OMS Office Information

• Member/Consumer
• Provider
  • Billing Instructions
  • Children's Services/EPSDT
  • Managed Care
  • Manuals and Publications
  • Policies/Rules
  • Portal Tools
    • Claims Status (Temporary claims portal)
    • Denied/Duplicate Claim Line (MECMS)
    • Financial
    • Prior Authorization
    • Procedure Code Lookup
  • Prior Authorization (PA) - Provider Instruction Sheets and Prior Authorization Forms
  • Provider Archived Information
  • Provider Enrollment
  • Provider Training Information
• Fiscal Agent Project/MIHMS
• News and Provider Meetings

Primary Care Case Management (PCCM)
Managed Care

MaineCare managed care is a Primary Care Case Management (PCCM) benefit for eligible MaineCare members (primarily the TANF population ~ Temporary Aid for Needy Families). MaineCare managed care is a mandatory benefit through an amendment to the State Plan. The State of Maine Department of Health and Human Services, Office of MaineCare Services, is continuously recruiting primary care providers (PCPs) to join MaineCare managed care.

• MaineCare managed care is a mandatory program through an approval by the Center for Medicare and Medicaid Services (CMS), previously known as Health Care Financing Administration (HCFA)
• The State of Maine Department of Health and Human Services, Office of MaineCare Services, is continuously recruiting primary care providers (PCPs) to join MaineCare managed care
• Primary Care Provider Network Services aims to increase PCP site participation, continue to increase MaineCare members’ access to care, and to enhance the State’s network of services to members

 

The primary objectives of MaineCare managed care are to:

• Recognize primary care providers for quality of patient care
• 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

Back to Top

• Overview
• How to become a Primary Care Physician (PCP)?
• How to add new Primary Care Physician (PCP)?
• Billing Procedures
• Exempted Diagnostic and Procedure codes
• Primary Care Provider Incentive Payment (PCPIP) Overview
• Primary Care Provider Incentive Payment (PCPIP)
• Pediatric Specialty Services

Overview of Primary Care Case Management (PCCM)	Word	PDFs or Other
Summary	(.doc)	(.pdf)
Introduction - PowerPoint PCP Presentation		(.ppt)
Frequently Asked Questions	(.doc)	(.pdf)
How to Reach Us?	(.doc)	(.pdf)
Referral Form	(.doc)	(.pdf)
MaineCare Swipe card	(.doc)	(.pdf)
Member Education Request Form	(.doc)	(.pdf)
Back to Top
How To Become a Primary Care Physician (PCP)
Instructions	(.doc)	(.pdf)
Terms and Conditions	(.doc)	(.pdf)
Rider	(.doc)	(.pdf)
Fact Sheet	(.doc)	(.pdf)
How to Add A New Primary Care Physician (PCP)
Instructions	(.doc)	(.pdf)
Form	(.doc)	(.pdf)
Billing Procedures
Billing CMS1500 01/2008	(.doc)	(.pdf)
Billing UB92 01/2008	(.doc)	(.pdf)
Exempt Diagnosis and Procedure Codes
Exempted Diagnostic and Procedure Codes	(.doc)	(.pdf)
Back to Top
Primary Care Provider Incentive Payment (PCPIP) Overview
(May 2008)
Implemented in the fall of 2000, the Primary Care Provider Incentive Payment (PCPIP) continues to provide additional compensation to providers who deliver high quality healthcare to their patients and who rank above the 20th percentile for certain measures when 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. Providers whose primary specialty is Family Practice, General Practice, Pediatrics, Obstetrics/Gynecology, or Internal Medicine and who are practicing primary care are eligible for the payment. Along with the bi-annual payment, a detailed report showing practice utilization review from MaineCare paid claims data is run for each billing number. The report shows performance measures compared amongst same specialty groups as a whole for MaineCare managed care populations as well as for tradition Fee-for-Service. Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC) and providers who receive cost settlement payments do not qualify for PCPIP but do receive the utilization review report.
Primary Care Provider Incentive Payment (PCPIP)
PCPIP Generic Letter 12/20/2007		(.pdf)
PCPIP Intro Letter 12/20/2007	(.doc)	(.pdf)
PCPIP Measures Table 12/20/2007	(.doc)	(.pdf)
PCPIP Measures Document 12/20/2007	(.doc)	(.pdf)
Pediatric Specialty Services
Pediatric Specialty Services available in Maine - MaineCare strives to keep patients in Maine as much as possible. This guide gives you contact information for many different pediatric specialists in Maine.
Overview of Pediatric Specialty Services 03/26/2008	(.doc)
Pediatric Specialty Services Available in Maine 03/26/2008	(.doc)
Back to Top

 

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.

 

Maine.gov | DHHS Home | OMS Home | Site Policies