PCCM/Managed Care FAQs

Primary Care Case Management (PCCM) is MaineCare's program to assign members to Primary Care Providers (PCPs) and coordinate care. Below are some frequently asked questions about the program.

 

 

.What is a Primary Care Provider (PCP)?
You choose a family doctor, nurse practitioner, or physician's assistant who will take care of most of your medical needs. This person is called a primary care provider. You can use MaineCare's online Provider Directory or call Member Services 1-800-977-6740 to find a PCP.
How do I sign up for PCCM?
MaineCare Member Services will mail you some information. Open it right away! Read the booklet and fill out the signup sheet or call our toll free telephone number 1-800-977-6740 to sign up. There is a deadline. You only have a few days to sign up and chose a primary care provider, or MaineCare will choose one for you.
What if I need to see a specialist?
You and your primary care provider will work together to get the care you need. Sometimes you may need to see another doctor or specialist, like the heart doctor. If you do need to see another doctor, your primary care provider must refer you (give you the OK). He or she will give you a form to take to the other doctor. This form is called a referral. If you do not get a referral from you primary care provider, MaineCare will not pay the bill.
Can I go the emergency room?

When you think it is an emergency, you can go the emergency room at the nearest hospital. You do not have to call your primary care provider first. To get emergency care, call 911 or the local emergency number for where you are. An emergency is any health problem (physical or mental) that could cause serious harm if not treated quickly. Here are some types of emergencies:

  • Problems Breathing
  • Poisoning
  • Fainting or Diziness
  • Chest Pain
  • Bad Burns
  • Mental Confusion
  • Broken Bones
  • Severe Bleeding
  • Sudden or Severe Pain
If I get sick and it is not an emergency , what do I do?
Call your primary care provider anytime, 7 days a week, 24 hours a day. If he or she is not there, someone else will help you, or an answering machine message will tell you what to do. Do not go to the emergency room for regular medical care.
Your first visit with your PCP -- what to bring
After you sign up, you will get a letter with your primary care provider's name and phone number.You must take this letter and your MaineCare card with you to all your MaineCare appointments. If the primary care provider on your letter is not the provider you want, call MaineCare Member Services right away. We can help you change to the primary care provider you want.
MaineCare Member Services can help!
MaineCare Member Services is here to help you. We can answer your questions and help you sign up. We can also help you find a family doctor or nurse if you don't already have one. All you need is to call:1-800-977-6740 Option 2.