[Provider] Out of State Care

[Provider Notification]

ATTENTION:            MaineCare Providers who refer patients
out-of-state and 

                                    Out of State MaineCare Providers 

 

Starting December 1, 2008, Schaller Anderson began to handle certain
Prior Authorizations (PA) for MaineCare members receiving out-of-state
medical care.

 

MaineCare members should be sent out of state only if the care they need
is not available in Maine.  Keeping care in Maine helps the patient stay
closer to family and friends.  It also is good for our in-state economy.


 

Listed below are types of care and the process for out-of-state care.  

 

Adults' and Children's Medical Care 

 

Unless it is a medical emergency, all out-of-state medical care needs
MaineCare's Prior Authorization.  Schaller Anderson, MaineCare's agent
for out-of-state prior authorization, handles 

*        outpatient services, and 

*        inpatient admissions, including acute and rehabilitation
facilities.

 

You may contact Schaller Anderson Medical Administrators, Inc, Prior
Authorization Unit, toll free at 1-866-543-2387.  You may FAX Prior
Authorization requests to 1-877-861-2615.  Provider instructions are
available online at Prior Authorization web page
<http://www.maine.gov/dhhs/bms/providerfiles/pa_inst_sheets_forms.html%2
3oos> 

 

Emergency Medical Care

 

Emergency medical care does not require a Prior Authorization.  If a
MaineCare member has a medical emergency and is admitted as an inpatient
to a hospital, we ask that the hospital notify Schaller Anderson within
1 business day.  Schaller Anderson will then work with the hospital and
patient to manage the stay and ensure a smooth transition to the
patient's Maine-based care providers.  You may FAX notification to
1-877-861-2615.

 

Children's Behavioral Health Services 

 

When you want to refer a child to an out-of-state hospital for
behavioral health services, call the statewide crisis line at
1-888-568-1112.  This will connect you to a Crisis Resolution Provider,
and start the Prior Authorization process.  All out-of-state hospital
care needs CBHS's approval.  

 

Adult Emergency Behavioral Health Services

 

For adults who have MaineCare and are admitted for emergency behavioral
health services out-of-state, contact MaineCare's Prior Authorization
Unit at 1-800-321-5557 Option #5 and by FAX at 207-287-7643.  

 

Other Services 

 

For other medically necessary out-of-state services not described above,
please contact MaineCare's Prior Authorization Unit at 1-800-321-5557
Option #5.

 

Reminder: There is no change for New Hampshire providers within 15 miles
of the ME/NH border or Canadian providers within 5 miles of the
ME/Canadian border (also known as REID providers).  These providers are
not treated as out-of-state providers.

Is your mailing address up to date with MaineCare?  Please keep
MaineCare up to date so your Remittance Statements and checks arrive on
time.  Call Provider Enrollment at 1-800-321-5557 Option #6.  

 

If you would rather not get these e-mails, visit MaineCare's List Serve
Subscription page
<http://www.maine.gov/dhhs/bms/member/innerthird/listserv.shtml>  to
unsubscribe.

 

This is a one-way communication.  Do not reply to this e-mail.  Your
e-mail will not receive response.  If you have questions, please call
1-800-321-5557.  

 

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