Prior authorization required for hip and knee services for State of Maine Health Plan members effective July 1, 2022
The State of Maine Health Plan has contracted with Carrum Health to approve all knee and hip replacement surgeries at the Carrum Health Center of Excellence provider, Spectrum. Beginning with dates of service on and after July 1, 2022, State of Maine members must go through the Carrum Health program for the following knee and hip services: 27447, 27446, 27125, 27130, DRG 469, DRG 470. Prior authorization is required for these services. If prior authorization is not granted and a member does not receive approval through Carrum Health, claims submitted to Anthem Blue Cross and Blue Shield for the services will be denied. Information about limited exceptions may be obtained through Carrum Health.
Please direct your patients to Carrum for approval at 888-855-7806 or visit carrum.me/stateofmaine for more information.
The State of Maine Health Plan is also implementing the AIM Specialty Health® Clinical Review Program for Musculoskeletal Services.
New Prior Authorization Requirements for State of Maine Health Plan Members