[Provider] UPDATE: APS Healthcare Prior Authorization / Utilization Review Requirements

[Provider Notification]

ATTENTION:  All MaineCare Behavioral Health Providers

 

The Maine Behavioral Health Administrative Services Organization (ASO)
PA/UR requirements may not apply to dual-eligible members, who have
coverage with both Medicare and MaineCare, and where Medicare is the
primary payer.

 

If Medicare pays claims for behavioral health services, and MaineCare is
billed for the co-pay and deductible, then no registration or review is
needed with APS Healthcare, and no PA number is required for MeCMS
billing.

 

If it appears that MaineCare will be the primary payer (in other words,
that Medicare may not pay in a particular situation, but MaineCare
will), then the provider must follow the ASO PA/UR requirements and
obtain a PA number for MaineCare billing prior to providing the service
or the claim will be denied.

 

Please contact MaineCare Billing and Information Unit at 1-800-321-5557,
Option 8 if you have any questions about this advisory.

 

 

This is a one-way communication.  Please do not respond to this message.

 

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