Primary Care Case Management (PCCM) Referral Update

December 27, 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 June 30th, 2012 (Note: this is an extension from 12-31-2011, listed in a previous communication.)

Referrals for dates of service prior to June 30th must be kept in the member’s record for record keeping purposes. In early-June, we will provide another update on PCCM referrals. 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.