Attention Pharmacy Providers: Handling of MaineCare Claims During Change Healthcare Network Outage

Feb 23, 2024

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.  

In accordance with MaineCare Benefits Manual Chapter II Section 80.07-11(D), we are temporarily authorizing the use of the 196 override code for a 3-day supply of any pharmacy medication claim, including controlled substances and inhalers or other fixed dose packaging. As a result of these temporary changes, regular prior authorization (PA) requirements for the pharmacy benefit are not in effect. Additionally, with utilization of the 196 override code, MaineCare is waiving the preferred drug list (PDL) requirements. Once normal operations have resumed, regular PA and PDL requirements will be in effect for continuation of medication therapy.  

This authorization for use of the override code does not enable benefit coverage for a member who has lost MaineCare coverage. Pharmacies can check eligibility for MaineCare members during this period by calling MaineCare Provider Services at 1-866-690-5585 or checking the HealthPas online portal. 

As a reminder, full benefit MaineCare members currently do not have copayments for their prescriptions. 

If pharmacies collect cash payments for prescriptions covered by MaineCare during this time, they should have a process to refund the member after this issue is resolved. 

We are working with Change Healthcare to determine a timeline for resolving these issues. We will send another message once we have more information or can announce a return to normal operations. 

Your Help to Ensure Ongoing Access to Buprenorphine and Other Life-Saving Medications 

Suddenly stopping buprenorphine and other medications can cause harm for members, including high risk of morbidity and mortality; maintaining access to buprenorphine is essential to keep people engaged in treatment and to avoid overdose death. To prevent medication interruptions we ask that, whenever possible, you support members by honoring buprenorphine requests and providing access to this and other necessary medications.