Notice Regarding Primary Care Provider Incentive Payments (PCPIP) and Utilization Review (UR) Reports

September 20, 2013

MaineCare is currently completing the primary care provider UR Report for the reporting period of 07/01/11-06/30/12, as well as the PCPIP for the reporting period of 10/01/2011 - 09/30/2012, for eligible providers. Due to data reporting changes, as well as provider billing processes, it has taken longer than expected to complete the data for the UR, therefore delaying the PCPIP.

This is the first UR for a MIHMS data reporting period. There have been some changes to the format of the UR Report as well as added quality measures. Definitions of these measures will be included in the mailing of the UR Report on September 20th and will also be posted to MaineCare’s PCCM webpage.

The schedule is as follows:

UR for reporting period 07/01/2011- 06/30/2012
- UR Report was mailed on Friday, 09/20/2013 - No payment

PCPIP for reporting period 10/01/2011- 09/30/2012 - PCPIP Report will be mailed to eligible providers on Friday, 09/27/2013 - The payment will be processed with the 10/02/2013 payment cycle

UR for reporting period 01/01/2012- 12/31/2012 - UR Report will be mailed to providers on Friday, 10/11/2013
- No payment

The above will realign MaineCare with its regular UR/PCPIP schedule. We appreciate your patience as we complete this process.

For any questions, please email PCP Network Services.