MaineCare Member ASO Information

The Department of Health and Human Services (DHHS) has selected APS Healthcare as an Administrative Services Organization (ASO). We help manage some MaineCare mental health and substance use services.

Who is APS Healthcare?

APS Healthcare is a health care company. Founded in 1992, the APS Healthcare team works to improve healthcare services, both in physical and mental health, for more than 20 million Medicaid, Medicare and other health insurance members across the United States and Puerto Rico.

What is an ASO?

An Administrative Services Organization, or ASO, works with providers of MaineCare mental health and substance use services. We look at the use of services for each member to make sure the services are the right type, at the right time and for the right length of time.

What does APS Healthcare do?

APS Healthcare looks at or “reviews” the mental health and substance use services that you get or your child gets, based on information from the provider. We then authorize or “OK” the service. We then give the provider an authorization number so that MaineCare can pay for the service.

The goals are to promote each member’s recovery, resiliency, and ability to live in the community of his or her choice, and to improve the quality of mental health and substance use services in Maine.

How does this affect me?

APS Healthcare reviews the mental health or substance use services that you get or your child gets. We look at information that your provider gives to us. It is the same information that is on the treatment plan.

If you have or your child has been getting MaineCare, you or your child will still get MaineCare.

What if I do not agree with a decision by APS Healthcare?

You can call us and ask us to look at the decision again. We will then review the service again. You can also have an appeal hearing with DHHS. A full description of the process is in the Member Handbook. You can also call us for a paper copy. Our number is 1-866-521-0027.

Who can I call at APS Healthcare if I have a question?

You can call APS Healthcare Member Services toll-free at 1-866-521-0027.

You can also call our Member Liaison at 1-866-521-0027. This person is a self-identified member. This person is there to answer your questions, help with information, and problem solving.

How else can I get information?

The APS Healthcare website- www.qualitycareforME.com - has information about the role of the Administrative Services Organization (ASO). It also includes links to the DHHS website and other relevant websites.

Our Member Handbook has lots of helpful information. It includes our review policies, grievance and appeals information, and our quality management work. This Handbook is on the website. You can also get a hard copy of it by calling APS Healthcare Member Services at 1-866-521-0027.

For additional information regarding Member Services and APS Healthcare, please call 1-866-521-0027.

Reading .PDF Documents

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