MaineCare is preparing to upgrade the system we use to pay MaineCare providers for healthcare services they provide to you. To support a smooth transition, there will be a temporary period when your provider may not be able to submit or have access to certain information.
This temporary period will begin on October 2, 2026 at 8:00 PM and will continue until the system is back to normal operations on October 12, 2026 at 8:00 AM.
What does this mean for me?
There is no change to MaineCare-covered services during this time, and you should continue to access care as usual. That includes using Non-Emergency Transportation and picking up prescriptions.
While most MaineCare services will continue as normal during the system upgrade, some requests and updates will be temporarily delayed while system information is being updated.
Medical Prior Authorizations
We will continue to review and process urgent medical prior authorization requests. An urgent medical service is care needed quickly to prevent a serious threat to life, limb, eyesight, bodily function, or organs, or to manage severe pain. Examples include, but are not limited to, urgent care for infections, heart or neurological conditions, cancer treatment, medical equipment, or postsurgical therapy.
We will not be reviewing and processing non-urgent (standard) medical prior authorization requests during this period, and it may take us a few days after this period to catch up. We are encouraging providers to submit non-urgent prior authorization requests as soon as possible.
Pharmacy Prior Authorizations (Prescriptions)
Prescribers should submit prior authorizations as normal.
Optum and the Pharmacy Help Desk will have access to real-time member eligibility information; there may be a minor delay in processing prior authorizations.
Behavioral Health Prior Authorizations
Your provider can continue to submit prior authorization requests for behavioral health services.
Private Health Insurance Premium Program (PHIP)
PHIP payments will be delayed by two weeks in October 2026 only. We will issue PHIP payments on October 20 instead of October 6.
We will issue November PHIP payments on their normal schedule. Please contact your PHIP benefit administrator if you have not received payment by Monday, November 2.
For questions about PHIP, please contact Member Services at 1-800-977-6740 or mainecaremember@gainwelltechnologies.com, Monday throughFriday, 7:00 AM – 6:00 PM.
What should I do if I am denied a service because my eligibility or address information is incorrect?
If you believe a provider has denied services because of incorrect eligibility or address information, please contact MaineCare as soon as possible:
- For questions about your eligibility or to make an address change, contact the Office for Family Independence (OFI) at 1-855-7974357
- For questions related to prescriptions, contact the Pharmacy Help Desk at1-866-796-2463. Please note that the Pharmacy Help Desk will be closed on Monday, October 12 for Indigenous People’s Day.
- For questions about other MaineCare-covered services, contact MaineCare Member Services at 1-800-977-6740.
When will normal operations resume?
Normal processing and operations will resume on October 12, 2026.
Thank you for your patience as the Office of MaineCare Services (OMS) completes this important system upgrade and continues to provide services to MaineCare members..