Claims
Our payment policies are generally consistent with Medicare and TRICARE®.
For more information about Medicare coverage and reimbursement rules, please visit the Medicare Learning Network.
For more information about US Family Health Plan coverage and reimbursement rules, please visit the Code of Federal Regulations.
Provider Portal User Guide (PDF) | Latest as of October 2023
Electronic Claims
Electronic claim submission allows for quicker processing and payments. We offer three Electronic Data Interchange (EDI) options. Contact them directly to register for Martin's Point electronic claims submission and electronic remittance advices (ERAs/835s):
Electronic Funds Transfer /Direct Deposit
Electronic funds transfer (EFT) service, also known as direct deposit, is available to providers who have first signed up to receive Martin’s Point ERAs/835s. To request EFT service, please complete and submit the EFT/Direct Deposit Authorization Form found in the Forms and Documents section.
Electronic Remittance Advice (835) Provider Guide
Our Electronic Remittance Advice (835) Provider Guide found in the Forms and Documents section should make it easier for you to understand Martin’s Point 835 files. It is a searchable PDF that maps industry-standard adjustment reason codes to the corresponding Martin’s Point claims editing rules and remarks on our 835 files.
National Uniform Claim Committee 1500 Claim Reference Instructional Manual
Paper Claims
Paper claims may be mailed to:
Martin’s Point US Family Health Plan Claims Department
PO Box 11410
Portland, Maine 04104
Martin’s Point Generations Advantage Claims Department
PO Box 11410
Portland, Maine 04104