Claims Paid without a Prior Authorization

October 15, 2012

Since MIHMS go live (9/01/2010), certain Prior Authorization (PA) edits were bypassed and some claims were paid without the required PA. MaineCare has turned on the PA edits. Effective immediately, providers will see claim denials if there is not an approved PA prior to submitting a claim.

Claims submitted and paid prior to this notice will not be reprocessed. No provider action is needed concerning the paid claims.