilitation

Yarmouth, Maine

Evergreen Manor

Saco, Maine

Gregory Wing of St. Andrews Village

Boothbay Harbor, Maine

Market Square Health Care Center

South Paris, Maine

Marshwood Center

Lewiston, Maine

Mineral Springs

North Conway, New Hampshire

Norway Center for Health & Rehabilitation

Norway, Maine

Pine Point Center

Scarborough, Maine

Russell Park Rehabilitation and Living

Lewiston, Maine

Sedgewood Commons

Falmouth, Maine

SMHC Newton Center

Sanford, Maine

Southridge Rehabilitation & Living Center

Biddeford, Maine

St. Andre Health Care Facility

Biddeford, Maine

St. Mary's d'Youville Pavilion

Lewiston, Maine

Windward Gardens

Camden, Maine

Winship Green Center for Health & Rehabilitation

Bath, Maine

 

STANDARD

Edgewood Rehabilitation & Living Center

Farmington, Maine

Orchard Park Rehabilitation & Living

Farmington, Maine

 

For more information, please email us at contactmhaco@mmc.org