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Medicaid Management Information Systems Maine Integrated Health Management Solution

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MaineCare reviews the medical necessity of some services and products to be provided to its members through the use of a Prior Authorization (PA). A prior authorization determines only the medical necessity of the authorized service and does not establish or waive any other prerequisite for payment, such as a referral.

The MIHMS Health PAS Online Portal (online portal) provides MaineCare providers with the tools to submit prior authorizations via the online portal. PA types that may be submitted through the online portal are:

  • Dental Services

  • Dentures

  • DME/Supplies

  • DME Urgent

  • EPSDT– OTS Services


  • EPSDT PDN OverCap

  • Hearing Aids

  • In-State Inpatient Procedures

  • In-State Outpatient Procedures

  • In-State Professional Services

  • OMS-OT

  • OMS-PT

  • Orthodontia

  • Orthotic/Prosthetic Devices– DME

  • Orthotic/Prosthetic Devices– DME Urgent

  • Out of State– Inpatient Procedures

  • Out of State– Inpatient Transplants

  • Out of State– Long Term Placement

  • Out of State– Outpatient Procedures

  • Out of State– Professional Services

  • Out of State– Transportation

  • Physician Administered Drugs

  • Private Duty Nursing– Under 21 Years

  • Radiology

  • TMJ Procedures

  • Vision

2.System Requirements

To successfully use all features of the Health PAS Online Portal, ensure that your computer system meets the following minimum requirements:

  1. Reliable Online connection

  2. Web browser- The latest version of Microsoft Internet Explorer is recommended. As versions of Internet Explorer become available it is recommended that these versions are used.

  3. The latest version of Adobe Acrobat Reader

3.Preparation for PA Submission Process

When completing and submitting a prior authorization via the online portal, the user will need to gather the following information:

  • MaineCare Member ID

  • Member Name

  • Member Date of Birth

  • Member Social Security Number (SSN)

  • Complete the criteria check list and prepare all the necessary documentation you will attach to the PA request you are submitting over the online portal. Paper documents may be scanned for the purposes of attachment.

4.Trading Partner

To access the secure section of the online portal to submit a PA to MaineCare via Direct Data Entry (DDE), you must first be a registered Trading Partner. To log into your Trading Partner Account (TPA):

  1. From the online portal home page, click the Provider tab at the top of the screen.

  2. On the Provider tab, enter your user name and password, which you created when you registered your TPA, into the Trading Partner Sign In. See Figure 4-1: Trading Partner Sign In.

  3. Click the Sign In button.

Figure 4 1: Trading Partner Sign In

NOTE: If you are not already a registered Trading Partner, click the link to the Trading Partner User Guides for more information at:

5.Prior Authorization Submission

There are three (3) ways you can submit a prior authorization using the online portal, as shown in Figure 5-1: Form Entry- Authorization Submission:

  • Patient Roster. See Section 5.1: Patient Roster or Primary Care Roster for more information.

  • Primary Care Roster. See Section 5.1: Patient Roster or Primary Care Roster for more information.

  • Authorization Submission. See Section 5.2: Authorization Submission for more information.

Figure 5 2: Form Entry– Authorization Submission

5.1Patient Roster or Primary Care Roster

The Patient Roster is created by the Provider and contains a list of the members that are patients of the Provider. The Primary Care Roster is an automatic list of the members that have been assigned to that Primary Care Provider. Members from the Primary Care Roster can be added to the Patient Roster List. The user may choose to identify the member by using the Patient or Primary Care Roster:

  1. Once you are logged in as a Trading Partner, click on either the Patient Roster or Primary Care Roster link under the Form Entry heading.

  2. The roster screen will display, as shown in Figure 5-2: Patient Roster or Figure 5-3: Primary Care Roster, depending on which roster you have chosen.

  3. Select the Billing Provider from the drop-down menu, if applicable. If there is only one Pay-To provider, this field will be grayed out.

  4. If you are using the Primary Care Roster, select the PCP from the drop-down menu.

  5. Select the member from the roster list by clicking the radio button, or

  6. Select the first letter of the member’s last name from the alphabetical list. If a letter is grayed out, there are no members assigned that have a last name which starts with that letter. If you are using the Patient Roster and the member does not appear, you will need to add the member to your Patient Roster before a submission can be completed. For instructions on adding new members, see the MHP Patient Roster User Guide at the following link:

NOTE: The user will not be able to add members to their Primary Care Roster. The Primary Care Roster members are assigned by Member Services.

  1. Once you see the correct member, select the radio button next to the member in the roster list.

  2. Click the Submit Authorization button to begin the authorization submission process.

Figure 5-2: Patient Roster

Figure 5-3: Primary Care Roster

  1. Go to Section 6: Submit Prior Authorization to complete the PA submission.
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