The following Sample Letters are designed to meet MaineCare prior authorization requirements. MaineCare generally has the most strict requirements for this type of documentation, and we encourage you to make as few changes to the format and content of these letters as possible to ensure a smooth authorization process. 

These letter templates may also be useful for prior authorization with private insurance companies, either as a starting point or a template, though we suggest you check on content requirements with individual companies before submitting a letter for authorization. 

Sample Letter:

 

Letter Template:

 

Letter Contents Requirement for MaineCare