• Read more about MaineCare Announces Interim Payments to Local Pharmacies During Vendor Network Disruption

Plans to temporarily pay independent and safety-net pharmacies to support MaineCare members' access to medications in response to Change Healthcare outage

AUGUSTA– The Department of Health and Human Services (DHHS) announced today that it has developed an interim payment system for independent and safety net pharmacies in response to the continued disruption of the pharmacy claims system for MaineCare, Maine’s Medicaid program.

• Read more about Independent and Safety Net Pharmacy Organizations Qualifying for MaineCare Interim Payment

The Department of Health and Human Services (DHHS) will be issuing interim payments for independent and safety net pharmacies in response to the continued disruption of MaineCare’s pharmacy claims due to the cybersecurity issue affecting Change Healthcare. For previous communications about this issue, see the February 27, 2024 e-message here. 

• Read more about Attention Pharmacy Providers: MaineCare Weekend Support on March 2 & 3, 2024

This notice is to alert you that MaineCare will be providing support to help pharmacy providers verify member eligibility over the weekend on March 2 and 3, 2024. You can call Gainwell Provider Services’ Interactive Voice Response (IVR) phone line to verify member eligibility for pharmacy claims.

• Read more about Call the Interactive Voice Response (IVR) to Verify Eligibility  

You can call Gainwell Provider Services’ Interactive Voice Response (IVR) phone line to verify member eligibility for pharmacy claims. You will need your pharmacy’s National Provider Identify (NPI) and the member’s MaineCare ID number. Call 1-866-690-5585 and press or say the number 1. The automated system will prompt you through the call. The system will respond best when responses are keyed into the keypad instead of announced verbally. 

 Instructions 

1. Call 1-866-690-5585. 

2. Select or say 1. 

• Read more about MaineCare Provider Enrollment Progress Update

Gainwell continues to reduce the number of open cases and the time it takes to complete their steps within the enrollment process. Gainwell completed 711 enrollment cases in February and the average turnaround time for case completion was 31.3 days. Case inventory decreased to 537 by the end of February and the average system age of the case in inventory is approximately 20 days old.

• Read more about Attention Providers: Submit Documentation Electronically to Avoid Delays - Clarification*

*Please note bolded text below for clarification of our previous message.  

• Read more about Attention Pharmacy Providers: MaineCare Pharmacy Service Disruption Update Call February 29, 2024

The Office of MaineCare Services is inviting you to join a Zoom webinar today, February 29, 2024. We will use this time is to review current guidance and as an opportunity for sharing questions and concerns with the State. Please register in advance.  

When: Feb 29, 2024 01:00 PM Eastern Time (US and Canada) 

• Read more about Attention Providers: Submit Documentation Electronically to Avoid Delays

As communicated on February 23, 2024, Change Healthcare is experiencing a network interruption related to a cyber security issue. This is a national issue affecting health care systems and Medicaid programs in many states, including Maine.  

• Read more about Post Incarceration Incentive Pilot Update

In December, MaineCare announced the Post Incarceration Incentive Pilot Payment. Please refer to our previous notice for additional information on the process for submitting services for providers that receive weekly, monthly, or non-claims-based reimbursement from MaineCare.   

• Read more about MaineCare Responds to Pharmacy Vendor Network Disruption

Authorizes pharmacies to provide 30-day supplies of covered prescriptions to MaineCare members

AUGUSTA – MaineCare, Maine’s Medicaid program, is continuing to respond to a disruption caused by a cyber security issue affecting Change Healthcare, an out-of-state vendor that operates MaineCare’s pharmacy claims system. This is a national issue affecting health care systems and Medicaid members in many states.