HSN Claims Information for Hospitals

The Health Safety Net (HSN) claims submission process involves new reporting requirements and data specifications. Highlighted changes include:

• All outpatient pharmacy-only claims must be submitted via the MassHealth Pharmacy On-line Payment System (POPS) beginning with dates of service on or after October 1, 2007.
• All hospital claims submitted to the Division on or after January 1, 2008 must be in the 837 I format.
• 837I claims are submitted via INET, the Division's Web-based reporting tool.

837I Claims

837I Companion Guide v2.1 - FINAL (PDF) | Word
837I Data Specifications - FINAL (PDF) | Excel
Appendix D - UB to 837 Crosswalk - FINAL (Excel) 
837I Secondary with Paper Payer COB Loops - DRAFT (PDF) | Word

835 Claims

835 Data Specifications - FINAL (Excel) 
835 Claim Adjustment Reason Code List - FINAL (PDF) | Excel
835 LX for 837P and 837D (PDF) | Excel
835 LX for 837I (PDF) | Excel

Other Information

• Payer Type and Payer Source Code List - Effective October 1, 2009 (PDF) | Word 
• Present on Admission (POA) Exemption Codes (Feb. 12, 2009) (Excel) 
• Covered Dental and DME HCPCS Codes  (Feb. 6, 2009) (PDF) | Word
• Noncovered ICD9 Diagnosis Codes (Feb. 6, 2009) (PDF) | Word
• Noncovered ICD9 Procedure Codes (Feb. 6, 2009) (PDF) | Word
• Noncovered CPTs and HCPCS Codes ( Feb. 6, 2009) (PDF) | Word
• Noncovered Revenue Codes (Feb. 6, 2009) (PDF) | Word
• DHCFP Payer Codes (PDF) | Excel
• Accepted Codes List v2.1 (PDF) | Excel
  

SENDS-INET Instructions

Instructions: How to access your SENDS Updates for HSNO (PDF) | Word
INET Reporting Tool
INET Registration

Frequently Asked Questions for Hospitals

How will the 837 process differ from the existing UB92 process?

Most of the process will be the same, however, the submitted data format will be different. Hospitals will be required to use the HIPAA compliant ANSI ASC X12 837 format. Data submissions will still be made through SENDS-INET, with all existing security and registration protocols. For more information on SENDS updates and INET, the Division's Web-based transaction service, please see our HSNO SENDS-INET instructions.

Should a hospital continue to submit claims for dates of service prior to October 1, 2007?

Yes. Hospitals are required to submit claims for services provided before October 1, 2007. Beginning January 1, 2008, hospitals must submit claims in the 837 format. Until then, claims submitted in the existing UB-92 format will be accepted.

Is there a companion guide and other specifications for the 837 process?

Yes. A companion guide and data specifications are available for download. .

Can a hospital convert to the 837 format before January 1, 2008?

Yes, however, the Division must approve a hospitals request to do so prior to submission.  

When will a summary of HSN claims edits be available?

The HSN claims edits target publication date is early November. In general, the edits will be based on the Medicare Outpatient Code Editor rules, but also modified to reflect differences in Medicare and HSN covered services.

When will a hospital receive an 835 file from the Division?

Presuming a hospital has converted it's claims submission to the 837 format, it will receive an 835 file within 24-48 hours after the Division received and accepted a claims file, barring any system delays.

Will the 835 file contain payment amounts?

No. The 835 file will be a zero pay file. i.e. no payment amount will be listed for the claim. Payments will be processed in the same manner current Uncompensated Care Pool payments are processed. Hospitals will receive a monthly summary detailing their monthly HSN payment amount.

How should a hospital submit Dental claims under HSNO if it does not utilize an electronic Dental Claim process?

A hospital currently has three options HSNO is able to accommodate (1) submit an 837D with the corresponding Level II Dental HCPCS, (2) submit an 837I with Dental HCPCS, (3) utilize the current UCP UB92 format with Dental HCPCS. Each involves their own set of issues for the provider, please select the option that allows your hospital to submit charges in an efficient and appropriate manner until further notice

When will the REVS messages be revised?

The REVS message revisions are targeted for publication in early November 2007.

Which inpatient grouper will be used for FY2008 claims?

Currently the Medicare version 24 grouper is being used. To match Medicare's movement towards MS-DRGs, the Division is exploring a vendor update. This should minimize the necessity for multiple grouper versions and claim editing contradictions.