Attention Pharmacy Providers: Updated Technical Instructions for Processing Backlogged Claims from February 21, 2024, through March 26, 2024

Apr 05, 2024

The Office of MaineCare Services thanks pharmacy providers for transmitting claims with dates of service during the outage period (February 21 through March 26). 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 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, Optum’s Change Healthcare Pharmacy Provider Help Desk is offering 2 options:  

1. The Provider Help Desk will be available for after-hours support by appointment. Please use the scheduling link provided within the technical instructions document 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 was 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 is inviting you to join an Office Hours call with the MaineCare Pharmacy team on Tuesday, April 09, 2024, from 3:00 PM – 3:45 PM 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/tZYsceyorjkrHNIN8u-8LcxnDjakIb13-y9w