Initial Authorization Request Form - Maine
Criteria Sheets for submission with your new PA requests can be found on the provider portal at https://mainecare.maine.gov . The portal offers references to policy in addition to the criteria information needed to validate the Prior Authorization. Additional documents can also be uploaded to the portal even after the PA has been submitted.
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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