Primary Care Case Management (PCCM) Referral Update

August 24, 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 a referral but do 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 December 31st 2011(Note: this is an extension from 9-01-2011, listed in a previous communication.)

Referrals for dates of service prior to December 31st 2011 must be kept in the member’s record for record keeping purposes. In mid-December, 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 the PCCM program or about being a PCCM PCP Provider please contact Health Network Services at 287-3320 or 287-4827.
If you have questions about referrals, please contact Molina Provider Services at: 1-866-690-5585.