Tips for PCCM Providers

November 17, 2011

To ensure that claims and fees are paid properly, PCCM providers need to keep their MaineCare enrollment up to date. This means notifying MaineCare as soon as possible when there are changes. This is particularly important when there is an ownership change, and when Rendering Providers join or leave the practice. The following steps should be taken in these situations:

When there are ownership changes:

  • Notify your Provider Relations representative.

When Rendering Providers join or leave the practice:

  • Update your enrollment online. Sign in as a Trading Partner and then click Provider Maintenance. See Provider Maintenance User Guide for step-by-step instructions.

  • Rendering Providers need to be added within the calendar month that they begin billing MaineCare. In extraordinary circumstances, providers can ask for retroactive enrollment dates.

  • If a PCP leaves the practice, please contact PCP Network Services about re-assigning the members. Policy requires all members to be re-assigned, before the PCP leaves the practice.

For enrollment questions, contact Provider Services at 1-866-690-5585. For Primary Care Case Management questions, contact Charyl Malik in PCP Network Services at 207-287-3320.