Billing Updates

Responses to Questions about the HSN 835

Responses to Questions about the HSN 835 (PDF) | Word

Based on feedback received from providers and the Massachusetts Hospital Association and an internal analysis performed by the Division of Health Care Finance and Policy (DHCFP), DHCFP compiled all questions and comments concerning the Health Safety Net 835 and responded to each concern. The publication of this document closes the response period for any changes to the HSN 835 for the duration of FY2008 insuring a Final 835 Specification that will be posted online. However, any suggestions that will aid providers in the overall process can still be submitted to Marc Prettenhofer at Marc.Prettenhofer@state.ma.us

Claims Adjudication and Resubmission of Denied Claims

Based on feedback received from providers, the Massachusetts Hospital Association (MHA), and an internal analysis performed by the Division of Health Care Finance and Policy (DHCFP), DHCFP has implemented a series of steps to assist providers with their denied claims and the resubmission process.

In many cases, DHCFP will reverse previous claim denials without any additional action required by the hospital. In other cases, the hospital will need to provide the Division with additional information for particular claims or it will need to correct the claim error and resubmit the claim using the normal resubmission process.

The following table summarizes the action required for each denial reason.
Known Denial Issues (PDF) | Excel

Standard Resubmission Processes

• The process for resubmitting UB92 claims is explained in the file linked below. Please note that the process is the same one DHCFP has used for several years.
  UB92 Resubmission Process (PDF) | Word 
• The process for resubmitting 837I claims for prime, secondary, partial, and special circumstances (formerly known as confidential) is explained in the file linked below.
  837I Resubmission Process (PDF) | Excel

UB92 Recipient Identification Numbers (RID) Submission Process

Providers are able to submit RID’s for UB92 claims denied for eligibility due to a name mismatch between REVS/MA-21 and information submitted by the provider. RID updating will only be be used for UB92 claim submissions because the 837I will allow for eligibility matches to be based on SSN, RID & Name / Date of Birth.

The new process for UB92 RID submission is explained in the file linked below.
UB92 RID Submission Process (PDF) | Word

Emergency Room Bad Debt (ERBD) Claims Eligible for HSN

Certain claims that were submitted as ERBD claims were denied because the patient was HSN eligible on the date of the emergency service. For patients who have full HSN eligibility, the denied claims will be classified as HSN from ERBD and reprocessed accordingly.

Providers who receive an ERBD denial based upon a member’s eligibility for partial HSN may need to re-submit their claim as HSN-eligible not ERBD if the patient has met their deductible. Providers may not bill deductibles or copayments as emergency bad debt.

Billing Deadlines

A 30 day transitional “grace period” has been added to the 90 day billing deadline for all HSN Primary claims submitted through the end of May.

Denials must be resubmitted within 90 days of the date of denial. However for claims previously denied, the 90 days will be measured from the date of this notice.

Non-adjudicated Claims

On May 19, a separate denial report will be made available on INET for claims that were not adjudicated due to dates of service prior to October 1, 2007 (also known as “pended” claims). The pended claims included 2007 dates of service from the Uncompensated Care Pool (UCP) that cannot be paid from the Health Safety Net (HSN). This “pended claim” report will pertain to all claims submitted to date and will contain an error message indicating that “The Claim is not HSN Eligible and was not adjudicated due to pre October 1, 2007 date of service.”

Subsequent claim denials for pre October 1, 2007 dates of service will be listed at the bottom of the provider’s monthly denial report and will be listed under the same error message as noted above.

Verification Reports Update

Revisions made to the Verification Reports beginning June 23, 2008 is detailed in the files below. Information on how providers can view the status of their submission via the “View Previous Submission” in DHCFP- INET is also outlined.

Verification Report Update; June 9, 2008 (PDF) | Word

Claims Updates

Claims updates are explained in the files below. Updates include Eligibility, Transactional Control Numbers, Free Care/Special Circumstances Applications and Claims Research information.

• Payer Source Codes (Oct. 29, 2009) (PDF) | Word 
• Claim Submissions (Oct. 13, 2009) (PDF) | Word 
• CLM/SBR Segments (Oct. 5, 2009) (PDF) | Word 
• Secondary Claim Submissions (Sept. 3, 2009) (PDF) | Word 
• UB92/UB04 Claims Processing System (Aug. 6, 2009) (PDF) | Word 
• Administrative Bulletin 09-13: Serious Reportable Events Guidelines (Effective Jun. 16, 2009) (PDF) | Word 
• Billing Guideline Update for 837I, 837P, and 837D Claims (Jun. 22, 2009) (PDF) | Word
• Provider Requests for HSN to Review Denied Claims RE: newMMIS / EVS Conversion (May 26, 2009) (PDF) | Word
• Verification of Eligibility on Submitted HSN Claims (May 21, 2009) (PDF) | Word
• HSN Split Eligibility Billing and Use of Occurence Codes (May 4, 2009)(PDF) | Word
• ERBD Waiver Request Process (Apr. 9, 2009) (PDF) | Word
  Special Circumstances Application Coding Requirements (Feb.23, 2009)(PDF) | Word
• Present on Admission (Feb. 12, 2009) (PDF) | Word
• Denial Reports (Jan.30, 2009) (PDF) | Word
• Secondary Payer (Nov. 12, 2008) (PDF) | Word
• General Update; (Nov. 3, 2008) (PDF) | Word
• Verification/ Field Error Report Warnings (Oct.15, 2008) (PDF) | Word
• 30-Day Grace Period (Oct. 14, 2008) (PDF) | Word
• Basic & Essential Start Date (Oct. 14, 2008) (PDF) | Word
• MAPAM Presentation (Sept. 18, 2008) (PDF) | Word
• MHA Claims Update (Sept. 18, 2008) (PDF) | Word
• MHA Claims Update (Aug.7, 2008) (PDF) | Word
• MHA Claims Update (Jul. 17, 2008) (PDF) | Word

Claim Adjustment Code Updates

The Division has been made aware of Medicare having a system issue with reporting CAS codes on 835 Inpatient Claims. Medicare reported inactive Claim Adjustment Codes for approximately 1 month (June, 2008 into July, 2008). HIPAA Code errors for Claim Adjustments produced by any Primary Payer on their 835 will, when submitted to HSN Secondary, result in a claim denial. 

Claim Adjustment Codes Update; September 8, 2008 (PDF) | Word

Questions

Providers with claim-specific questions should contact the Division’s Claims Customer Support Center at (866) 697-6080.

Providers with questions regarding this bulletin should contact the Division’s Help Desk at (800) 609-7232 or via email at dhcfphelpdesk@state.ma.us.