Transition Plan

Provider Transition Plan Effective 12/1/07

• For currently served MaineCare members: providers may “phase in” these members to the ASO processes over a 90 day period (except for 65M&N Services). The phase-in period will begin on 12/1/07 and will end on 2/29/08.
• For all newly served MaineCare members, who begin service on or after 12/1/07; providers will include these members in the ASO PA or Registration process as described in the provider manual.
• 65M&N Services Only: For currently served MaineCare members in 65M&N Services, providers will submit all UR and discharge reviews to APS as described in the provider manual.

Hospitals Only:

• No Initial Registration is required.
• Submit a Hospital Initial-Discharge Review for members discharging 12/1/07 and later, who began service prior to 12/1/07.
• Starting 12/1/07 Hospitals conduct a PA Review as the first review, for members in treatment 3 days or longer. The review process then applies.

ASO Provider Transition for Currently Served MaineCare Members:

• Transition Review for all open members: Providers must conduct a Transition Review for currently served MaineCare members active in a service and whose service start date is prior to 12/1/07.
• CareConnection: Providers are strongly urged to conduct all reviews with APS via CareConnection.
• Authorization effective date: All Authorizations issued for transition reviews will have a retroactively dated start date of 12/1/07 to ensure no gap in billing for providers.
• 90 Day Transition period, from 12/1/07 to 2/29/08 only. After 2/29/08, retroactive authorizations to 12/1/07 will not be issued for transition reviews of members who were in service prior to 12/1/07.
• Begin transitioning members as soon as possible after 12/1/07.
• When appropriate for the service, transition members at the date of their ISP/ITP review.
• For members that discharge after 1/1/07 providers will need a MECMS PA number for billing. The provider must submit an Initial Registration and a Discharge Review, to obtain the MECMS PA number and to Discharge the member.