Initial Authorization Request Form - Maine
Section 2: Purpose- This form MUST be used when mailing or faxing a new prior authorization request. When mailing your request, color copies will be easier to process. Write only within the fields and clearly circle only one type of PA request.
Download Initial Authorization Request Form - Maine
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Physical Therapy Request for Chronic Pain Form
mainecare.maine.govDepartment of Health and Human Services MaineCare Services Prior Authorization Unit, Physical/Occupational Therapies 11 State House Station Augusta, Maine 04333-0011
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