Attention Pharmacy Providers: Maine Point of Purchase System (MEPOPS) will return to service on March 27, 2024

Mar 25, 2024

MaineCare has established a timeline for restoration of its pharmacy benefit system, Maine Point of Purchase System (MEPOPS), following the disruption that occurred on February 21, 2024, due to the national cyber security issue with Change Healthcare. For more information about the Department’s response to this outage and resources available to pharmacies, please see this pharmacy provider FAQ.  

MaineCare will initiate a phased restoration of MEPOPS on March 27, 2024. This is the first phase of the restoration; we will send confirmation that this first phase is active on March 27, 2024. We will follow up as the phases progress until we can confirm that the system is fully operational. 

In consultation with the State of Maine Office of Information Technology (OIT) and after reviewing documentation provided by Optum leadership and a 3rd party security firm regarding the security of pharmacy services, the Department is restoring MEPOPS in a new operating environment. In collaboration with OIT, we have engaged with Optum and reviewed supporting documents that validate the security of the system and supporting environment which gives us the confidence to make this decision.   

Beginning March 27, 2024, pharmacies may transmit claims with dates of service during the outage period (February 21 – March 27) and may also transmit claims ongoing. As stated in its February 27, 2024 message, MaineCare will pay all eligible claims submitted during the outage. 

MEPOPS will be restored with all claim information and prior authorization data back to February 21, 2024. Pharmacies will experience some claim denials due to certain claim characteristics that were not waived during the outage, or claims that were submitted incorrectly. You can find a list of these characteristics on the technical instructions document on the MaineCare Provider Resources webpage. Some normal operating processes, like requirements for prior authorizations and member copays, will continue to be suspended during this initial phase while Change Healthcare works toward full restoration of its system for MaineCare. No copays should have been collected on any covered prescriptions dispensed to active MaineCare members during the outage.  

The Department stands ready to assist pharmacies as we transition MEPOPS back into service: 

• MaineCare is committed to assisting pharmacies with override instructions to facilitate processing of claims for eligible members.   

• Technical instructions for processing outage claims and accessing additional supports can be found on our Provider Resources webpage.  

• For immediate assistance with claims processing, pharmacies may call Optum’s Change Healthcare Pharmacy Provider Help Desk with questions at 1-888-420-9711.  

• For assistance with bulk processing of backlogged claims, Optum’s Change Healthcare Pharmacy Provider Help Desk is offering 2 options: 

1. The Provider Help Desk will be available for afterhours support by appointment. Please use this link to schedule your appointment by entering your name, email address, phone number and Pharmacy NPI when prompted. 

2. Encrypted emails with claims questions may be emailed to the Provider Help Desk at MaineHD@optum.com. Please include Pharmacy NPI, Rx number, and date of service for claims.  

These supports will be in place for at least 2 weeks after MEPOPS is restored, until April 10, 2024. After this 2-week period, the state will evaluate the need for continued support and communicate a decision to stop or continue any or all of these resources. 

MaineCare Pharmacy Service Disruption Office Hours – Thursday March 28, 2024 

For additional support, MaineCare is inviting you to join the next Office Hours call with the MaineCare Pharmacy team on Thursday, March 28, 2024, from 11 a.m. – 11:45 a.m. related to the current service disruption. We will use this time as an opportunity for sharing questions and concerns and providing technical support from the State. Please register in advance for this meeting: 

https://mainestate.zoom.us/meeting/register/tZMuduuhrzguG9cvWTFKS3oNy_uVNAY_iB47 

As there are developments related to the cyber security issue, we will send updated communications.