Important. Please Read NewMMIS Notices - Chronological Archive

Messages from the Week of November 16, 2009

11/19/09

Legacy Electronic Data Interchange (EDI) Web Portal to be Discontinued on 11/27/2009

On November 27, 2009, MassHealth will discontinue use of the former EDI  Web Portal that supported legacy MMIS for electronic transactions (files created before implementation of NewMMIS in May 2009). If you need copies of any 835 or 997 transactions that were created before June 2009, you must download the files before November 27, 2009, at www.mass.gov/masshealth.gov. Click on Information for MassHealth Providers, then on MassHealth Claims Submission, then on Web-Based MassHealth Transactions, and then on Production Transactions.

After November 27th, only 835 and 997 files created since NewMMIS implementation will be accessible on the Provider Online Service Center (POSC) at www.mass.gov/masshealth/providerservicecenter.

MassHealth Customer Service has contacted any users of the former EDI Web portal that have accessed the site within the last three months to inform them of this change. 

For additional information about this transition, please refer to All Provider Bulletin 185 and All Provider Bulletin 187.

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 11/22 from 7:00 am to 11:00 am and 6:00 pm to 11:00 pm

The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable Sunday 11/22 from 7:00 am to 11:00 am and 6:00 pm to 11:00 pm due to system maintenance. Thank you for your patience during these scheduled maintenance windows and for your continued service to the Mass Health program.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

11/16/09

Masshealth Issues Member Seasonal Flu and H1N1 (Swine) Flu Informational Flyer

MassHealth has prepared an informational flyer to inform MassHealth members about coverage of the seasonal flu and H1N1 (swine) flu vaccines.  This informational flyer can be used as a resource to help providers inform their members about their MassHealth seasonal and H1N1 flu vaccine coverage. The flyer addresses vaccine eligibility concerns for both seasonal and H1N1 flu with regard to the member’s MassHealth plan requirements. The flyer also communicates some coverage limitations and lists further references for obtaining more flu-related information.

The flyer is being mailed to all households that have MassHealth members. You can download a PDF of the flyer by clicking on the Seasonal and H1N1 Flu Vaccine Coverage for MassHealth Members link under the News & Updates column on the home page of the MassHealth Web site.

For more information about the administration of the H1N1 vaccine, please refer to All Provider Bulletin 197, dated October 2009, available from the Provider Library at www.mass.gov/masshealthpubs.

Adult Day Health Services (ADH) Claims Reprocess

MassHealth initiated scheduled maintenance to ADH service codes on October 2, 2009.  The scheduled maintenance inadvertently caused some ADH service claims with dates of service between April 1, 2009 and October 23, 2009 to deny erroneously with Edit code 8121 (Adult Day Health Limit—1 Per Day). In addition, some claims were underpaid as a result of the maintenance.

MassHealth corrected the issue to ADH service codes on October 23, 2009 to ensure that future claims would process according to current billing procedures. MassHealth has systematically reprocessed all erroneously denied claims and adjusted claims that were underpaid. These adjustments will appear on the December 1, 2009 pay cycle.  Thank you for your patience.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.

Messages from the Week of November 9, 2009

11/12/09

To all MassHealth Providers

In anticipation of the upcoming holiday season, we wish to inform you that steps have been taken so that payments will not be delayed nor otherwise affected due to the holidays. The normal schedule will apply for posting the provider Remittance Advices and 835 transactions on the NewMMIS Provider Online Service Center.

Planned Session for Provider DDE WebEx:  TPL/CST

Training for Nursing Facility Providers- Portal DDE Claim Entry
Date: Wednesday, November 18, 2009 
Time: 1:00 - 2:30 pm 

MassHealth will be hosting a WebEx educational session to review how to enter TPL and Medicare crossover claims via DDE for Nursing Facility Providers. The sessions will allow providers to follow along as we enter a claim. We will then request providers to enter DDE claims themselves into production and ask questions as they go through the process. To register, please go to http://masshealthnewmmisprovidertraining.ehs.state.ma.us/

Third Party Liability (TPL) Cover Letter Notice

TPL cover letters are no longer required or accepted by MassHealth. NewMMIS functionality allows MassHealth to edit for other insurance by procedure code, modifier, place of service and other claim information. If the service is sometimes covered by the other insurer depending upon the patient's status (for example, home bound skilled level of care) please refer to your provider manual appendix for "Supplemental Instructions for TPL Exceptions." For questions, please contact MassHealth Customer Services at 1-800-841-2900.  Thank you.

NewMMIS

Please note:  NewMMIS users may experience intermittent connectivity issues due to technical upgrades Wednesday, 11/18, from 7:00 am to 9:00 am 

CORRECTION TO MESSAGE ISSUED LAST WEDNESDAY, NOVEMBER 4

Timeframe for Using Legacy PCC Referral Numbers Has Been Extended  

All Provider Bulletin 194: Primary Care Clinician (PCC) Referral Process (June 2009) indicated that, effective November 30, 2009, MassHealth would no longer accept the use of legacy-based provider numbers for referrals from PCCs. MassHealth is extending this deadline, and will continue to accept legacy PCC referral numbers for all new and pre-NewMMIS referrals until further notice.

When entering the legacy referral number into the Referral field, you must include two leading zeroes before the legacy PCC provider number.

If you have claims that denied for Edits 3120 (Referral Required on Claim) or 3124 (Rendering Provider Does Not Match Referral Auth) you may resubmit those claims using the legacy PCC referral number in the referral field.

Please continue to check POSC Broadcast Messages for updates to instructions for submitting claims that require referrals. Thank you. 

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

Messages from the Week of November 02, 2009

11/03/09

To Physicians and Group Practices:  Billing for H1N1 Vaccine Administration Before 10/18/09

When billing for H1N1 vaccine administration for dates of service before 10/18/09, when the sole purpose for the visit is vaccine administration, providers should use unlisted CPT Code 90749 and attach an office note indicating H1N1 administration. This code will be priced and paid as indicated in All Provider Bulletin 197.

Effective for dates of service on and after 10/18/09, follow the instructions in All Provider Bulletin 197, dated October 2009. To download a copy of the bulletin from the Provider Library, go to www.mass.gov/masshealthpubs.

Whenever possible, providers should make every effort to administer flu vaccines during regular visits with their members. In such cases, MassHealth will not provide any additional payment for administering the vaccine (s). In instances where providers cannot administer the H1N1 vaccine as part of a regular visit, MassHealth will pay only for the administration of the H1N1 vaccine, and will pay all providers the same fee, regardless of the provider type, in accordance with DHCFP Medicine regulation 114.3 CMR 17.00.

Timeframe for Using Legacy PCC Referral Numbers Has Been Extended

All Provider Bulletin 194: Primary Care Clinician (PCC) Referral Process (June 2009) indicated that, effective November 30, 2009, MassHealth would no longer accept the use of legacy-based provider numbers for referrals from PCCs. MassHealth is extending this deadline, and will continue to accept legacy PCC referral numbers until further notice.

When entering the legacy referral number into the Referral field, you must include two leading zeroes before the legacy PCC provider number.

If you have claims that denied for Edits 3120 (Referral Required on Claim) or 3124 (Rendering Provider Does Not Match Referral Auth) you may resubmit those claims using the legacy PCC referral number in the referral field.

Please continue to check POSC Broadcast Messages for updates to instructions for submitting claims that require referrals. Thank you.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.

Messages from the Week of October 26, 2009

10/29/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 11/1 from 6:00 pm to 10:00 pm

The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable Sunday 11/1 from 6:00 pm to 10:00 pm due to system maintenance. Thank you for your patience during these scheduled maintenance windows and for your continued service to the Mass Health program.

Pre-Admission Screening (PAS) Function Unavailable from Friday, 10/30 at 9:00 pm to Sunday, 11/1 at 10:00 pm

October 30^th is the last day that MassPro will process Pre-Admission Screening (PAS) Acute Hospital and Acute with Rehab Hospital requests. Permedion will take over this function starting Monday, November 2^nd.  In preparation for this change-over, providers will not be able to submit requests via the PAS panel on the Provider Online Service Center (POSC) from Friday, 10/30 at 9:00 pm to Sunday, 11/1 at 10:00 pm. 

To Home Health Agencies and Independent Nurses:  Prior Authorization Numbers Required on Claims for Procedure Codes T1002 and T1003

MassHealth previously announced the reprocessing of claims for continuous nursing services, single rate night shift and single rate weekends (T1002 UJ and T1003 UJ), that denied erroneously. All affected claims were due to be reprocessed and appear on remittance advice 100020, dated October 13, 2009. However, MassHealth has since discovered that only those claims having a prior authorization (PA) number were reprocessed at that time.

If your T1002 UJ and T1003 UJ claim was not processed on RA 100020, please resubmit it as if it were a new claim. Be sure to include the PA number but do not include the former internal control number (ICN) number.

Going forward, you must include a PA number on all continuous skilled nursing services (T1002 and T1003) claims submissions or your claims will be denied.  Thank you for your patience and cooperation.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

Messages from the Week of October 12, 2009

10/14/09

POSC Password Reset

Providers have indicated that when attempting to change their POSC password once it has expired, selecting the close button prompts the system to return to the same change password page they just completed. Please note that MassHealth is aware of this problem and is working to change it. In the interim, once you receive the message that your password has been successfully changed, please select the appropriate service from the left-hand side of the page to access the POSC.

** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices

Messages from the Week of October 5, 2009

10/8/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 10/11, from 6:00 pm to 10:00 pm

The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable Sunday, 10/11, from 6:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.

New ICD-9-CM Codes

MassHealth has updated the claims processing system to accept new 2010 ICD-9 Diagnosis and Procedure codes effective 10/1/09. Providers may begin using the new diagnosis and procedure codes for claims with dates of service on or after 10/01/09. Any claim submitted with a date of service on or after 10/1/09 that does not contain valid diagnosis or procedure codes will be denied.  Thank you for your cooperation.

WebEx Training Sessions to be Held for Provider DDE:  TPL/CST

MassHealth will host several WebEx educational sessions to review how to enter TPL and Medicare crossover claims via DDE. The sessions will allow providers to follow along as we enter the claims. We will then request providers to enter DDE claims for themselves into production and ask questions as they go through the process.  To register, please go to http://masshealthnewmmisprovidertraining.ehs.state.ma.us/.

Session 1 - Institutional Claims with Medicare A/B Paid

Date: Wednesday, October 14, 2009

Time: 1:00 - 2:30 pm - Institutional Inpatient

Time: 3:00 - 4:30 pm - Institutional Outpatient or Outpatient Ancillary

Session 2 - Professional Claims with Medicare B Paid

Date: Wednesday, October 21, 2009

Time: 1:00 -2:30 pm

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

10/5/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT, Monday, 10/5, from 9:00 pm to 10:00 pm

The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable TONIGHT, Monday, 10/5, from 9:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.

Remittance Advice Now Sorted By Member ID

MassHealth has heard your request for changing the PDF Remittance Advice (RA) sort. After thorough review, MassHealth is pleased to announce that starting with RA 100019, dated October 6, 2009, sorting will be by Member Identification Number instead of Internal Control Number (ICN). Thank you for your feedback. If you have questions about this change you can call MassHealth Customer Service at 1-800-841-2900.

Permedion Inc. Begins Acute Hospital Utilization Management Program November 2

Permedion Inc., a subsidiary of Health Management Systems, will assume operations as the MassHealth Acute Utilization Management Program (UMP) contractor on November 2, 2009. Starting on November 2, all Preadmission Screening Requests should be submitted to Permedion via the POSC, phone or fax numbers below. Masspro will continue to process any preadmission calls and requests received through October 30, 2009. Permedion will begin conducting prepayment reviews starting the week of November 2, 2009. Permedion postpayment review sampling will begin in November and Permedion will provide Peer Reviewer representation at hearings.

1-877-735-7416 (Permedion Phone)
1-877-735-7415 (Permedion Fax)

Permedion HMS Government Services
510 Rutherford Ave.
Charlestown, MA 02129

UJ Modifier/Prior Authorization Issue

MassHealth has identified an issue with claims denying erroneously for continuous nursing services, single rate night shift and single rate weekends (T1002 UJ and T1003 UJ). Affected claims will be reprocessed and appear on remittance advice 100020, dated October 13, 2009. No further action is required by providers at this time. MassHealth is addressing the cause of this issue and will communicate updated instructions for submitting UJ claims as a POSC Broadcast Message.

Dental Providers--Nursing Facility Visit

Effective October 1, 2009, MassHealth added dental CDT service code D9410 (Nursing Facility Visit) to the Dental Program Subchapter 6. The service code may be used when making a nursing facility visit. The code D9410 may be billed in addition to the actual service performed and may be billed once per day per member. If you have questions, please contact MassHealth Customer Service at 1-800-207-5019.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

Messages from the Week of September 28, 2009

10/2/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 10/4, from 6:00 pm to 10:00 pm

The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable this Sunday, 10/4, from 6:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.

September 30th Was Final Day to Use PIN to Register for NewMMIS Provider Online Service Center (POSC)

Existing Providers that have not yet registered should contact MassHealth Customer Service at 1-800-841-2900 to gain access to the POSC.  Thank you for your cooperation. 

Update about Medicare Part B Crossover Pricing

MassHealth previously informed providers that NewMMIS supports the repricing of Medicare Part B Crossovers. MassHealth will pay Medicare Part B Crossover claims up to the MassHealth allowable amount less any Medicare payment, or the coinsurance and deductible amount, whichever is less.  In calculating the difference between the MassHealth allowable amount and the Medicare payment, NewMMIS will apply the following payment rules:
 
1) If MassHealth has not adopted the Medicare code and has a comparable code for the service, it will use the comparable code and rate for payment. Please see "Medicare Code to MassHealth Comparable Code Cross Reference" listing.

2) If MassHealth has not adopted the code because it is a non-covered service, MassHealth will not pay the Medicare coinsurance and deductible.  Please see attached documents "MassHealth Non-Covered Codes for All Pts" as well as "MassHealth Non-Covered Codes for Spec Prov Types" listings.
 
If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900.  Thank you for your patience and cooperation. 

Update on Automated Test Panel (ATP) Service Codes:  For Physicians, Nurse Practitioners, Nurse Midwives, Clinical Labs, and Acute Outpatient Hospitals 

Please be sure to review the Clinical Laboratory Services Rate regulation (114.3 CMR 20.04) to obtain the list of Service Codes subject to the ATP panel rate payment methodology.  This regulation is available online by clicking on the Clinical Laboratory Services Rate regulations.

** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices.

Messages from the Week of September 21, 2009

09/25/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 9/27, from 6:00 pm to 10:00 pm

The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable this Sunday, 9/27, from 6:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.

** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

09/21/09

NewMMIS Password Expiration Notices to Begin Wednesday, September 23, 2009

In an effort to help ease transition to NewMMIS, MassHealth relaxed the enforcement of the standard security requirement to change passwords every 90 days on the Provider Online Service Center (POSC). Now that it has been almost four months since NewMMIS implementation, MassHealth will reinstate enforcement of this policy beginning this Wednesday, September 23, 2009.

After September 23, providers with passwords that have been in effect for more than 90 days will be prompted to change passwords. In addition, if your password is due to expire within 15 days of the standard 90-day period, you will receive a password expiration prompt and the option to make the change when you log in.  Please be sure to follow the instructions on the screens if you receive these prompts.  Thank you for your patience and cooperation. 

To assist you, we remind you of the NewMMIS Password rules:

Passwords must contain:

• Between 8 and 16 characters
• One upper case character (i.e., A, B, C)
• One lower case character (i.e., a, b, c,)
• One number (i.e., 1, 2,3)

Passwords cannot contain:

• The words “test”, “password” or “pass”
• Your first name, your last name, or your full name
• Your account ID
• Your email address
• Any recently used password

** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

Messages from the Week of September 14, 2009

09/18/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Saturday, 9/19, from 7:00 am to 10:00 am

The NewMMIS POSC, including the Voice Response application, EVSpc, and all eligibility services, will be unavailable this Saturday, 9/19, from 7:00 am to 10:00 am due to system maintenance. We apologize for the inconvenience.

** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices.

Prior Authorizations with Status of “In Process” to be Deleted on September 30, 2009

Please be advised that on September 30, all Prior Authorization (PA) requests created between May 16, 2009 and August 31, 2009 with a status of IN PROCESS will be deleted.  PA requests with a status of IN PROCESS represent PAs that were started but never submitted to MassHealth. 

** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices

Messages from the Week of September 7, 2009

09/11/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 9/13, from 4:00 pm to 10:00pm

The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable this Sunday 9/13, from 4:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.

Update:  MassHealth HIPAA Trading Partner Testing Has Resumed

MassHealth resumed HIPAA compliance and comprehensive testing on September 9, 2009. Please call MassHealth Customer Service at 1-800-841-2900 to arrange trading partner testing before submitting any test files. Select Option 1, Option 8, then Option 3 to speak with an Electronic Data Interchange (EDI) unit representative to coordinate testing. You may also email your request to test electronic X12 transactions to hipaasupport@mahealth.net. Any test files submitted without prior knowledge and coordination with the EDI unit will not be monitored for review of results.

If you plan to use an approved billing intermediary or software vendor to submit electronically you do not have to test with MassHealth directly. EDI will still need to obtain certain necessary information however prior to testing with your billing intermediary or software vendor. For more information, please refer to testing instructions at www.mass.gov/masshealth/newmmis.

Utilization Management Program Updates For Acute Hospitals

MassHealth has made some changes to the Utilization Management Program for acute hospitals that will take effect on November 2, 2009.  As a result of these updates, the annual volume of claims subject to pre-payment reviews will increase from 15,000 claims to 20,000, inpatient post-payment reviews will increase from 10,000 claims to 15,000 claims, and outpatient post-payment reviews will increase from 5,000 claims to 20,000 claims. Post-payment reviews will be conducted as a combination of mail-in and on-site reviews.  Thank you for your continued cooperation. 

Update: Medicare Part B Crossover Claim Re-pricing

Some Medicare Part B crossover claims that were previously in suspense status have been processed by MassHealth. Please note that MassHealth will use the comparable MassHealth code for rate derivation when the crossover claim is billed with a code that MassHealth has not adopted. Please refer to the recent NewMMIS notice NewMMIS Functionality Supports Medicare Part B Crossover Claim Repricing at www.mass.gov/masshealth/newmmisnotices for additional information.

Messages from the Week of August 31, 2009

09/04/09

Notice Concerning NewMMIS Claim Edit 800:  “HCPCS Requires National Drug Code (NDC)”

MassHealth has identified that 837P electronic claims submitted with National Drug Code (NDC) information for physician-administered drugs are being erroneously denied for Edit 800: “HCPCS Requires NDC.” In addition, MassHealth has learned that many of these claims are being submitted without the required NDC information. Please check POSC Broadcast Messages for instructions on resubmitting these claims. Please remember that these claims cannot be billed via direct data entry (DDE) on the Provider Online Service Center (POSC) at this time.

For more information please visit www.mass.gov/masshealth click on Information for MassHealth Providers, then on National Drug Code (NDC) Requirements for Physician-Administered Medications or call MassHealth Customer Service at 1-800-841-2900.

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

09/02/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Wednesday 9/2, from 9:00 pm to 10:00 pm

The NewMMIS POSC, including the internal NewMMIS application, will be unavailable Wednesday 9/2 from 9:00 pm to 10:00 pm due to system maintenance.  Eligibility-related services WILL be available, including the Automated Voice Response, EVSpc and HTS.  Thank you for your patience and cooperation. 

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

08/31/09

To all MassHealth Providers:  Availability of 835s

Please be advised that this week’s HIPAA 835 files will be available tomorrow, September 1, for download by trading partners on the NewMMIS portal.  As a reminder, this is consistent with previous communications to providers that Tuesday is the designated day for 835 availability, although occasionally they have been available earlier.  We therefore want to take this opportunity to remind providers once again that they can expect to receive their 835 files each Tuesday.  We appreciate your patience and cooperation.     

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

Messages from the Week of August 24, 2009

08/28/09

Important Message about Replacement Claims Transactions

Claims adjustments can be done electronically using the HIPAA-compliant 837 or direct data entry (DDE) format as a replacement transaction. Replacement transactions correct previously paid claims and are not meant to be used for resubmitting denied claims. The replacement claim should include all corrections as well as the full amount requested, not the difference between what was paid previously and what you are expecting now. For HIPAA-compliant 837 formats, submit the corrected claim as a replacement Frequency Code 7. For DDE formats, hit the Replace button, correct the claim and click on the Submit button. This procedure can be used to change any field on the claim except for changes to the Member Number, Pay-to Provider Number, Date of Service, or Claim Type. MassHealth recommends that you share this information with your software vendor or electronic billing intermediary. For additional information, consult the applicable MassHealth Companion Guides on the MassHealth Web site at www.mass.gov/masshealth/newmmis. Click on Need Additional Information or Training then on Updated Billing Guides, Companion Guides, and Other Publications.

MassHealth HIPAA Trading Partner Testing To Resume

MassHealth will resume HIPAA Compliance and Comprehensive Testing on September 9, 2009. Please call MassHealth Customer Service at 1-800-841-2900 to arrange Trading Partner testing before submitting any test files. Select Option 1, Option 8, then Option 3 to speak with an Electronic Data Interchange (EDI) unit representative to coordinate testing. You may also e-mail your request to test electronic X12 transactions to hipaasupport@mahealth.net.  Any test files submitted without prior knowledge and coordination with the EDI unit will not be monitored for review of results.

If you plan to use an approved billing intermediary or software vendor to submit electronically you do not have to test with MassHealth directly. EDI will still need to obtain certain necessary information, however, prior to testing with your billing intermediary or software vendor. Testing instructions are being updated and will be posted to the Web. Please continue to check POSC Broadcast Messages for more information.

To all Nursing Facility and Rest Home Providers

Nursing facility and rest home providers who bill for Medical Leave-of-Absence (MLOA) and Non-medical Leave-of-Absence (NMLOA) using direct data entry (DDE), must enter the appropriate Occurrence Code and choose “BI” as the Occurrence Type from the Extended Services tab. In addition, please remember to complete the From and To date fields. Claims submitted for these services that do not contain this information will be denied.  Thank you for your cooperation.

Update:  Medicare Part B Crossover Denials for Error 7740

Some Medicare Part B crossover claims that were previously in suspense status have been processed by MassHealth.  Medicare Part B crossover claims submitted to MassHealth for services that are not covered by MassHealth will be denied with Error 7740- FINAL EDIT PROC NOT COVERED BY PROV CONTRACT.  Please refer to Broadcast Message dated 08/06/09 "NewMMIS Functionality Supports Medicare Part B Crossover Claim Repricing" for additional information

08/27/09

Third-Party Liability (TPL) Termination Letters from an Insurer

To notify MassHealth of a member’s termination of insurance, you must complete a Third-Party Liability (TPL) Indicator Form. The TPL Indicator Form and the insurer letter must be faxed to the TPL unit at 617-357-7604. Please exclude MCO, Medicare and Medicare Advantage plans. You must specify the termination date of the insurance policy on the TPL Indicator Form. The TPL unit will update the member’s file within five business days. Prior to submitting your claim to MassHealth, please check EVS to verify that TPL information has been updated.  If you are submitting a paper claim to MassHealth, do not attach the TPL Indicator Form or the insurance termination letter to your claim.

The TPL Indicator Form may be downloaded at www.mass.gov/masshealth. Click on MassHealth Regulations and Other Publications, then on Provider Library, and then on MassHealth Provider Forms.

Important Message to all Nursing Home Providers

Nursing home providers submitting TPL claims no longer need to include non-Explanation of Benefits (EOB) attachments. Instead, MassHealth advises that you keep any TPL attachments such as Medicare Advanced Beneficiary Notices, Insurer UR Notices, Medicare Notices of Non-Coverage on file.  For TPL purposes, Patient Status code or Condition codes are no longer used.  Using these obsolete codes may cause your claims to deny.  Providers must now submit electronic or paper TPL claims using the correct Adjust Reason code.  Please follow the billing instructions listed in Transmittal letter (TL) NF-54 (April 2009).  In addition, paper submissions must bill with a completed TPL Exception Form for Nursing Facilities and All Inpatient Hospitals. The TPL Exception Form is located on the Mass Health Web site at www.mass.gov/masshealth. Click on Mass Health Regulations and Other Publications, then on Provider Library, and then on Mass Health Provider Forms.

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

08/26/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 8/30, from 6:00 pm to 10:00pm

The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday 8/30, from 6:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

Messages from the Week of August 17, 2009

08/20/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Tonight, 8/20, from 9:00pm to 10:00pm

The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable tonight, Thursday, 8/20, from 9:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.

 ** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

08/17/09

PIN Registration for New MMIS Provider Online Service Center (POSC) has been extended to September 30, 2009

MassHealth has heard your request for additional time to register to access the Provider Online Service Center (POSC), and has extended the registration period. The last day a provider may register on the POSC using their PIN will be September 30, 2009. After this date, the Primary User for each provider organization will be required to contact MassHealth Customer Service to gain access to the POSC. If you have not yet registered, we strongly urge you to take full advantage of the additional time to complete the POSC registration before September 30, 2009.  Thank you for your cooperation. 

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

Messages from the Week of August 10, 2009

08/14/09

Nursing Home Providers that Bill for Members in Rest Home Beds Should Resubmit Denied Claims

Claims submitted by nursing homes that bill for members in rest home beds have been denying incorrectly. MassHealth has corrected this issue. Nursing home providers billing for these services should resubmit the denied claims using “Type of Bill” 860 through 865 and “Value Code” 24. Including this information will allow MassHealth to uniquely identify these services and process the claims appropriately. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

08/13/09

To all Providers of Medical Supplies, Durable Goods, Oxygen and Respiratory Equipment and Pharmacy Providers

MassHealth is researching an issue involving HCPC codes that have been denied for Edit 2505: Member Covered by Medicare. Some of these codes will soon be mapped and set to “pay.” In addition, MassHealth will reprocess those claims that denied incorrectly with Edit Code 2505 prior to the change to make them payable.  MassHealth will communicate at a future time which HCPC codes were affected and when claims will be reprocessed. No further action is required by providers at this time. 

Nursing Home Crossover Denials for Error 4059: Revenue Code Not on File 

Crossover claims will no longer encounter denial Error 4059: Revenue Code Not on File, when billed with revenue codes 180, 182, 184, or 189 to report MLOA (Medical Leave of Absence) days. MassHealth will not reprocess previously denied claims. Instead, providers should resubmit the affected claims that denied.  If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

08/12/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT, 8/12, from 6:00 pm to 8:00 pm

The NewMMIS POSC, including the internal NewMMIS application and all eligibility services, will be unavailable tonight 8/12, from 6:00 pm to 8:00 pm due to system maintenance

NewMMIS Is Currently Experiencing Technical Difficulties:

Please be advised that users of both the NewMMIS Provider Online Service Center (POSC) and the internal NewMMIS application are experiencing difficulty accessing NewMMIS this morning.  Technical teams are aware of the problem and working to resolve it.  We apologize for the inconvenience and appreciate your patience.  We will keep you posted on the status of this issue. 

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices.

08/11/09

Important Update about NewMMIS and Rest Home Claims

MassHealth has identified that some Rest Home claims were denied inappropriately for Edit 2052: Level of Care/Aid Cat Conflict. Claims that denied erroneously with this edit will be reprocessed and begin to appear on the August 18, 2009 Remittance Advice. No further action is required by providers. We apologize for any inconvenience this may have caused.

Reminder for Providers Submitting Adjusted Claims in NewMMIS

MassHealth recently informed providers that they can resume submitting claims as adjustments with the Legacy MMIS Transaction Control Number (TCN). The issue of some of these claims denying inappropriately was resolved.

However, when submitting adjusted claims using a Legacy TCN, please be sure to include the leading “20” of the TCN. For paper claim adjustments enter an “A” followed by the TCN.

MassHealth thanks you for your patience and cooperation.

** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices 

Messages from the Week of August 3, 2009

08/07/09

Important Update:  Helpful Materials Available for MassHealth Providers:

For MassHealth Providers Who Submit Institutional Claims for MassHealth, MassHealth and Medicare, and MassHealth and Other Insurance:

MassHealth has posted three updated job aids on the e-learning training Web site. The Job Aids outline NewMMIS direct data entry (DDE) requirements for providers submitting Institutional Claims for members with MassHealth only, members with MassHealth and Medicare both and members with both MassHealth and other Insurance.   These job aids have been added as: POSC - Submit an Institutional Claim with MassHealth, Submit an Institutional Claim with MassHealth and Medicare, and Submit an Institutional Claim with MassHealth and Other Insurance to the e-learning Web site at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/.  The job aids are located in course POSC - Submitting Institutional Claims under the heading Course Materials.

For MassHealth Providers Who Bill Using the Form CMS-1500

MassHealth ha­­s posted additional CMS-1500 paper billing support documents to both the NewMMIS and e-learning training Web sites. The documents outline fields that need to be entered when filling out a CMS-1500 form for TPL and provide additional instructions for providers who bill using the paper CMS-1500.

These paper billing support documents have been added as Special Instructions for Submitting Claims on the CMS-1500 for Members with Medicare Coverage and Special Instructions for Submitting Claims on the CMS-1500 for Members with Commercial Insurance to the e-learning Web site at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/. The documents are located in course POSC - Submitting Professional Claims under the heading Course Materials.

The documents have also been added to the NewMMIS Web site, http://www.mass.gov/masshealth/newmmis.  Click on Need Additional Information or Training?  Then, click on Updated Billing Guides, Companion Guides, and Other Publications.  The documents are located under the heading Billing Guides as Special Instructions for Submitting Claims on the CMS-1500 for Members with Medicare Coverage and Special Instructions for Submitting Claims on the CMS-1500 for Members with Commercial Insurance.

For MassHealth Providers Who Submit TPL Exception Claims for Home Health Agencies or for Chronic and Rehabilitation Hospitals:

MassHealth has posted additional job aids on the e-learning training Web site. The Job Aids outline NewMMIS direct data entry (DDE) requirements for providers submitting TPL Exception Claims for Home Health Agencies or for Chronic and Rehabilitation Hospitals.

These job aids have been added as: TPL Exception Claim Submission for Home Health Agencies and TPL Exception Claim Submission for Chronic and Rehabilitation Hospitals to the e-learning Web site at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/. The job aids are located in course POSC - Submitting Institutional Claims under the heading Course Materials.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

08/06/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Saturday, 8/8 from 7:00 am to 10:00 am

The NewMMIS POSC, including the internal NewMMIS application and all eligibility services, will be unavailable Saturday 8/8/09 from 7:00 am to 10:00 am due to system maintenance.

New Software Patch Now Available for MassHealth EVSpc Software Users   

A new EVSpc patch (version 4.03) has been posted at Information and Software for Electronic Transactions to address a number of provider requests. If you have the new version of the EVSpc software for NewMMIS you simply need to download that patch and not the entire version of the software. Information and Software for Electronic Transactions also has a link for release notes detailing the nine updates that were applied to the software which include the software now highlighting changes to member eligibility from a previous eligibility inquiry on the EVSpc software for the same member.  Please call MassHealth Customer Service at 1-800-841-2900 with any questions.

NewMMIS Functionality Now Supports Medicare Part B Crossover Claim Repricing

As outlined in All Provider Bulletin 114, (See www.mass.gov/Eeohhs2/docs/masshealth/bull_2002/all-114.pdf), MassHealth will pay Medicare Part B crossover claims up to the MassHealth allowable amount less any Medicare payment, or the coinsurance and deductible amount, whichever is less.

In calculating the difference between the MassHealth allowable amount and the Medicare payment, NewMMIS will look to see if MassHealth has adopted the Medicare code or has a comparable code for the service and look at the rate for the applicable code. MassHealth will not pay for non-covered services. 

However, MassHealth will pay co-insurance and deductibles for services that are covered by Medicare and would not otherwise be covered by Medicaid when the service is provided to a MassHealth member who is eligible for coverage of Medicare coinsurance and deductibles.   

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

08/05/09

NewMMIS “Zero Paid Claims” Issue Has Been Resolved

Beginning in July 2009, some claims began paying zero inappropriately with EOB code 9928: COB-TPL Cost Savings. MassHealth is pleased to inform you that it has resolved the issue. Affected claims are being reprocessed. No further action is required by providers at this time. If you have questions, contact MassHealth Customer Service at 1-800-841-2900.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

 08/04/09

Claims Adjustment Issue in NewMMIS Has Been Resolved:

In July, MassHealth advised providers that certain claims submitted as adjustments with the Legacy MMIS Transaction Control Number (TCN) were denying inappropriately and that providers should hold such submissions pending further notice.

MassHealth is pleased to inform providers that this issue has been resolved and that providers can now submit claims as adjustments with the Legacy MMIS TCN

MassHealth thanks you for your patience and cooperation.

Messages from the Week of July 27, 2009

07/30/09

Notice of POSC Technical Issues:  

Please be advised that the POSC has experienced a few 15-30 minute periods of technical issues since Tuesday 7/28/09.  Until the issue is resolved, you might experience short periods where POSC is not accessible or responsive.  When this happens, you may not be able to complete the current action you are performing. Should you experience an outage or slow response, please wait 15 minutes and try your transaction again. We apologize for any inconvenience this causes.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

07/28/09

Notice Concerning Acute Outpatient NewMMIS Claims Filed with an Institutional Form or Transmission:

Some providers are receiving the following message in error in response to acute outpatient claims filed on an institutional UB-04 claim form or via an 837 I claim transmission:  “520 INVALID REVENUE CODE/PROCEDURE CODE COMBINATION.”  MassHealth is aware of this issue and its cause, and is actively working to add the revenue code/procedure code combinations that are accepted.  We will keep you posted as to our progress.  Thank you for your patience and cooperation.

EVS Health Safety Net (HSN) Secondary Messaging Issue Has Been Resolved:

Previously, EVS incorrectly displayed the following restrictive message when a patient was eligible for Health Safety Net or Partial Health Safety Net and there was no other health insurance on file on the date of service searched:

“Member is HSN Secondary. Bill member’s private health insurance. See 114.6 CMR 13.00 for info on TPL REQs.”

This restrictive message now only appears when the member has other insurance that is known to MassHealth.  This issue has now been resolved.  If you have any questions, please contact the Health Safety Net Helpdesk at 1-877-910-2100.

Update Regarding NewMMIS Claims Denied for Error Code 1945:

Claims processed in NewMMIS for week ending July 24 that denied in error for edit “1945-MULT SAK PROV LOCS FOR BILLING PROV SPEC” may now be rebilled to MassHealth. The error, caused by a change to the MassHealth NPI crosswalk that resulted in denials for providers that bill with a single NPI but who have multiple service locations, has been resolved.   We apologize for the inconvenience.  Providers who receive this error message appropriately should contact MassHealth Customer Service at 1-800-841-2900 to discuss claim submission options.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

7/27/2009

Important Announcement about Claims Submitted on NewMMIS

Beginning July 20, 2009 some claims in NewMMIS began denying inappropriately for error code 1945-MULT SAK PROV LOCS FOR BILLING PROV SPEC.  A change was made to the MassHealth NPI crosswalk on July 19 that resulted in denials for providers that bill with a single NPI but have multiple service locations. MassHealth is working to correct this issue as quickly as possible and will provide an update soon.  Thank you for your patience.

Messages from the Week of July 20, 2009

7/21/09

NewMMIS E-Fax Issue Has Been Resolved

Previously, MassHealth indicated that we were experiencing problems viewing some of the attachments submitted by providers using e-fax.  This problem has been resolved.  All attachments generated via e-fax will be created in PDF format. Please ensure that you download the free Acrobat Reader 7.0 or newer to open and read documents in PDF format.  If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900.

To MassHealth Providers Who Bill Using Form UB-04

MassHealth has posted an additional UB-04 TPL paper billing support document to both the NewMMIS and e-learning training Web sites. The document outlines fields that need to be entered when filling out a UB-04 form for TPL and provides additional instructions for providers who bill using the paper UB-04.

This paper billing support document has been added as the UBO4 Claim Form_TPL Required Information job aid to the e-learning Web site at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/. The job aid is located in course POSC - Submitting Institutional Claims under the heading Course Materials.

This document has also been added to the NewMMIS Web site as Special Instructions for Submitting Claims on the UB-04 for Members with Other Health Insurance. It can be found at http://www.mass.gov/masshealth/newmmis under Need Additional Information or Training? Click on Updated Billing Guides, Companion Guides, and Other Publications.  The document is located under the heading Billing Guides.

Thank you for your cooperation. 

TPL Denials for Error Codes 2502 and 2505 for Personal Care Agencies and Independent Living Providers

MassHealth will reprocess claims that denied for error codes 2502, Member Covered by Other Insurance, or 2505, Member Covered by Medicare for Billed Procedure Codes S5160 and S5161, on a future RA. Please do not resubmit these claims. No further action is required by providers. New third party liability (TPL) claims submitted to MassHealth for these services will not receive error 2502 or 2505. If you have questions, please call MassHealth Customer Service at 1-800-841-2900.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices 

URGENT:  Message for Users Experiencing Login Issues on NewMMIS this Morning 

Please be advised that some NewMMIS users are experiencing login issues this morning.  A feature requiring users to reset their passwords after 90 days is not working properly.  Consequently, when some users reset their password, they receive an unexpected error message.  Technical teams are aware of the problem and are currently working to resolve the issue.  We apologize for any inconvenience.  We will provide updates on this issue as more information becomes available.  Thank you for your patience. 

Messages from the Week of July 13, 2009

7/17/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 7/19 from 6:00 pm to 8:00 pm:

The NewMMIS POSC, including the internal NewMMIS application and all eligibility services, will be unavailable from 6:00 pm to 8:00 pm due to system maintenance.

7/16/09

Update from MassHealth About NewMMIS and Prior Approvals:

MassHealth has identified some issues in the Prior Approval (PA) area that are expected to be corrected over the next few weeks. These changes will enable the MassHealth PA Unit to process requests more quickly and eliminate any backlog.  Please be assured that MassHealth is committed to resolving these issues expeditiously, and to working with providers to ensure that services to members are not interrupted, and that members newly requesting services receive timely access to those services.  To that end, we've determined that additional training would help providers during this time to work through the issues and to enhance their overall understanding of the new system and processes.  The next training addressing PA/PAS issues is scheduled for August 15.  You may register for a session through the MassHealth e-Learning system at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/default.asp. Once logged in, open the Course Catalog and select NewMMIS Question and Answer Sessions by Topic for Providers.  Click on View Course Details and Enroll. To register for a session, click on Session Schedule tab and select the applicable Action button.

While we address these issues, here is some information that will be helpful to you:  

Please be aware that Personal Care Attendant (PCA) PAs are being extended to eliminate a break in service. When the new PA is adjudicated the extension will be end-dated and the new PA will start the next day. To further assist PCA providers, MassHealth is updating the job aids regarding prior authorization to make those job aids specific to the PCA program.     

Durable Medical Equipment (DME) providers should e-mail Tania.Gray@state.ma.us and "cc:" cemilia.ceme@state.ma.us if they have specific PAs that are about to expire in order for the PAs to be adjudicated immediately. To help MassHealth concentrate on PAs whose expiration date is imminent, DME providers are asked not to contact MassHealth about PAs that are not due to expire until August.

All providers:  Be sure to check EVS before submitting PA's to determine if the member is eligible. Please note a warning message will also display if you attempt to submit a PA via the POSC for a member that is not eligible.

Voiding PAs:  If you previously encountered difficulty voiding PAs, please be advised that this issue has been resolved and you should now be able to void a PA if you have changed your mind and no longer want to submit the PA to MassHealth.  Once the PA has been submitted to MassHealth you will need to contact the PA Unit if you want to void the PA.

Searching using an old provider number:  You can search for PAs using your old provider number but please be advised that two zeros must be inserted in front of your "legacy" provider number.

Duplicate Errors: In certain circumstances providers get a "duplication" error when they attempt to submit a PA.  To avoid this error, change the service date by one day (so it does not duplicate against the previous PA).  This allows the PA to go through. You should indicate the correct service dates in the comment section and MassHealth will update the dates on the PA.

E-fax issue:  MassHealth is experiencing problems viewing some of the attachments that come in via e-fax. Please note that the PA Unit will contact you if there is a problem viewing your attachments. Work is underway to resolve this issue.  We will keep you posted as to resolution progress.  Please do not stop using e-fax service as, absent the ability to upload scanned documents, this is the most expeditious way to submit your attachments with your electronic PA submission.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

7/15/09

Direct Data Entry Cannot Be Used For Billing National Drug Codes (NDC) For Physician-Administered Drugs:

Please be advised that claims for physician-administered drugs that require NDC information cannot be received as direct data entry (DDE) claims in the Provider Online Service Center. These claims must be submitted on paper using the CMS-1500 claim form or electronically using an 837 transaction.  

For general information about billing these claims, please see the appropriate billing or companion guide or go to www.mass.gov/masshealth and click on MassHealth and HIPAA, then on Electronic Data Interchange (EDI) and HIPAA Information for Providers, then on the MassHealth Companion Guides link, and choose the 837P/837I Companion Guide or UB-04 or CMS-1500 Billing Guide.

Third Party Liability (TPL) Paper Claims Notice:

Some providers may have experienced a delay in the processing of their TPL paper claims (Commercial and Medicare) due to a lack of submitting required information on the claim form.  MassHealth has addressed the issue for the majority of the affected claims.  Providers should begin to see their TPL claims process on future remittance advices. As a reminder, it is important that you enter the carrier code on your claim form. If there are multiple payers, indicate the carrier code on each explanation of benefits (EOB). Please refer to Appendix C of your MassHealth provider manual for a list of MassHealth carrier codes. The provider manuals can be found in the Provider Library at www.mass.gov/masshealth/masshealthpubs. If you have questions, please call Customer Service at 1-800-841-2900.

Atypical Providers Billing with the NewMMIS Provider ID Service Location (PID SL):

MassHealth identified a system issue for atypical providers submitting 837I and 837P transactions using their PID SL. The system is dropping the service location (SL) from the PID SL, causing claims to deny for EOB code 254-Billing Provider Location Missing.  This issue is being corrected by Thursday, July 16, 2009.  Please note that paper claims and direct data entry (DDE) claims have not been affected. The claims that were denied erroneously as a result of this issue will be reprocessed at a future date. Providers can wait for the reprocess of these claims or resubmit them through EDI after July 16 or through direct data entry (DDE) or on paper. If you have questions please call MassHealth Customer Service at 1-800-841-2900. 

Please Hold Claims Adjustments:

Certain claims submitted as adjustments with the Legacy MMIS Transaction Control Number (TCN) have denied inappropriately with EOB codes 550-Adjustment Failed and 1101-Invalid Adjustment Former TCN. Claims that denied erroneously with these edits will be reprocessed on a future date. No further action is required by providers. Due to this problem, MassHealth recommends that providers hold all adjustments that would be submitted with a former Legacy MMIS TCN until further notice. We apologize for the inconvenience.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT, 7/15 from 6:00 pm to 9:00 pm:

The NewMMIS POSC, including the internal NewMMIS applications, will be unavailable TONIGHT, 7/15, from 6:00 pm to 9:00 pm due to system maintenance.  However, from 8 pm to 9 pm, the following WILL BE AVAILABLE:  EVSpc, HTS and the Automated Voice Response (AVR).

7/14/09

Webex Provider training sessions:

MassHealth is holding several NewMMIS Webex training sessions for the provider community throughout July and August. Each session will focus on a different functional area of the system. Some of the topics include third-party liability, referrals, prior authorizations, and professional and institutional claims.

You may register for a session through the MassHealth e-Learning system at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/default.asp. Once logged in, you should open the Course Catalog and then select NewMMIS Question and Answer Sessions by Topic for Providers. To identify specific learning opportunities, click on View Course Details and Enroll. To register for a session, click on the Session Schedule tab and select the applicable Action button. Failure to follow these registration steps exactly will result in an incomplete registration and you will not receive the needed course materials.

MassHealth will e-mail downloadable software and course access instructions to all registered providers upon successful enrollment into a course. If you have questions contact MassHealth Customer Service at 1-800-841-2900.

Topic	Month of July 1PM – 3PM	Month of August 1PM – 3PM
TPL & Crossovers	7/7/09	8/3/09
PA/PAS	7/15/09	8/13/09
Professional Claims	7/20/09	8/17/09
Referrals	7/23/09 – new date	8/10/09
Institutional Claims	7/30/09	8/25/09

 

 

 

 

 

 

 

 

 

 

 

 

Please Remember to Check View Broadcast Messages in the Provider Online Service Center (POSC):

It is important that you make it a part of your routine to check Broadcast Messages daily for any critical information or communications that MassHealth has posted. POSC Broadcast Messages are one of the primary methods MassHealth uses to communicate timely updates to providers. To access Broadcast Messages, sign on to the POSC, click on Manage Correspondence and Reporting, and then click on View Broadcast Messages.

Medicare Benefits Exhausted Claims Notice:

MassHealth has identified an issue where the Medicare Part B ancillary payments are not being deducted from Medicare Benefits Exhausted claims. MassHealth is actively working on a resolution and will reprocess all affected claims. In the interim, providers should continue to bill these claims to MassHealth. Please check future messages for updates. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

Nursing Home Crossover Claims Notice:

MassHealth has identified an issue where a patient paid amount is deducted when there is no patient paid amount on file for the member. No action is required by the provider. Masshealth is actively working on a resolution and will reprocess all affected claims. Please check future messages for updates. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

TPL CLAIM SUBMISSIONS FOR MEDICARE NONCERTIFIED CLINICIANS (Community Health Centers, Therapists, Mental Health Centers):

Please be advised that previously-used third-party liability (TPL) billing instructions for Medicare noncertified clinician services are no longer valid. For now, providers should submit any claims for Medicare noncertified services directly to MassHealth. These claims will not be denied due to the Medicare coverage of the member at this time. MassHealth is revising billing instructions for how to bill for services provided by Medicare noncertified clinicians and will begin editing for Medicare coverage when the new billing instructions are published. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

Messages from the Week of July 6, 2009

7/10/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 7/12 from 6:00 pm to 9:00 pm:

The NewMMIS POSC will be unavailable Sunday from 6:00 pm to 9:00 pm due to system maintenance.  However, during this time the following WILL BE AVAILABLE:  EVS, EVSpc, HTS, the Automated Voice Response (AVR), and the internal NewMMIS application.  Thank you.

07/07/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT Tuesday, 7/7 from 9:00 pm to 10:00 pm:

Tonight, July 7, NewMMIS POSC will be unavailable from 9:00 pm to 10:00 pm due to system maintenance.  During this time, EVS, EVSpc, HTS, the Automated Voice Response (AVR), and the internal NewMMIS application will all be unavailable. 

Messages from the Week of June 29th

07/02/09

Lost Permissions Problem Corrected: 

Previously, defects in subordinate ID creation and maintenance panels prevented some providers from modifying permissions, and/or permissions were not being accepted after modifications were made to user profiles. These defects have been fixed. Users should no longer receive error messages indicating that a user is already linked when they attempt to assign permissions. Additionally, role modifications made to existing user profiles should be accepted and now stay applied.

 PIN Registration at the POSC Ending August 25, 2009 : 

August 25, 2009 is the last day that Providers may register on the POSC using their PIN. After this date, the Primary User for each provider organization will be required to contact the CST to gain access to the POSC. If you have not yet registered, we strongly urge you to complete the POSC registration before August 25, 2009.

View the status of electronic batch claims - a general rule of thumb to check for claim status : 

Viewing the status of electronic claims through the POSC varies based upon the media type  used and the time that the claim is submitted. If your claim is submitted at the POSC via Direct Data entry (DDE) the status of that claim will appear immediately upon submission of the claim. If you utilize the 837 batch claim submission option, and submit a batch of claims in the morning, you will be able to view the status of the claims that same afternoon. However, if you submit the 837 batch claims in the afternoon, you should not expect to be able to view the status of those claims until the next business day. This allows sufficient time to process the claims in that batch.

Notice to PCAs regarding FI Information on Prior Authorizations:

The FI information that is being automatically populated for PAs in the 'FI' field in the 'Basic Medical Detail' section on the 'Line Items' tab may be incorrect. This incorrect information will not have any impact on the systems ability to accurately process your PA request. If you encounter incorrect information that is automatically populated in the FI field, please disregard it. You will be informed when this issue has been corrected.

07/01/09

To all MassHealth Providers

The 835 files for the June 19th financial cycle are now available for download.

Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Tonight

NewMMIS and the POSC will be unavailable tonight, Wednesday, July 1 from 8:00 pm to 9:00 pm for system maintenance. In addition, the HTS service will be unavailable from 8:45 pm to 9:00 pm. This will not impact the other services with NewMMIS. Thank you for your continued support.

Notice to all NewMMIS and Provider Online Service Center (POSC) Users

Users of NewMMIS and the POSC may experience intermittent unavailability between 5:00 am and 5:30 am each day while system maintenance occurs. This will not impact the other services with NewMMIS. Thank you for your continued support.

Messages from the Week of June 22nd

6/30/09

To all MassHealth Providers:

The 835 payment files for the June 19th financial cycle are delayed.  We will keep providers updated as to when the 835 files are available to download from the NewMMIS Provider Online Service Center (POSC).  Thank you for your patience and cooperation. 

To all NewMMIS Provider Online Service Center (POSC) Users Who Use the Firefox Web Browser:

POSC users who use the Firefox web browser are advised to refrain from using the Firefox browser "Back" button while working in the POSC application, as this may have unexpected results.  Instead, please use the POSC navigation buttons labeled "Back" or "Go Back to Search Results.”  Thank you for your cooperation.

06/26/09

Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, June 28:

NewMMIS and the POSC, including the internal NewMMIS application, will be unavailable Sunday, June 28 from 8:00 pm to 9:00 pm for system maintenance.  During this time, the following access methods for eligibility verification will remain available:

• EVSpc
• HTS
• Automated Voice Response at 1.800.540.0042

Update on MassHealth Payments for the Remainder of Fiscal 2009

MassHealth executed its regularly scheduled pay cycle on Friday, June 19 and will do so again on Friday, June 26.  Each pay cycle results in remittance advices being available on the following Tuesday, with checks issued three days later and EFTs accessible six days later. 

• The June 19 pay cycle included all types of providers; the pay cycle included payments for clean claims received on or before May 27. 
• The pay cycle on June 26 will include all types of providers, and will include payments for clean claims received on or before June 3.

MassHealth intends to resume normal processing of payrolls in July. Additional information regarding those payrolls will be communicated through the MassHealth website, the Provider Online Service Center (POSC) and other channels.

MassHealth continues to evaluate hardship payment requests and is actively approving such requests subject to the availability of MassHealth resources. Providers who have been approved for a hardship payment are being contacted directly regarding such payments.  If you are considering submitting a hardship request, please do so in light of the claims that you expect will be paid in the payroll that will run on June 26. 

Requesting a Hardship Payment

Providers who are facing significant financial distress resulting from payment delays may call Customer Service at 1-800-841-2900 to request a hardship payment per the guidelines below. 

When calling Customer Service to request a hardship payment, providers will be asked to demonstrate urgent need and should be prepared with the following information:

• The name and contact information for a single individual within the organization who is knowledgeable about financial matters and authorized to make financial decisions;
• The immediate impact of the financial hardship;
• The number of days of operating cash on hand;
• The proportion of MassHealth MMIS payments within the provider’s overall payer mix;
• Date and amount of  the last MassHealth payment received; and
• The minimum payment necessary to alleviate the financial hardship through the end of June.

When calling, providers should clearly indicate that they are requesting a hardship payment.  Customer service representatives are prepared to respond to these calls and will request the information outlined above and convey it to MassHealth for evaluation in light of the severity of the need and the availability of resources.  MassHealth is mindful of the difficulties imposed by fiscal management decisions and appreciates your patience and understanding as we manage through the end of the fiscal year.

Important Follow-up Message to MassHealth Providers About Claims and Payments:

MassHealth recently announced that some claims that were approved to pay in the last pay cycle are being held in a “fiscal pend” status to enable the agency to manage cash flow within available resources at fiscal year end.  MassHealth is actively developing a plan for disbursement of funds for the remainder of the fiscal year and anticipates making some limited payments between now and the end of the month.  Details regarding the schedule of such payments and their distribution among provider types will be communicated as soon they are available.  Normal pay cycles are expected to resume in July. 

MassHealth will consider hardship payment requests fromindividual providers who are facing significant financial distress resulting from payment delays.  When calling Customer Service (1-800-841-2900)to request a hardship payment, providers will be asked to demonstrate urgent need andshould be prepared with the following information:

• The name and contact information for a single individual within the organization who is knowledgeable about financial matters and authorized to make financial decisions;
• The root cause of the financial hardship, i.e., claims submission difficulties, NewMMIS system defects, MassHealth payment delay, etc.;
• The number of days of operating cash on hand;
• The proportion of MassHealth MMIS payments within the provider’s overall payer mix;
• Date and amount of  the last MassHealth payment received; and
• The minimum payment necessary to alleviate the financial hardship through the end of June.

When calling, providers should clearly indicate that they are requesting a hardship payment.  Customer service representatives are prepared to respond to these calls and will request the information outlined above and convey it to MassHealth for evaluation in light of the severity of the need and the availability of resources.  MassHealth is mindful of the difficulties imposed by fiscal management decisions and appreciates your patience and understanding as we manage through the end of the fiscal year.

Important Update:

New MMIS POSC Primary Users Modifying Permissions for Subordinate Users

Recently, we notified NewMMIS POSC users of a resolution to an issue in which POSC Primary Users attempting to modify permissions for their subordinates were losing permissions of users in other accounts, and modifications made to subordinate accounts appeared to save successfully, but actually did not. 

While most providers are not reporting any difficulties, a small number of providers are reporting they are still encountering problems.  MassHealth is researching these reports and will update users shortly. 

In the meantime, we reiterate our previous update regarding this issue:

You still you may begin to modify accounts again. If you do experience a problem again, please do not create additional ID’s for users. This only populates the system with a significant number of unused accounts. Please contact NewMMIS Customer Service at 1-800-841-2900.

Thank you for your patience and cooperation. 

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

FYI:  Change in Claims/Payment Processing Cycles Due to July 4th Holiday

In order to accommodate early processing in advance of the July 4th holiday, the NewMMIS weekly claims and financial payment processing cycles will be run on Thursday, July 2 rather than Friday, July 3.

For more information about the relationship between claims submittal, adjudication and RA reporting, please see the notice entitled “NewMMIS Payment Cycle”, dated June 2, 2009, found under the “Manage Claims and Payment” heading on the www.mass.gov/masshealth/newmmisnotices web page.  Also, feel free to refer once again to the two communications shown at the top of that web page, entitled “Important Follow-up Message to MassHealth Providers about Claims and Payments” and “To all MassHealth Providers.”

Thank you for your patience and cooperation. 

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

06/22/09

Update:  New MMIS Provider Online Service Center (POSC) Primary Users Modifying Permissions for Subordinate Users

Providers were notified in late May that POSC Primary Users who attempted to modify permissions for their subordinates were losing permissions of users in other accounts.  Subsequently, modifications made to other subordinate accounts appeared to save successfully, but the accounts were not actually modified. 

At that time MassHealth informed providers that they should assign permissions at the time the subordinate accounts were created, and NOT to modify accounts after they were created. 

MassHealth has fixed this problem in the application.  You may begin to modify accounts again.  We apologize for any inconvenience this may have caused.

If you experience a similar incident again, please do not create additional ID’s for users.  This only populates the system with a significant number of unused accounts.  Please contact NewMMIS Customer Service at 1-800-841-2900.

Thank you for your patience and cooperation. 

Messages from the Week of June 15th

06/17/09

NewMMIS and Provider Online Service Center (POSC) System Maintenance Thursday, 6/18:

On Thursday, June 18, there will be two NewMMIS and POSC system maintenance outages affecting NewMMIS, the POSC, EVS, EVSpc, HTS, the Automated Voice Response (AVR), and the internal NewMMIS application.  During these times will be no access to these services, nor access to eligibility verification services.  The outage times are:

5:00 am to 5:30 am

8:00 pm to 2:00 am

Important Follow-up Message to MassHealth Providers About Claims and Payments:

MassHealth recently announced that some claims that were approved to pay in the last pay cycle are being held in a “fiscal pend” status to enable the agency to manage cash flow within available resources at fiscal year end.  MassHealth is actively developing a plan for disbursement of funds for the remainder of the fiscal year and anticipates making some limited payments between now and the end of the month.  Details regarding the schedule of such payments and their distribution among provider types will be communicated as soon they are available.  Normal pay cycles are expected to resume in July. 

MassHealth will consider hardship payment requests fromindividual providers who are facing significant financial distress resulting from payment delays.  When calling Customer Service (1-800-841-2900)to request a hardship payment, providers will be asked to demonstrate urgent need andshould be prepared with the following information: 

• The name and contact information for a single individual within the organization who is knowledgeable about financial matters and authorized to make financial decisions;
• The root cause of the financial hardship, i.e., claims submission difficulties, NewMMIS system defects, MassHealth payment delay, etc.;
• The number of days of operating cash on hand;
• The proportion of MassHealth MMIS payments within the provider’s overall payer mix;
• Date and amount of  the last MassHealth payment received; and
• The minimum payment necessary to alleviate the financial hardship through the end of June.

When calling, providers should clearly indicate that they are requesting a hardship payment.  Customer service representatives are prepared to respond to these calls and will request the information outlined above and convey it to MassHealth for evaluation in light of the severity of the need and the availability of resources.  MassHealth is mindful of the difficulties imposed by fiscal management decisions and appreciates your patience and understanding as we manage through the end of the fiscal year.

06/16/09

NewMMIS System Maintenance TONIGHT 6/16:

Tonight, Tuesday June 16, portions of NewMMIS will be unavailable from 9:00 pm to 9:30 pm for system maintenance. 

EVS (from POSC) and POSC will be AVAILABLE.

HTS services, EVS pc, and AVR (Auto Voice Response) will be UNAVAILABLE.

All other Virtual Gateway Services will be available. We apologize for the inconvenience.

TO ALL MASSHEALTH PROVIDERS:

As the end of the fiscal year approaches, MassHealth will need to delay some Fiscal Year 2009 payments until Fiscal Year 2010. In the past, such claims would have appeared on the legacy remittance advice (RA) in a status of "fiscal pend." Additional systems work is required in NewMMIS before RAs produced by NewMMIS are able to display that same status message. As such, you may receive RAs that do not contain any information about claims that are approved to pay in this fiscal year but are being held for payment until next fiscal year. We apologize for the inconvenience and are mindful of the financial strains that payment delays cause for providers.

If you experience a significant financial hardship related to unpaid MassHealth claims, please call MassHealth Customer Service at 800-841-2900 to request relief.  We will evaluate such requests based on the severity of the need and in light of available MassHealth resources. Please note that this situation is temporary and payments will resume on schedule with approval of the FY2010 budget.

Thank you for your cooperation during this difficult period.

06/15/09

Notice of NewMMIS System Maintenance TONIGHT, 6/15:

Tonight, Monday June 15, portions of NewMMIS will be unavailable from 9:00 pm to 10:00 pm for system maintenance.  The following lists what will be available and unavailable tonight during this time:

• HTS services:                     Unavailable
• EVS pc:                             Unavailable
• AVR (Auto Voice Reponse): Unavailable
• EVS (from POSC):              Available
• POSC:                               Available

Messages from the Week of June 8th

06/13/09

IMPORTANT NewMMIS UPDATE AS OF SATURDAY JUNE 13, 1:30PM: System Maintenance for NewMMIS and Provider Online Service Center (POSC) extended beyond 11:00AM:

Please note that system maintenance originally scheduled to be completed at 11:00 am today, Saturday June 13, for NewMMIS, the POSC, EVS, EVSpc, HTS, the Automated Voice Response (AVR) and the internal NewMMIS application needs to be extended beyond that time.  All of these functions are currently unavailable.  During this time, there is no access to eligibility verification services.  Work is currently underway to have all services available as soon as possible.  Please check for a message on the web site https://gateway.hhs.state.ma.us/authn/index.jsp?throughout the day Saturday for status updates.  If you see no messages on that page, this means all services mentioned above are available.  Thank you for your patience and cooperation.  

06/12/09

System Maintenance June 13 for NewMMIS and Provider Online Service Center (POSC):

Please note that NewMMIS, the POSC, EVS, EVSpc, HTS, the Automated Voice Response (AVR) and the internal NewMMIS application will all be unavailable Saturday, June 13, from 6:00 am 11:00 am for system maintenance.  During this time, there will be noaccess to eligibility verification services.  Thank you for your patience and cooperation.   

Notice about Certain Transportation Claims: 

MassHealth has identified that certain claims for transportation providers are erroneously denying for “Edit 251 – 1st Modifier Invalid.” MassHealth is reviewing the denied claims and will reprocess these claims once the problem is resolved. No further action is required by providers at this time.

Explanation of Benefit Codes List:

A list of the explanation of benefit (EOB) codes that appear on the remittance advice is posted on the MassHealth Web site. This list was previously published as Part 6 of Subchapter 5 of every MassHealth provider manual. It is now a freestanding list. You can find the list from the MassHealth home page by clicking on:

1. “Information for MassHealth Providers”, then on
2. “MassHealth Claims Submission”
3. You will see “List of Explanation of Benefit Codes Appearing on the Remittance Advice.”   The link is not called Error Codes, as stated in Part 6 of Subchapter 5. That incorrect navigation will be corrected in an upcoming transmittal letter.

Notice to PCM Providers:

Some PCM providers who attempt to adjust existing Prior Authorizations (PAs) that were converted from APAS do not have the NewMMIS issued Prior Authorization number for that PA. In order to acquire the appropriate NewMMIS PA number, providers should search for the PA on the “Search for Prior Authorizations" panel by entering certain information (i.e. select the correct Provider ID Service Location, member name, status, etc.) into the PA search panels in NewMMIS.  Please refer to the "Inquire on PA" job aid located on www.mass.gov/masshealth/newmmis to review how to use the search function.

Important Information about HIPAA Batch Claims:

Recently, a number of HIPAA batch claims have denied for edit 1945, as we are not able to match the claim to the correct unique provider service location.  This may occur when a provider has enumerated with one NPI for multiple NewMMIS provider IDs.  Providers who have enumerated with one NPI for multiple NewMMIS provider IDs and that are "required" to bill MassHealth using a taxonomy code, must enter the Provider Type Qualifier of BI in PRV01 of the 2000A loop in 837 HIPAA batch claims.  The HIPAA Companion Guides are being updated to reflect this information.  Providers will need to resubmit these claims and should contact Customer Service at 1-800-841-2900 if they have questions. 

06/09/09

Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance this week - June 9 - 12

Between 5:00 am and 5:30 am each day this week users of POSC may experience intermittent unavailability. This is a temporary problem and will be corrected shortly.

Between 12:00 Midnight and 12:30 am daily this week Member and Claims operations on POSC, IVR, HTS and EVSpc will be unavailable

This Thursday, June 11, NewMMIS and the POSC will be unavailable from 9:00 pm to 10:00 pm for system maintenance.

Advisory about Primary Users Modifying Permissions for Subordinate Users

Currently, some NewMMIS POSC Primary Users are not able to grant or modify permissions for some Subordinate Users. We are aware of this issue and it is currently being evaluated. In the interim, if you encounter problems granting or modifying Subordinate User permissions, please stop making any modifications to your subordinate profiles. You do not need to call Customer Service or take any other action at this time. A fix to this issue will be announced soon and distributed to users and posted on
http://www.mass.gov/masshealth/newmmisnotices.

Thank you for your patience and cooperation.

** For more information about these notices or any previous notices, please visit
http://www.mass.gov/masshealth/newmmisnotices

Attention HIPAA 835 Transactions Users

The HIPAA 835 transactions that were planned to be available for download on the evening of June 8  will not be available until  June 11, 2009 at the earliest.  This postponement is to allow additional validation of the payment information received from the Comptroller's office.

Accessing Eligibility Inquiry History on NewMMIS

To view eligibility inquiry history on NewMMIS, please be sure to do the following from the Provider Online Service Center (POSC) home page: 

1. Select the "Manage Members" option from the POSC home page
2. Select "Inquire Eligibility Request"
3. Enter the Tracking Number or Member ID and Date of Service.  You will then see all applicable eligibility inquiry requests.

Reminder - How to Access Copies of PA Letters

If you wish to review PA notices, please be sure to go to the POSC home page and select "Manage Correspondence and Reporting", then select "View Notifications."

Reminder - About Service Authorization Numbers

Please note that Service Authorization Numbers may contain alpha characters in addition to the first character, which identifies the type of service authorization. 

06/08/09

Recommended Times to Contact MassHealth Customer Service about NewMMIS Issues:

Since NewMMIS was implemented on May 26, MassHealth Customer Service has been experiencing higher call volumes and occasionally longer wait times than during the period prior to implementation.  If you are able, please consider contacting us when call volume is lowest:  8:30 - 9:30 AM, 12:00 - 2:00 PM or 5:00 - 6:00 PM.  We hope this is helpful to you.  Thank you for your patience and cooperation.

To Providers Attempting to Verify Eligibility using Member Name:

It has been reported that some providers attempting to verify eligibility using member name are receiving the following message:

Multiple Members found matching criteria-call 800-833-7582 for assistance

First,the phone number in this error message is incorrect and will be updated shortly in NewMMIS.  The correct telephone number for providers to call is 800-841-2900. 

Second, providers who receive multiple search results when attempting to verify eligibility by member name should refine their search results by performing eligibility verification using: 

• The member's 12-digit Medicaid ID, OR
• Social Security Number, OR 
• For DYS and DCF Members only:  Other Agency ID beginning with X or Y.

Eligibility verification performed using the above search criteria will always return search results for a single member, thus eliminating multiple search results. 

Messages from the Week of May 31st

06/05/09

Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, June 7:

NewMMIS and the POSC will be unavailable Sunday, June 7 from 6:00 pm to 12:00 midnight for system maintenance.  In addition, the EVS eligibility system will be unavailable from 6:00 pm to 7:00 pm Sunday night.  From 7:00 pm to 12:00 midnight, the following access methods for eligibility verification will remain available:

• EVSpc – available for download at www.mass.gov/masshealth/newmmis
• TS – any vendor or provider that connects to NewMMIS in a system-to-system approach or web service
• Automated Voice Response at 1.800.540.0042

06/04/09

Important Notice about Medicare Part C Claims

Masshealth is conducting additional validation of Medicare Part C claims. While this validation is in process, certain Part C crossover claims will suspend for Edit 1036:  RENDERING PROVIDER NOT ELIGIBLE TO BILL THIS CLAIM TYPE.  The issue is expected to be resolved shortly.  Therefore no actionis necessary for providers. Thank you for your patience

Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Tonight:

NewMMIS and the POSC will be unavailable tonight, Thursday, June 4 from 9:00 pm to 10:00 pm for system maintenance.

O6/04/09

To all specialists / servicing providers billing for services that required a PCC Plan referral before implementation of NewMMIS on May 26, 2009:

When submitting claims for such services you must place two leading zeros in front of the old PCC referral number.  For example, if the PCC referral number under legacy MMIS was 9712345, you must now use 009712345 when submitting the claim in NewMMIS.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

06/03/09

Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Tonight

NewMMIS and the POSC will be unavailable tonight, Wednesday, June 3 from 9:00 pm to 10:00 pm for system maintenance.

Messages from the Week of May 24th

06/02/09

Notice of NewMMIS Provider Online Service Center (POSC) System Maintenance Tonight:

The NewMMIS POSC will be unavailable tonight, Tuesday, June 2 from 9:00 pm to 10:00 pm for system maintenance.

NewMMIS Payment Cycle

NewMMIS adjudicates claims more quickly than the former system, offering providers more timely insight into the status of their claims submissions.  Soon after claims are submitted, providers are able to check their status via the POSC to see if claims are approved to pay, are denied or are suspended.  However, the actual payment cycles for NewMMIS are the same as they were under the old system, with MassHealth typically releasing funds for paid claims to most providers within three weeks after the claim has been approved to pay.  When interpreting your remittance advice, it is important to understand that claims in a denied or suspended status will appear on the very next remittance advice after they are adjudicated, while claims in a paid status will not appear until payment is released.  This means that paid claims will appear on the remittance advice 1-3 weeks after denied or suspended claims from the same batch submission.  To reiterate, actual payment cycles for NewMMIS are the same as under the old system; they have not changed.  The adjudication of claims is more rapid and the status of adjudicated claims is made available to providers sooner.  Please ensure that your billing and operations staff are aware of this information

Messages from the Week of May 24th

05/29/09

Notice of NewMMIS Provider Online Service Center (POSC) System Maintenance 5/31

The NewMMIS POSC will be unavailable Sunday, May 31 from 8:00 am to 12 noon for system maintenance.During this time, the following access methods for eligibility verification will remain available:

• EVSpc – available for download at www.mass.gov/masshealth/newmmis
• HTS – any vendor or provider that connects to NewMMIS in a system-to-system approach or web service
• Automated Voice Response at 1.800.540.0042
• Temporary Eligibility Operator Support at 1.800.833.7582

Temporary hours of additional support over the weekend of May 30th and 31st for providers who do not yet have a user ID and password for the POSC

MassHealth has noted that some providers have not yet registered for a user ID and password to access the MassHealth Provider Online Service Center (POSC). You need this access in order to verify member eligibilit

For providers who do not yet have a user ID and password, MassHealth is providing additional temporary support staff over the weekend of May 30th and 31st to assist with eligibility verification. If you already have your user ID and password for the POSC, please do not call these numbers for eligibility verification. These numbers are for use ONLY by providers who do not have a user ID and password AND who have a MassHealth member in the office or facility over the weekend for whom they need to verify eligibility.  

The temporary hours of additional support are as follows:

For eligibility verification questions and general POSC questions:  
Saturday, May 30
8:00 AM – 12:00 PM 
1-800-841-2900

For eligibility verification questions only:
Saturday, May 30
12:00 PM - 9:30 PM
1-800-833-7582

Sunday, May 31
7:00 AM - 9:30 PM 
1-800-833-7582  

Claims from nursing facilities that provide level four service

MassHealth is aware that claims from nursing facilities that provide level four services may process erroneously. We have diagnosed the problem and expect it to be resolved in June. We apologize for any inconvenience this may cause.

Checking member eligibility status on the Provider Online Service Center (POSC)

Some users may encounter an error when checking for member eligibility status on the POSC. The error causes the screen to be filled with a long technical message that begins “javax.portlet. PortletException: Cannot get value for expression”. If you receive this message, please log out, wait 30 minutes, and log back in.

Technical teams are in the process of resolving this issue. In the meantime, please do not call the CST help desk as the issue is known and the fix is underway. We will update you shortly and apologize for any inconvenience this may cause.

05/26/09

Notice of NewMMIS Issues

NewMMIS is experiencing intermittent issues and may continue to experience these issues throughout the day. If you are encountering difficulties, please wait an hour and try again. Technical teams are working to address the issue and we apologize for any inconvenience this may cause.

05/24/09

Lost Permissions

Some Users are experiencing the loss of access to certain functions on the Provider Online Service Center (POSC).  If you are a Subordinate User and experience the loss of this functionality please check with the Primary User within your organization.  If you are a Primary User and have lost access to certain functions please contact Customer Services at 1-800-841-2900 immediately.  While this issue is being fixed, please do not modify permissions after they have been added.  We will notify you once the issue has been resolved.

Messages from the Week of May 17th

05/23/09

Providers should resubmit claims from the 2088 RA Run that denied for code 095

Please note that any claim that denied on the 2088 remittance advice  for code 095 (dated 5/26/09), Claim Cannot be Processed/Resubmit to NewMMIS, should be resubmitted to NewMMIS. Providers must use their National Provider Identifier (NPI) for all claims submissions. “Atypical Providers” should bill using their 10-digit Provider ID/Service Location (pid sl) number, which was sent in the MassHealth provider PIN registration letter in March. If you have questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Providers entering data during Prior Authorizations 

MassHealth has received reports that providers are intermittently receiving error codes and/or error messages indicating that the web service is not available upon data entry of Prior Authorizations (PAs).  This problem has been diagnosed and MassHealth is actively developing a solution for this issue.  If you receive this message during data entry, please save your PA request, record your tracking number, and return to complete your PA later.  We apologize for any inconvenience this may cause.

Be advised of crossover denials for edit 503

MassHealth has become aware that Medicare is sending erroneous Coordination of Benefits (COB) payer information that is resulting in crossover denials for edit 503. Medicare will not be correcting these claims. Providers should submit their claims directly to MassHealth for payment consideration. You can submit your claims either electronically through the Provider Online Service Center (POSC) or on paper. Claims processed in NewMMIS will ignore the erroneous payer information and adjudicate appropriately. Providers must use their National Provider Identifier (NPI) for all claims submissions. “Atypical Providers” should bill using their 10-digit Provider ID/Service Location (pid sl) number, which was sent to providers in the MassHealth provider PIN registration letter in March. For questions, contact MassHealth Customer Service at 1-800-841-2900.

To Providers Submitting Electronic 837I and 837P Claims to NewMMIS:

Providers are reminded that when submitting 837 Institutional and 837 Professional claims to NewMMIS to enter theNewMMIS Trading Partner ID in the ISA06.  We are seeing a high incidence of files being rejected because trading partners are continuing to use the current legacy seven-digit MassHealth ID.

Thank you in advance for your cooperation.  If you have questions about any of these messages, please call 1-800-841-2900.

05/20/09

Providers submitting 837I and 837P claims to NewMMIS

Providers are reminded that when submitting 837 Institutional and 837 Professional claims to NewMMIS to enter the NewMMIS Trading Partner ID in the ISA06. All claims submitted to NewMMIS must have the new Provider ID / Service Location and/or member ID and other necessary data elements identified in the MassHealth Companion Guides and Billing Guides. We are seeing a high incidence where files are being rejected because trading partners are continuing to use the current legacy seven-digit MassHealth ID.  

To Providers Who Have Registered for the NewMMIS Provider Online Service Center (POSC) as a "Primary User":

Providers who have registered at the POSC as a "Primary User" should not give anyone access to the "Manage Subordinates" function other than the individual in your organization whom you have selected as your primary back-up.   It is your responsibility and obligation to protect the data that you enter and manage. If the "Manage Subordinates" function is granted to anyone other than your primary back-up, the "granted to" user is able to view a list of all subordinate users you have created, their personal information (i.e. Last 4 of SSN, DOB, etc.), and they will be able to modify access to those user accounts.  This is a serious privacy concern.  Primary Users are instructed not to assign this access to anyone other than their back-ups in the NewMMIS POSC Primary User guide.  This is noted as well in the security set-up examples noted on Mass.gov.

Advisory About Modifying Permissions After They Have Been Added:

MassHealth has been informed that some providers have noticed that their access to certain functions on the POSC appear to have been removed in error.  This seems to happen when the provider modifies permissions for another user (user from provider location A (“A”) allows user from provider location B (“B”) access to view their information or perform services on behalf of A and then decides to modify B’s given permissions) or when the Primary User modifies the access for their subordinates at the primary site.  While this issue is being evaluated, please do not modify permissions after they have been added.  Once this issue is fully reviewed, we will advise you of next steps.

Notice about Prior Authorization (PA) Messages You May See on the POSC: 

Please be advised that currently, a "PA not required" message is displayed on the POSC when entering a Prior Authorization request for services that sometimes require a PA.  This is a so-called “soft edit” and will not prevent you from entering the PA.  MassHealth is aware of this issue and will correct it after NewMMIS implementation.  In the interim, please refer to Sub-chapter 6 of your provider manual to determine if PA is required. If you are a DME provider you should refer to the DME/Oxygen tool to determine if PA is required.  Both the provider manuals and the DME/Oxygen tool can be found on www.mass.gov/masshealth - Click on “MassHealth Regulations and Other Publications”, then click on “Provider Library.”

Messages from the Week of May 10th

05/15/09

Important Note About Trading Partner Testing

On May 16, providers may begin to submit electronic claims via the POSC. However, the 837 test feature available on the POSC will not be fully operational until June 8th. Providers are encouraged to submit HIPAA compliance tests through May 18th via the EDI Web site at https://masshealth2.ehs.state.ma.us/transactions/test/logon.do. MassHealth will temporarily stop trading partner testing at the end of business on May 18th. Please do not submit any test files via the POSC until trading partner testing resumes on June 8th. Any test files submitted via the POSC will not be processed until June. Additionally, any corresponding tracking numbers issued by the POSC will not be valid until the test claims are processed in June.