Update: Guidance for Psychiatric Hospitals Seeking Prior Authorization (PA) for Mental Health Intensive Outpatient (IOP) Services

Aug 18, 2023

On June 4, 2023 the Office of MaineCare Services (OMS) notified providers of IOP services regarding the upcoming requirement to submit a PA through the Atrezzo system operated by Acentra Health (formally Kepro) and adhere to the substantive standards set forth in MBM, Chapter II, Section 65, Behavioral Health Services.     

Effective September 1, 2023, providers enrolled under MBM, Chapter II, Section 46, Psychiatric Hospital Service who offer IOP services will be required to submit PAs to Acentra Health for review, and bill using the following Healthcare Common Procedure Coding system (HCPC) code and modifier when applicable. PAs will be reviewed by Acentra Health in accordance with the standards set forth in Section 65.05.   

It is the Department’s preference that IOP providers enroll and bill under Section 65, however, until the rules governing Psychiatric Hospital Service and reimbursement are updated, MaineCare will continue to allow billing under Section 46.      

If you have questions regarding the standards set forth in Section 65, or the billing requirements for providers enrolled under Section 46, please reach out to Provider Relations Specialist Tiffany Norton.