Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-5 - AMBULANCE SERVICES
Subsection 144-101-II-5.08 - POLICIES AND PROCEDURES

Universal Citation: 10 ME Code Rules § 144-101-II-5.08

Current through 2024-38, September 18, 2024

5.08-1 Records

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.

5.08-2 Procedure 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.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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