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Provider Manual and Forms

Note: Please go to the Provider Training page for additional APS CareConnection training options. The contents of Appendix A, Appendix B, and Appendix C are available in individual documents based on their Table of Contents. If you would like to request any of the individual documents, please contact APS Provider Relations at 1-866-521-0027, Option 1, or via e-mail at mainecare-prov@apshealthcare.com.

Service Grid  in PDF

Provider Manual  in PDF
    Appendix A  in PDF
    Appendix B  in PDF
    Appendix C  in PDF

ICD-9/DSM IV TR Crosswalk  in PDF

ICD-9/DC 0-3 Crosswalk  in PDF


Other Provider Instructions

FAQs for Intensive Outpatient Program (IOP) August 2013  in PDF

FAQs for Contact for Service Notifications (CFSN) and Wait List Reports 7-10-13  in PDF

FAQs for Section 21 Waiver Services for Adults March 2013  in PDF

FAQs for Section 28 Rehabilitation and Community Support Services March 2013  in PDF


Section 97 – Intensive Temporary Residential Treatment (ITRT)

Section 97 – Application

Section 97 – Process  in PDF

Section 97 – Consultation Guide  in PDF

Section 97 – Temporary High Intensity Service Application  in PDF

Section 97 – Temporary High Intensity Service Checklist

Section 97 – Suggested Documentation  in PDF

Section 97 – FAQs for Application Process Change  in PDF

Section 97 – Listing of Possible Placement Options  in PDF

Release of Information Form  in PDF


Section 97 – Private Non-Medical Institution (PNMI)

Section 97 - Clinical Documentation Guidelines  in PDF


Section 28 – Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations (RCS))

Section 28 – Referral

Section 28 – Comprehensive Assessment

Section 28 – Comprehensive Assessment Score Summary

Release of Information Form  in PDF


Section 65 - Day Treatment Services

Section 65 Day Treatment - Clinical Documentation Guidelines  in PDF


Section 13 - Targeted Case Management (TCM)

Section 13 - Tip Sheet  in PDF


Section 17 - Community Support Services

Section 17 Adult ACT - Clinical Documentation Guidelines  in PDF


Review Forms

Initial Registration Request Form  in PDF

Contact for Service Notification  in PDF

Prior Authorization Request Form  in PDF

Continued Stay Review Request Form  in PDF

Medication Management Only Continued Stay Request Form  in PDF

Outpatient Mental Health Only Continued Stay Request Form  in PDF

Discharge Review Form  in PDF


Screening Forms (in .ZIP format)

AC-OK: Adult Screen for Co-Occurring Disorders

AC-OK: Adolescent Screen for Co-Occurring Disorders

Instructions and FAQ about the AC-OK are posted on the DHHS-COSII Website at this link: http://www.maine.gov/dhhs/cosii/provider/documents.shtml


Reading .PDF  in PDF and .ZIP Documents

In order to view the .PDF files, you will need Acrobat Reader.

In order to extract .ZIP files, you will need WinZip.

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