(EPSDT) Shell Case Guidance for Behavioral Health Providers

This notice includes guidance from Acentra Health in partnership with the Office of MaineCare Services (OMS), on the use of shell cases in Atrezzo.

A shell case may be requested for children’s services to assess whether a service is medically necessary and can be covered under the VitalCare for Kids (EPSDT) program. Per OMS policy, shell cases generally cannot be used to override duplicative or non-concurrent services. Please refer to the MaineCare Benefits Manual, Chapter II, Section 94 for EPSDT requirements.

To request a shell case for a child:

• Call Acentra Health Provider Relations at 866-521-0027 (Option 3) and provide:
  • Member demographics
  • Procedure code
  • Start date
  • Brief clinical justification

Acentra will create the shell case and give you the case ID. You must then add a note explaining:

• Why the service is medically necessary
• How your service differs from any services the member already receives
• How units will be used
• Treatment goals the member is working towards

Acentra Health’s Clinical Team will review the request and determine if approval under VitalCare for Kids (EPSDT) is appropriate.

Note: Shell cases are not available for adult services. Providers must coordinate care to determine the most appropriate service.

For questions regarding the Atrezzo shell case process please contact the Acentra Health Provider Relations Department through our live agent chat on our website, at 1-866-521-0027, Option 3, or via email at ProviderRelationsME@acentra.com.