Attention MaineCare Providers of Children’s Services

Jan 13, 2023

Providers have asked how to request an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) authorization midway through services that have already been approved under MaineCare policy. Below is the process to request an EPSDT authorization in conjunction with an active service:  

• Agency has a current authorization for a MaineCare member under 21 years of age 

• A need for EPSDT services arises mid authorization 

• The provider should contact Kepro Provider Relations and request that a “shell case” be entered so the provider can request EPSDT services for a period 

• Provider will enter rationale into the “shell case” for EPSDT authorization review 

• The clinical team will review the EPSDT case 

• If the EPSDT services are approved, they will be selected on the case and shown in the provider’s download notification report 

• Providers will need to bill with the EP modifier for dates of service approved for EPSDT  

A copy of this flowchart can be found on Kepro’s website.  

For EPSDT questions please reach out to the MaineCare EPSDT Coordinator, Tia Bolduc at: DHHS.EPSDT@Maine.gov. For questions on EPSDT submissions into Atrezzo please reach out to Kepro Provider Relations at: ProviderRelationsME@kepro.com