MaineCare Member Eligibility

January 5, 2012

This is to notify you that we have encountered a processing issue with MaineCare eligibility.

In the production of the monthly eligibility file, some member’s eligibility ended without a new January eligibility opening. Many of the members identified should have remained opened for the new month.

We have identified the members affected by this issue, and we are in the process of correcting the eligibilities. Over the next couple of days, the files should be corrected and the eligibility information will be updated. Once this is done, we expect that the claims that are currently rejecting can be reprocessed and submitted for payment.

Pharmacies currently processing prescriptions and receiving messaging from GHS stating “filled after coverage expired” or “no coverage on date of service” can call the MaineCare Pharmacy Helpdesk at 1-866-796-2463 if they want to confirm eligibility.

Member services will request that members ask their provider to contact Provider Services to confirm eligibility.

We appreciate your patience and your continued service to our MaineCare members.