Maine Flag

Radiology Billing Services in Maine

Starting October 1, 2026, Maine is narrowing MaineCare eligibility: certain immigrants without green cards lose full coverage, and 80-hour monthly work requirements begin for roughly 86,000 expansion-group members on January 1, 2027. RBS rebuilt its Maine process around that eligibility shift, Jurisdiction K’s seven-state Medicare rules, and Anthem’s documented claims-processing gaps found in a May 2025 state exam.

MaineCare Eligibility Is Changing. Has Your Biller Noticed?

Maine didn’t just update a form, it’s narrowing who qualifies for MaineCare under a new federal law. Starting October 1, 2026, certain immigrants lose full coverage, and work requirements begin for the expansion group on January 1, 2027. Add a Jurisdiction K Medicare contract shared with New York, and a claim built on last year’s eligibility assumptions starts breaking fast.

Confirm a patient's current MaineCare eligibility before every claim, not last year's

Track Jurisdiction K's Maine-specific Medicare guidance apart from six larger states

Apply Maine's 30-day payment deadline and 18% annualized interest penalty correctly

Keep claims clear of the documented processing gaps found in Anthem's 2025 exam

Processed Claim Value
$ M+
Avg. A/R Collection Time
0 Days
Turn Around Time (TAT)
0 Hours
Client Retention Rate
0 %
Annual Claims
0 M+
First-Pass Claim Rate
0 %
Avg. Revenue Growth
8- 8 %
Avg. Denial Reduction
0 %

Four Reasons Maine Claims Get Denied Now

An eligibility shift this broad hides a lot of ways a clean claim goes sideways. Here’s exactly where it costs you.

One Contractor, From Maine to New York

National Government Services runs Jurisdiction K, one Medicare contract spanning Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont, pairing Maine’s small provider base with New York’s massive one. Rules tuned for that mix don’t always fit Maine’s claim patterns. RBS reads Jurisdiction K’s Maine-specific guidance directly, instead of assuming a New York-sized default applies.

MaineCare Eligibility Narrows in 2026

Starting October 1, 2026, over 600 immigrants, refugees, and asylum seekers without green cards lose full MaineCare benefits under a new federal law, and roughly 86,000 expansion-group members face 80-hour monthly work requirements beginning January 1, 2027. The state projects 31,000 could lose coverage to ineligibility alone. RBS verifies a patient’s current MaineCare eligibility before billing.

A Newer Compact Member Since 2017

Maine enacted the Interstate Medical Licensure Compact in 2017, roughly three years after the compact’s first wave of states. That later start leaves Maine’s compact pipeline newer than many neighboring New England states. Out-of-state radiologists reading Maine studies under an expedited license still answer to Maine’s own board rules. RBS verifies compact status before billing any out-of-state read.

One Carrier, 117 Documented Criticisms

Anthem Health Plans of Maine covers 54.6% of insured lives statewide, and a May 2025 state exam found 117 criticisms, including 31 untimely claim denials and 2,240 behavioral-health claims with improper cost-sharing. Maine law, Title 24-A Section 2436, requires payment within 30 days or 1.5% monthly interest, 18% a year. RBS tracks Anthem’s documented processing gaps against that deadline.

Complete Radiology Revenue Cycle Management

Certified CIRCC and CPC coders handle every CPT code, modifier, and global billing rule specific to diagnostic and interventional radiology — maximizing reimbursement on every encounter across all modalities and payer types.

What Changes When RBS Takes This Off Your Plate

Radiology billing isn’t generalist RCM. The TC/PC splits, the review clocks, the LCD churn are specialty-specific. Here’s the shift practices see once RBS steps in for a Maine group navigating narrowing MaineCare eligibility, a dominant commercial carrier under regulatory scrutiny, and a state where 5.5% of residents still carry no insurance at all (America’s Health Rankings, 2024).

Before RBS

Staffing costs run $60K to $90K a year, hard to justify for a small practice

Denial rates sit at 20 to 35%, often tied to shifting MaineCare eligibility

One staff member's day off and claims processing grinds to a halt

Manual data entry mistakes cost more than the imaging scan itself

A missed MaineCare eligibility change sends the claim back weeks later, unpaid

After RBS

Performance-based pricing, RBS earns only when your practice collects

98%+ first-pass clean claim rate, checked against active Maine payers

365 days a year, 24/7 revenue cycle coverage, with zero staffing gaps

AI-OCR reads every superbill, EOB, and ERA the moment it arrives

Every claim billed against a patient's current MaineCare status, not last year's

Precision RCM & Coding Built for Radiology

Generic billing is the fastest way to a denied radiology claim. RBS delivers specialty-specific revenue integrity built for imaging’s TC/PC splits and modifier rules, so you capture every dollar you’re owed.

Diagnostic Radiology

CT Scan

MRI & MRA

Nuclear Medicine

PET / PET-CT

Ultrasound

Interventional Radiology

Teleradiology

Mammography

DEXA / Bone Density

Hospital Radiology

Radiation Oncology

Coverage Confirmed for Every Payer You Work With

From national carriers to regional Medicaid plans, coverage is checked against the exact payer, plan, and product type on file — never a generic match. Every result reflects current payer policy, not outdated data from months ago.
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana

From Portland to Bangor, Billed on Current Facts

A denial along the southern coast and a denial in Aroostook County rarely share a cause: different referral patterns, different distance to specialists, different local payer mix. RBS bills each Maine area the way its own provider network actually works, not a single statewide guess.

Greater Portland

Cities
  • Portland
  • South Portland
  • Westbrook
Counties
  • Cumberland County
  • York County

Central Maine

Cities
  • Augusta
  • Waterville
  • Lewiston
Counties
  • Kennebec County
  • Androscoggin County

Midcoast Maine

Cities
  • Brunswick
  • Rockland
  • Bath
Counties
  • Sagadahoc County
  • Knox County

Bangor Region

Cities
  • Bangor
  • Brewer
  • Orono
Counties
  • Penobscot County
  • Hancock County

Aroostook County

Cities
  • Presque Isle
  • Caribou
  • Houlton
Counties
  • Aroostook County

Western Maine

Cities
  • Farmington
  • Rumford
  • Bethel
Counties
  • Franklin County
  • Oxford County

Wired Into Every System You Already Run

Your EHR, RIS, and PACS stay exactly as they are. We plug our coding workflow directly into what you already use — no migration, no new login for your radiologists, no disruption to how your team already works.

Maine Runs on Rules Built for Maine. So Does Every Other State We Bill.

A claims team working off last year’s eligibility rules misses that MaineCare is narrowing who qualifies and Anthem’s own 2025 exam found 117 documented criticisms. Our specialists train on Maine’s actual, current payer structure, not a generic script, so a stale-eligibility mismatch is never the reason a claim gets denied.
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Frequently Asked Questions

Which Medicare contractor processes radiology claims in Maine?

National Government Services, under Jurisdiction K, which also covers Connecticut, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont, not Maine alone.
Starting October 1, 2026, certain immigrants without green cards lose full MaineCare benefits. Starting January 1, 2027, roughly 86,000 expansion-group members face 80-hour monthly work requirements.
Yes, since 2017, roughly three years after the compact’s earliest member states joined.
Maine law, Title 24-A Section 2436, requires insurers to pay an undisputed claim within 30 days or owe 1.5% monthly interest, 18% annualized, plus attorney’s fees.
Every claim is checked against a patient’s current MaineCare eligibility status, not an assumption carried over from a prior visit.

Whichever Maine Office Files It, RBS Gets It Paid

Somewhere in your outstanding claims right now, there’s a clean scan sitting unpaid because a patient’s MaineCare eligibility changed, or it ran into one of the documented processing gaps from Anthem’s 2025 exam. Across the practices we review, that adds up to 5 to 10% of collectible revenue, aging quietly by the day. RBS finds it, recovers it, and builds a process that stops it from recurring. Start with a free audit, no commitment, just a clear answer on what’s actually recoverable before you decide anything.

No setup fee. No monthly minimum.

Cancel anytime.

Response within 24 hours.

Pay only a percentage of what we collect for you.

Free claims and A/R audit before you commit to anything.

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What Our Clients Say?

Rebecca Lawson

★★★★★

Radiology Practice Manager

Since partnering with your radiology billing team, our billing workflow has become much smoother. They understand imaging procedures, payer requirements, coding, and claim follow-ups. Their team is responsive, professional, and always stays on top of outstanding claims.

Dr. Christopher Bennett

★★★★★

Medical Director, Diagnostic Imaging Center

Your team truly understands the challenges of radiology billing. They handle claims accurately, follow up on unpaid accounts, and help resolve billing issues efficiently. Their expertise and communication have made our revenue cycle more organized and reliable.

Dr. Andrew Whitaker

★★★★★

Radiologist & Imaging Center Owner

Our team has been an excellent partner for our imaging center. They understand radiology billing, coding, claim submission, denials, and follow-ups. Their attention to detail and consistent communication have helped streamline our billing process and improve our revenue cycle.

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