Author: Scott Paradis, PMP, Onboarding Project Manager
It may be well ahead of the anticipated Q2 2025 application period for the Office of MaineCare Services’ Primary Care Plus (PCPlus) program, but our teams at HealthInfoNet are already preparing for the next wave of requests – whether that may be to expand existing participants’ connections with us to meet new reimbursement levels, or to onboard new organizations altogether as participants of the statewide Health Information Exchange (HIE).
While the PCPlus program does not require primary care practices to maintain a connection with the statewide HIE to meet its basic level of reimbursement (i.e., Tier I), a connection is required for the higher intermediate (i.e., Tier II) and advanced (i.e., Tier III) reimbursement levels. The following HIE-related requirements include:
- Tier II: HL7 data interface supporting real-time Admission Discharge Transfer (ADT) messages containing all patient demographics and encounter/visit information (including diagnosis and procedure coding)
- Tribal health facilities with an access-only connection to the HIE’s Clinical Portal electronic health record system may also be eligible for the Tier II reimbursement level
- Tier III: HL7 data interface supporting real-time ADT and/or Observation Result (ORU) messages containing all patient demographics, encounter/visit information (including diagnosis and procedure coding), vital signs, and laboratory test results
To ensure that your organization can meet an enhanced tier during the upcoming application period, we strongly recommend that you contact us between now and the end of the year to inquire about a new project request.
- For organizations interested in newly participating in the HIE, complete our online participation request form.
- For existing HIE-participating organizations interested in enhancing their connections to meet new reimbursement levels, complete our online new project request form.
For general information and/or questions about the PCPlus program, you can contact MaineCare’s dedicated inbox at pcp-network-services.dhhs@maine.gov.
