Prior Authorization (PA) Requirement for Section 68 Occupational Therapy Services (OT) and Section 85, Physical Therapy Services (PT), CR 39144

February 21, 2014

Effective 01/21/14, these services require PA before services can be delivered and covered/reimbursed.

Requests for PA of Occupational Therapy and Physical Therapy services can be submitted to MaineCare (MIHMS) either by fax 1-866-598-3963 or by Direct Data Entry (DDE) on the PA portal (login under Trading Partner agreement) at: https://mainecare.maine.gov/ProviderHomePage.aspx Either way, it is necessary to fill-in all mandatory data fields on the cover sheet (either paper initial request form or electronic cover sheet). Failure to fill-in all mandatory fields may result in a rejection of the PA request. Also, whenever additional information is submitted in support of an active PA, the “Prior Authorization Supporting Documents or Updates Cover Sheet” is required; be sure to write the original PA number in box 4 “Prior Authorization number.” The cover sheets for faxed requests are located on the Health PAS Online Portal at https://mainecare.maine.gov/ProviderHomePage.aspx .

Please note, PA request do not need to be submitted for Speech Therapy services until further notice. You should follow the requirements set forth in the MaineCare Benefits Manual.

If you have questions regarding the PA process and forms, please contact Provider Services at 1-866-690-5585. If you have questions regarding policy and service coverage, please contact your Provider Relations Specialist.

Please refer to the listserv message sent on 12/31/14:

Changes to MaineCare Benefits Manual, Section 68 Occupational Therapy and Section 85 Physical Therapy

Effective 1/1/14, the Department will adopt rules to require certain members to request Prior Authorization for Physical Therapy and Occupational Therapy Services. In order to accommodate providers, the Department is allowing a three (3) week grace period. Therefore, Prior Authorization requirements for Physical Therapy and Occupational Therapy will not be effective until 1/21/14. A new Prior Authorization Request form has been posted on the HealthPas portal. Log in to your trading partner account to access the new form.

The adopted policy can be found at http://www.maine.gov/dhhs/oms/rules/index.shtml as of 1/1/14