Primary Care Case Management (PCCM) Referral Warning Update

July 10, 2012

MaineCare’s Primary Care Case Management (PCCM) program requires that members have a referral to see certain specialists. Providers will see a warning issued on Remittance Advice (RA) for all claims with dates of services 9/01/2010 and later that require a referral but do not have one. The warning is a reminder to providers that a referral is needed. Providers will continue to see a warning on their RA when a referral is needed for claims with dates of service after 6/30/2012. We will notify you when the warning period will end. (Note: this is a change from a previous listserv that states the warning period will end on 6/30/2012.)

Referrals must still be kept in the member’s record for record keeping purposes. We continue to work on this effort. In the coming weeks, 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, please contact PCP Network Services at (207) 287-3320 or (207) 287- 6349.

If you have questions about referrals, please contact Molina Provider Services at: 1-866-690-5585.