MaineCare Provider Services
News
Primary Care Case Management (PCCM)
Background
MaineCare's Primary Care Case Management (PCCM) is a mandatory program covering eligible MaineCare members (primarily the TANF population ~ Temporary Aid for Needy Families). Primary care providers are always welcome to become PCCM providers.
The primary objectives of MaineCare managed care are to:
- Recognize through incentive payments high quality primary care providers
- Improve MaineCare members’ access to providers
- Have MaineCare members establish a “medical home”
- Increase continuity of care
- Strengthen the patient and provider relationship
- Reduce unnecessary utilization and expenditures
Please see below for more information.
- Overview of PCCM
- Billing - CMS 1500, UB92 forms
- Codes exempt from referral requirements
- How to add a new PCP to an existing PCCM site
- How to become a PCCM participating Primary Care Physician
- Incentive Payments - Overview
- Incentive Payments - Letters and Measures
| Overview of Primary Care Case Management (PCCM) | Word | PDFs or Other |
|---|---|---|
| Summary | (.doc) | (.pdf) |
| Introduction - Presentation | (.ppt) | |
| Frequently Asked Questions | (.doc) | (.pdf) |
| How to Reach Us? | (.doc) | (.pdf) |
| Referral Form | (.doc) | (.pdf) |
| Member Education Request Form | (.doc) | (.pdf) |
| Back to Top | ||
| How To Become a Primary Care Physician (PCP) | ||
| Instructions | (.doc) | (.pdf) |
| Terms and Conditions | (.doc) | (.pdf) |
| Rider | (.doc) | (.pdf) |
| Fact Sheet | (.doc) | (.pdf) |
| How to Add A New Primary Care Physician (PCP) | ||
| Instructions | (.doc) | (.pdf) |
| Form | (.doc) | (.pdf) |
| Billing Procedures | ||
| Billing CMS1500 01/2008 | (.doc) | (.pdf) |
| Billing UB92 01/2008 | (.doc) | (.pdf) |
| Exempt Diagnosis and Procedure Codes | ||
| Exempted Diagnostic and Procedure Codes | (.doc) | (.pdf) |
| Back to Top | ||
| Primary Care Provider Incentive Payment (PCPIP) Overview | ||
The Primary Care Provider Incentive Payment (PCPIP) pays additional compensation to providers who deliver high quality healthcare to their patients and who rank above the 20th percentile for certain measures compared to other physicians within their specialty. The goals of PCPIP:
Incentives are paid to providers who are practicing primary care and whose primary specialty is Family Practice, General Practice, Pediatrics, Obstetrics/Gynecology, or Internal Medicine . See below for more details. |
||
| Primary Care Provider Incentive Payment (PCPIP) Letters and Measures | ||
| PCPIP Generic Letter | (.pdf) | |
| PCPIP Intro Letter | (.doc) | (.pdf) |
| PCPIP Measures Table | (.doc) | (.pdf) |
| PCPIP Measures Document | (.doc) | (.pdf) |
| Back to Top | ||
Note:If you can not read the above files you can use these links to access Word Viewer for .doc files or Adobe Acrobat for .pdf files or PowerPoint for .ppt files.
