Primary Care Case Management (PCCM) Referral WARN Update

November 14, 2012

MaineCare’s Primary Care Case Management (PCCM) program requires that members have a referral to see certain specialists. To date, providers have been seeing a WARN issued on their Remittance Advice (RA) for all claims that require a referral but do not have one. We are currently making preparations for that WARN period to end in early 2013. These preparations include provider training planned for early December. In the coming weeks you will begin to see updates on the following topics: • PCCM Provider Panel Reports- This report identifies the PCCM members that you currently see as of the 15th of each month. • PCCM Roster Reports- The Roster Report gives PCCM Primary Care Providers (PCP) a listing of the members to be included in their next Management Fee payment. • PCCM Management Fees- This is the Per Member Per Month payments to PCCM providers based on the information in the PCCM Roster Report. Please be reminded that during the referral WARN period, referrals must still be kept in the member’s record for record keeping purposes. Providers who are able to successfully submit referrals must continue to do so. If you are not able to submit referrals in MIHMS, please contact Molina Provider Services at: 1-866-690-5585. 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.