Independent and Safety Net Pharmacy Organizations Qualifying for MaineCare Interim Payment

Mar 04, 2024

The Department of Health and Human Services (DHHS) will be issuing interim payments for independent and safety net pharmacies in response to the continued disruption of MaineCare’s pharmacy claims due to the cybersecurity issue affecting Change Healthcare. For previous communications about this issue, see the February 27, 2024 e-message here. 

Pharmacies that qualify for the interim payments are independent, small Maine chains, and/or serve as safety net providers for low-income residents. The Department is defining “safety net” pharmacies as those that operate in federally-qualified health centers, Critical Access Hospitals, and long-term care facilities. At this time, pharmacies that are part of health systems and large multi-state chains are not eligible for this interim payment . See the list of eligible pharmacy organizations here.   

The amount of the interim payment equals the average weekly MaineCare reimbursement to each qualifying pharmacy before the disruption. The Department will issue these weekly interim payments beginning this Wednesday, March 6. Pharmacies should receive payment on Thursday or Friday of this week depending on their bank and payment specifications. The interim payment will appear on the Remittance Advice, listed separately from any claims payments to the organization, and labeled as "Other." The payment made the week of March 4 will cover both the weeks of February 26 and March 4. Pharmacies do not need to apply for this interim payment but will be subject to reconciliation of payments once the disruption ends.  

Once Change Healthcare resumes operations, the Department will provide retrospective reimbursement for all pharmacies serving MaineCare members back to February 21, 2024, the first day of the system outage. The interim payments will be accounted for during this process. 

To reach DHHS about this issue: 

• Pharmacies with questions about the interim payments may call MaineCare Provider Relations pharmacy representative Shannon Beggs at (207) 624-4012. 

• Pharmacies checking individuals' MaineCare eligibility may call MaineCare Provider Services IVR at 1-866-690-5585. See the IVR Eligibility Check Instructions (PDF). Pharmacies can also check MaineCare member eligibility by logging into your secure trading partner account on the Health PAS Online Portal and clicking on the Eligibility Verification link. For full instructions to check eligibility, see the MHP Eligibility Verification User Guide.   

• MaineCare members experiencing trouble getting their prescriptions filled may call the MaineCare Pharmacy Help Desk at 1–866–796–2463. They may experience delays due to call volume.