Primary Care Case Management (PCCM)

Background

MaineCare's Primary Care Case Management (PCCM) is a mandatory program covering eligible MaineCare members (primarily the TANF population ~ Temporary Aid for Needy Families). Primary care providers are always welcome to become PCCM providers.

The primary objectives of MaineCare managed care are to:

  • Recognize through incentive payments high quality primary care providers
  • Improve MaineCare members’ access to providers
  • Have MaineCare members establish a “medical home”
  • Increase continuity of care
  • Strengthen the patient and provider relationship
  • Reduce unnecessary utilization and expenditures

Please see below for more information.

 

Overview of Primary Care Case Management (PCCM) Word PDFs or Other
Introduction - Presentation   (.ppt)
Primary Care Provider (PCP) Checklist (.doc) (.pdf)
Specialist Checklist (.doc) (.pdf)
Questions and Answers (.doc) (.pdf)
How to Reach Us? (.doc) (.pdf)
Referral Form (.doc) (.pdf)
Member Education Request Form (.doc) (.pdf)
PCCM: What is it and what does it mean to me? (Member Information) New! (.doc) (.pdf)
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How To Become a Primary Care Physician (PCP)
Terms and Conditions (.doc) (.pdf)
Rider (.doc) (.pdf)
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Primary Care Provider Incentive Payment (PCPIP) Overview

The Primary Care Provider Incentive Payment (PCPIP) pays additional compensation to providers who deliver high quality healthcare to their patients and who rank above the 20th percentile for certain measures compared to other physicians within their specialty.

The goals of PCPIP:

(1) Increase Access of MaineCare members to providers.

(2) Reduce unnecessary/inappropriate ER utilization, and,

(3) Increase utilization of preventive/quality services.

Incentives are paid to providers who are practicing primary care and whose primary specialty is Family Practice, General Practice, Pediatrics, Obstetrics/Gynecology, or Internal Medicine . See below for more details.

Primary Care Provider Incentive Payment (PCPIP) Letters and Measures
PCPIP Sample Letter   (.pdf)
PCPIP Quality Indicators (.doc) (.pdf)
PCPIP Overview (.doc) (.pdf)
Primary Care Provider Utilization Review (UR) Measures (.doc) (.pdf)
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Note:If you can not read the above files you can use these links to access Word Viewer for .doc files or Adobe Acrobat for .pdf files or PowerPoint for .ppt files.