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  • Initial Authorization Request Form - Health Pas-online - Maine.gov - Mainecare Maine

Get Initial Authorization Request Form - Health Pas-online - Maine.gov - Mainecare Maine

INTENSIVE OUTPATIENT (IOP). INITIAL AUTHORIZATION REQUEST FORM. Tobe Completed by OBH. Revised 7.1.16. Tracking #. Date/Time of Receipt.PROVIDER INFORMATION. Provider Company Name. Person Making Referral.Credentials.

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Contact Us Eligibility and Benefits Questions. Phone: 1 (855) 797-4357. For help logging into your My Maine Connection Account: MMCHelp.DHHS@maine.gov. Electronic Benefit Transfer Card. For EBT self-service, please visit https://.pinetreecard.com/

Prior Authorizations Phone:1-866-690-5585 (TTY: 711)Fax:1-866-598-3963E-mail:MaineCareProvider@gainwelltechnologies.com

Call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711(Maine relay). You can also email.

By mail: Prior Authorization Unit, Office of MaineCare Services, 11 State House Station, Augusta, ME 04330. By fax: 1-866-598-3963....You can submit claims in several ways: Electronic ANSI ASC X12 837 files. ... Direct Data Entry on the HealthPAS Online Portal. ... Paper Claims.

Email your appeal to farmington.dhhs@maine.gov or any of the regional offices.

Call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711(Maine relay). You can also email.

How long will it take to get a decision from DHHS? DHHS is supposed to make a decision about whether or not you can get MaineCare within 45 days of receiving your complete application. If you have not heard from DHHS within 45 days, you should contact them at 1-855-797-4357 and ask about the status of your application.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232