MaineCare Referrals for Walk-in and Urgent Care Services - Primary Care Case Management (PCCM) Eligible Members

MaineCare Referrals for Walk-in and Urgent Care Services - Primary Care Case Management (PCCM) Eligible Members

Effective February 21, 2020, MaineCare members with PCCM eligibility will no longer require referrals for walk-in and urgent care services.

What does this mean for me as a Primary Care Provider (PCP)?

• PCPs will not need to submit a MaineCare referral when a member with PCCM eligibility receives services at a walk-in or urgent care clinic.
• Your practice will have walk-in and urgent care clinics as an option for your members to receive acute services when primary care appointments are not available.

What does this mean for me as a Walk-in or Urgent Care provider?

Walk-in and Urgent Care providers won’t need a referral in the Health PAS Online Portal for a service claim to pay for acute services.

Why is this change being made?

• If the PCP is not available for members’ acute care needs, we would like to encourage members to seek non-emergent services at a walk-in or urgent care clinic instead of the Emergency Department (ED).
• This change removes the barrier of requiring a referral for non-emergent acute services.

If you have questions, please email MaineCare at PCP-Network-Services.DHHS@maine.gov. You may refer members to MaineCare Member Services for questions at: 1-800-977-6740; TTY Users: Dial 711 (Maine Relay). Offices are open Monday through Friday, 7:00 am to 6:00 pm.