Maine.gov
Provider Help Desk: (p) 888-420-9711 (f) 800-408-1088 | Member Help Desk: (p) 866-796-2463 (f) 207-287-8601
Prior Authorization (PA) Helpdesk (for Provider PA inquiries): (p) 888-445-0497 (f) 888-879-6938

Forms

Name Description Date
Reversal Form 21.81 KB 2014/08/28
MEPARTD Manual Claim Form NCPDP D.0 168 KB 2014/04/29
MEPOP Manual Claim Form NCPDP D.0 168 KB 2014/04/29
ME Compound Manual Claim form NCPDP D.0 168.08 KB 2014/04/29
BMS012 Form 64.22 KB 2010/12/23