Attention Providers: UPDATE on Issues Processing MaineCare Pharmacy Claims
In follow-up to our February 23, 2024, e-message,
Attention Pharmacy Providers: 30-Day Prescriptions Authorized in Response to Change Healthcare Network Outage
This message is to announce that MaineCare is now authorizing 30-day prescriptions to continue to assist pharmacies in fulfilling MaineCare member prescriptions in response to the Change Healthcare network interruption. This is a change from MaineCare’s temporary authorization of the use of a 3-day override as noted in our February 23, 2024 e-message.
Attention Providers: Possible Delays in Prior Authorizations Due to Network Interruption
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 members in many states, including Maine.
Attention Providers: Network Interruption Resulting in Issues Processing MaineCare Pharmacy Claims
You may be aware that Optum Change Healthcare is experiencing a network interruption related to a cyber security issue. This is a national issue affecting Medicaid members in many states, including Maine. As a result, MaineCare is experiencing issues processing pharmacy claims.
Attention Section 67, Nursing Facilities (NFs): Draft Rate Methodology Public Review and Comment
As part of the Department’s reimbursement reform efforts, MaineCare initiated a rate determination in June of last year, for Section 67, Nursing Facilities and Section 97, Appendix C, Residential Care Facilities.
Maine DHHS Proposes Framework for Nursing Facility Rate Reform
Feb 2, 2024
Today, the Maine Department of Health and Human Services (DHHS) released the framework (PDF) for MaineCare (Maine Medicaid) nursing facility rate reform for fiscal year 2025, which will support the direct care workforce, incentivize permanent staff, and promote quality care and positive health outcomes for Maine residents who live in nursing facilities.
Attention Pharmacy Providers: Handling of MaineCare Claims During Change Healthcare Network Outage
As noted in our previous e-message, Change Healthcare is experiencing a network interruption related to a cyber security issue. This is a national issue affecting Medicaid members in many states. As part of the impacts of these technical issues, we are not able to process retail pharmacy claims until further notice.
Sections 68, Physical Therapy and 85, Occupational Therapy Providers: Medicare Standardization Rates Implemented for Calendar Year 2024 (CY24) CR 122976
In follow up to our January 19, 2024 notice, service codes and rates for Sections 68 and 85 of the MaineCare Benefits Manual, effective January 1, 2024, are now implemented to reflect 72.4% of the most recent 2024 Medicare rates.
Adjustment of Claims
Attention Pharmacy Providers: Network Interruption
You may be aware that Change Healthcare is experiencing a network interruption related to a cyber security issue. As a result, MaineCare is experiencing intermittent network issues processing claims. If you experience issues with claims, please follow your routine offline claims processing procedures. We are working to gather more details about the impacts and determine a timeline for resolving these issues and will return to normal business as soon as possible.
Over the Counter (OTC) Naloxone Standing Order for MaineCare Members
On September 8, 2023, in partnership with the Maine Center for Disease Control and prevention, MaineCare authorized a standing order for licensed pharmacists to create a single use prescription for OTC naloxone two dose nasal spray kit. This standing order can be accessed on the MaineCare website in the Provider Resources section under the Pharmacy header.