Updated MaineCare Orthodontia Pro-Rate Request Form
Effective January 1, 2026, the MaineCare Orthodontia Pro-Rate Request Form is updated on the Manuals, Forms, and Criteria Sheets page of the Health PAS Online Portal.
This updated form reduces the administrative burden for providers and the Department when a prior authorization for Comprehensive or Limited Orthodontic treatment must be repriced because treatment stops before it is completed.
If you have any question regarding this update, please email Shannon Beggs, Provider Relations Specialist.