Initial Authorization Request Form - Maine
Fax To: 1-866-598-3963 or Mail to: PA Unit Office of MaineCare Services 11 State House Station Augusta ME 04333 For questions please call: Provider Services at 1-866-690-5585 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.
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