Attention Pharmacy Providers: Status of Restoration of Maine Point of Purchase System (MEPOPS) and Updated Technical Instructions for Processing Backlogged Claims

Apr 30, 2024

The Office of MaineCare Services thanks pharmacy providers for transmitting claims with dates of service during the outage period (February 21, 2024, through March 26, 2024). In collaboration with Optum Change Healthcare, we have updated the technical instructions to reflect recent feedback received from pharmacy providers about claims denials.

We are entering a new phase in the recovery from the service outage and are beginning to restore waived edits. Edits will be restored in a phased manner. Beginning May 1, 2024, edits for Reject-79 Refill Too Soon and Reject-79 Refill Too Soon Carryover will return to normal functioning in the Pharmacy claims system.

Please continue to follow the MaineCare Preferred Drug list. 

We are committed to continuing to provide the following support: 

• 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 please submit an encrypted email to the Help Desk, including the list of claims requiring overrides to MaineHD@optum.com. Please include Pharmacy NPI, Rx number and date of service for claims.

MaineCare Pharmacy Service Restoration Office Hours – Friday May 03, 2024

For additional support, MaineCare is inviting you to join the next Office Hours call with the MaineCare Pharmacy team on Friday, May 03, 2024, from 1 p.m. – 1:45 p.m. related to the current phase of service restoration. We will use this time as an opportunity for sharing questions and concerns and providing technical support from the State. Register in advance for this meeting:

https://mainestate.zoom.us/meeting/register/tZIuc-iqrT8oG9dfmVXRQDYWgtfaY_SBW0vz

For questions, please contact Provider Relations Specialist Shannon Beggs.