C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-5, subsec. 144-101-II-5.08

Current through 2024-51, December 18, 2024

Subsection 144-101-II-5.08 - POLICIES AND PROCEDURES

5.08-1Records

Records must include, but need not be limited to:

A. Name, address and MaineCare ID number of the member;

B. Completed Patient/Run Reporting Form; and

C. Signed "Application for Emergency Involuntary Admission to a Psychiatric Facility" ("Blue Paper") form, if applicable.

5.08-2Procedure to Request Prior Authorization (PA)

The procedure to request Prior Authorization is as follows:

A. The provider shall verify eligibility of the member in the manner described in Chapter I, Section 1 of the MaineCare Benefits Manual.

The request for Prior Authorization shall be made by the provider in writing to MaineCare Services, Prior Authorization Unit by submitting a request through the MaineCare Portal at https://mainecare.maine.gov.

C. The provider shall report the following information to MaineCare Services, Prior Authorization Unit when requesting PA:

1. Name of member and MaineCare ID number;

2. Diagnosis;

3. Physician's approval;

4. Medical necessity for transport;

5. Base departure (for air ambulance);

6. Estimated amount of time required for air travel;

7. Land ambulance involved for out of state transport of member by air ambulance; and

8. Other pertinent information.

D. Emergency cases where the provider is unable to reach the Prior Authorization Unit shall be given special consideration and may be granted retroactive authorization when all other requirements for approval listed above have been met.

5.08-3 Program Integrity

See Chapter I, Section 1 of the MaineCare Benefits Manual.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-5, subsec. 144-101-II-5.08