February 17, 2011
MaineCare’s Primary Care Case Management (PCCM) program requires that members have a referral to see certain specialists. For dates of service 9/1/2010 and later, the claims system has issued a warning on claims that should have had a referral but did not. The warning appears on the Remittance Advice (RA) statement. Providers will continue to see a warning on their Remittance Advice (RA) statements for claims with dates of service up to and including April 30th(Note: this is an extension from 2/28/2011, listed in a previous communication.)
Referrals for dates of service prior to May 1, 2011 must be kept in the member’s file for record keeping purposes. In Mid- April, we will provide more details about the referral process. Until then, we encourage providers who are able to successfully submit referrals to continue to do so.
If you have questions about PCCM or about referrals, please contact Provider Network Services at 287-3320 or 287-4827