Attention Pharmacy Providers: Temporary MaineCare Payment Holds
On February 26, 2025, we announced that, absent emergency action by the Legislature, the Department would need to temporarily hold certain provider payments beginning with the payment cycle that will run on March 12, 2025. As of the time of this message, the Legislature has not approved the necessary funding to avoid these measures.
For the payment cycles that will run on March 12 and, if necessary, March 19, the Department plans to temporarily withhold payment for multi-state chain, large health system, and out-of-state retail pharmacies.
MaineCare will hold claims for these pharmacies during the weekly financial cycle as part of our temporary hold on certain provider payments. Independent pharmacies located in New Hampshire towns within 15 miles of the Maine border will continue to be paid.
Pharmacy claims will continue processing as normal in Maine Point of Purchase System (MEPOPS). Claims will show as Paid in MEPOPS, which is an indication that MaineCare will reimburse the provider for those claims; however, the payments will not be released for payment processing until funds are available. Pharmacies will know if their claims are temporarily held because pharmacies will not receive a Remittance Advice (RA) if their claim is not paid.
Please refer to the information shared in our March 5, 2025, e-message for more information.
Consistent with state and federal requirements, providers may not bill, demand, or otherwise seek payment from MaineCare members (or a representative of the member) in order to provide for any MaineCare covered service, with the exception that they may ask for copayments. However, pursuant to MaineCare Benefits Manual Ch 1 Section 1.09-1(B), no provider may deny services to a member for failure to pay a copayment.
We will share additional information as we are able.