MaineCare Eligibility Criteria
Overview
In addition to the clinical data feeds received from HIE-participating organizations, HealthInfoNet also receives a daily member eligibility file from the Office of MaineCare Services (MaineCare) that identifies MaineCare (Medicaid) members so that reporting can be stratified to meet precise workflow needs.
Eligibility Criteria
Dashboard | Filter | Description |
|---|---|---|
Insights | MaineCare Eligible Member | The indication of whether a user’s attributed patients are active, eligible MaineCare (Medicaid) members at the time of reporting per MaineCare’s daily member eligibility file. Valid values include Yes (i.e., active, eligible MaineCare members) and No (i.e., not active, eligible MaineCare members). Note: Should a patient’s MaineCare eligibility status vary during the 365-day encounter lookback period, only those patients who are active, eligible members at the time of reporting will be identified using this filter. |
MaineCare User Role-Based Permissions
For HARP users that belong to the Office of MaineCare Services:
The only attributed patients available are those who have had a MaineCare (Medicaid-) eligible encounter in the last year; of these patients, the MaineCare Eligible Member filter can be used to further identify those patients who are active, eligible MaineCare members at the time of reporting per MaineCare’s daily member eligibility file.
The only encounter records available are Inpatient and Emergency Department encounters with an admission date that coincides with an attributed patient’s active MaineCare eligibility status.