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PA Prior Authorization New PA Request MEDICALLY URGENT REQUEST Submitter Name: Fax Date: Submitter Telephone #:Submitter Fax #:Submitting Provider Return Address: Section 1: (See Section 3 for instructions)
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Provider - mainegov is a tool used by healthcare providers in Maine to report information about the services they offer and the payments they receive.
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Providers must report information such as the type of services provided, the number of patients served, and the amount of payments received.
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