Maine Surprise Bill IDR Portal

Maine Surprise Bill Independent Dispute Resolution

MAXIMUS Federal is an approved entity for providing independent dispute resolution services for Maine 2019 Public Law, chapter 668, An Act to Protect Consumers from Surprise Emergency Medical Bills. Maine law allows for independent dispute resolution of a bill for covered emergency services rendered by an out-of-network medical service provider. The law’s protections apply to bills for such emergency medical services received on or after October 1, 2020. The law calls for arbitrators to preside over disputes between eligible patients, health care providers/facilities, and carriers.

Purpose of this site

This site allows the parties to initiate dispute resolution with MAXIMUS. MAXIMUS will notify the other party and request a response. Data and documents are securely transmitted and stored.

Users of this site

eligible patient and provider
out-of-network provider and carrier

How to opt-in for self-insured health benefit plan

If you represent a self-insured health benefit plan that has not yet elected to participate in the Maine Independent Dispute Resolution (IDR) system pursuant to 24A M.R.S. §4303-E(2) and subsection 6(7) of the Bureau of Insurance Rule 365, you may do so here. You will need to amend your plan documents to reflect the applicability of the IDR process to the plan’s enrollees.
You may electronically submit your opt-in notice and register for a Maximus portal account
As a reminder, in order for the plan’s participating status to remain in effect without interruption, we must receive your plan’s renewal notice before the expiration of the plan year. We strongly encourage submitting your renewal at least two months in advance.

How to prepare for the online application

Who may apply for an independent dispute resolution (IDR)?

An uninsured patient.
A person covered under a self-insured/ERISA plan (that has not opted in); or
A health care provider.

What types of bills may be disputed?

A surprise bill for emergency services.
Any other bill for covered emergency services by an out-of-network provider to a person covered by an insured or self-insured health plan.
Bills totaling $750 or more received by an uninsured person for emergency health services for a single visit regardless of the number of providers.
For further information, see Rule 365

How to prepare for dispute resolution?

Gather dispute data and documentation. For example:
- Copy of bill(s).
- Claim form(s).
- All copies of Explanation of benefits (EOB)/Explanation of payment (EOP) or Remittance Notices.
- Pertinent communication between patient, provider and/or carrier
- Explain why your proposed amount makes sense.

How to register for an account to use this site?

Create your account here. You will need an email address to register and apply online*.
After your registration has been approved, log in and activate your newly created account. Newly created accounts must be activated within 3 calendar days.
Complete the dispute resolution application electronically or respond to request for a dispute response.

*If you do not have an email address, or would prefer to fill out a paper application, download and fill-out a pdf application for a patient or a provider .You may fax, mail or email the completed application to MAXIMUS. See application for further instructions.

How to navigate after logging in?

To help you navigate the ME IDR Portal online application process, click here for a user guide.

Dispute Resolution Process

MAXIMUS reviews the application to confirm the application is complete and all required documentation has been provided.
MAXIMUS notifies the responding party to submit their response along with required documentation.
MAXIMUS requests information from the parties as needed.
Parties will have the opportunity to review written information submitted by the other party.
MAXIMUS will issue a written decision within 30 calendar days after receiving a completed application for dispute resolution.
Parties may check case status at any time by logging into this site.

Dispute Resolution Decision

Maximus encourages parties to resolve their disputes themselves. If they do not, Maximus will decide the dispute as follows:

For disputes involving a patient and a provider, the award decision will either be the patient’s proposed payment amount or the provider’s fee.
For disputes involving a provider and a carrier, the award decision will either be the out-of-network provider’s fee or the carrier’s payment amount.
If a party fails to respond to a request for information, the dispute will be decided based on the available information received by Maximus.

Dispute Resolution Fees

Parties in dispute	Fee Description	Fee Amount
Patient and Provider	Confirmation that dispute application is eligible for Maine IDR. Always charged to Provider	$125
Patient and Provider	If eligible, then the dispute Resolution fee applies. Always charged to Provider	$325
Out-of-network Provider and Carrier	If dispute application is deemed ineligible, out-of-network Provider charged fee for application review.	$125
	Non-prevailing party fee if Maximus arbitrator resolves dispute.	$450
	Good faith negotiation settlement (split between parties)	$325