Attention MaineCare Providers: Plans to Release Payments Pended During Temporary MaineCare Payment Holds – June 16, 2025

On March 5, 2025, the Department shared that it would temporarily hold certain MaineCare provider payments beginning with the payment cycle that ran on March 12, 2025. Payment withholding has continued since then utilizing the same approach. In anticipation of receiving supplemental funding for Fiscal Year 2025, provided in P.L 2025 Ch. 2 on June 20, 2025, the Department is planning to release held provider payments and reinstate normal provider payment operations starting next week.

For the upcoming payment cycle running on June 25, 2025, the Department will take the following actions: 

  • Pay Critical Access Hospital prospective interim payments (PIPs) the 30 percent that was previously withheld; 
  • Revert to normal operations regarding pending and paying high-dollar hospital claims; 
  • Pay all pended claims for multi-state chain, large health system, and out-of-state retail pharmacies and durable medical equipment services; and 
  • Pay all pended claims for out-of-state providers of hospital and ambulance services. 

Affected providers will be able to track the medical/dental claim status of these previously held claims in the HealthPAS Online Portal. Temporarily held claims previously reflected a “pend” status during the payment withholding period that began on March 12, 2025.  As the Department begins the process of releasing the held claims, providers will begin to see their claims move to a “waitpay” or “pay” status through June 25, 2025.

For pharmacies whose payments have been held during this time:

Pharmacies will be caught up on all payments and reversals and be back to normal payment processing after the payment cycle on July 2, 2025. Pharmacies will see the relevant detail on their remittance advices.

  • All claims that have been temporarily withheld will be paid during the June 25, 2025, cycle. 
  • All reversals that have been pending during the temporary payment withholding period will process in the following cycle on July 2, 2025. This may cause the net July 2, 2025, payment to pharmacies to be lower than normal, reflecting the higher volume of reversals.

We remain committed to keeping providers informed. If the planned payment approach needs to change or if there are other relevant developments, we will send a communication out as soon as possible.