C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-95, subsec. 144-101-II-95.03
Each MaineCare member is eligible for those medically necessary covered services described in this Section. The Department reserves the right to request additional information to evaluate medical necessity.
Some services under this section require prior authorization by the Department or its Authorized Agent. The Department may use criteria outlined in this policy in addition to using prior authorization criteria that is industry recognized prior authorization criteria utilized by a national company under contract. In cases where the criteria are not met, the provider/Member may submit additional supporting evidence such as medical documentation, to demonstrate that the requested service is medically necessary.
For Podiatry services that require authorization, please contact the prior authorization unit. Prior authorization contact information and prior authorization forms, can be found at: http://www.maine.gov/dhhs/oms/provider_index.html .
Refer to the MaineCare Benefits Manual (MBM), Chapter I, General Administrative Policies and Procedures, and MBM, Section 90, Physician Services for additional information regarding prior authorization requirements.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-95, subsec. 144-101-II-95.03