The Monthly Surcharge Payment Report will be used by Surcharge Payers to report specified payments made to Hospitals, Ambulatory Surgical Centers and Physician Hospital Organizations.

Monthly Surcharge Payment Report
Report Information
General Instructions
Providers Information
Providers Download
Line Instructions
Column Instructions
Upload Submission Data
Generating Reports
Reopen Requests
    

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Monthly Surcharge Payment Report

The Monthly Surcharge Payment Report will be used by Surcharge Payers to report specified payments made to Hospitals, Ambulatory Surgical Centers and Physician Hospital Organizations. The application will also allow Surcharge Payers to submit Member Months or Equivalent data. The application is user friendly and provides the user with the simplest process available for submitting their monthly report and it is always open to the main screen containing the Submission Criteria Selection.

From the Organization drop-down list select an organization. Users will only be able to select organization names that are present in the drop-down list.
 

  • Organization names cannot be edited.In the event that your organization name or associated information is incorrect contact the Division of Health Care Finance and Policy(Division) at 1-800-888-2250 and press 2 for the UCP hotline. You can also email the Division at pool.help@state.ma.us. .

 
Report Information

Upon request by the Division, certain surcharge payers shall report private sector payments for health care services to Massachusetts Acute Hospitals, Ambulatory Surgical Centers and Physician Hospital Organizations as designated in the application. All amounts reported will reflect payments made during the respective month regardless of the date services were rendered. Payers shall separate private sector payments into Total Payments, Medicare Exemptions, Medicaid Exemptions, and Worker's Compensation Exemptions, Other Government Exemptions, Third Party Liability Exemptions and Other Exempt categories. Please refer to the instructions below for detailed definitions for each Column.

 
General Instructions

The governing regulation for the Uncompensated Care Pool is 114.6 CMR 11.00. For information about the UC Pool reporting requirements, see section 114.6 CMR 11.03. The Monthly Surcharge Payment Report is due the first business day of each month and should be transmitted at the same time the monthly surcharge payment is mailed to the Division of Health Care Finance and Policy (Division).

 
Providers Information

The user will choose the Hospitals, ASCs and PHOs from a drop down list. Users will see a list containing the Hospital, ASC and PHO names. Users will not be able to edit or add information contained in this drop down list. The user will then enter payment information for the chosen Hospital, ASC or PHO into the first 7 payment fields, Total Payments, Medicare Exemptions, Medicaid Exemptions, Worker's Compensation Exemptions, Other Government Exemptions, Third Party Liability Exemptions, and Other Exemptions. The application automatically calculates totals for Total Exemptions and Net Payments Subject to the Surcharge . Total Exemption is calculated by adding Columns 3, 4, 5, 6, 7 and 8, and net payment subject to the surcharge is computed by subtracting total exemptions from total payments (column 2-column 9).

If you have questions about a specific facility that is not listed in the name drop-down list, contact the Division of Health Care Finance and Policy at 1-800-888-2250 and press 2 for the UCP hotline. You can also email the Division at pool.help@state.ma.us.

  • For further instructions see Column Instructions.

    Definitions

    Total Payment
    All payments made for health care services to a Massachusetts Hospital, Ambulatory Surgical Center and Physician-Hospital Organization less any payments for a supplemental Medigap plan (e.g., Medex). Total Payments include Private Sector Payments that are exempt from the surcharge, i.e. Medicare Exemptions, Medicaid Exemptions, Federal Employee Benefit Payments, Worker's Compensation payments and Property and Casualty payments. Private Sector Payments that are exempt from the surcharge should be included.
    Medicare Exemptions
    Payments made on behalf of Medicare beneficiaries for services covered under Medicare Indemnity plans or Medicare Managed Care programs.
    Medicaid Exemptions
    Payments made on behalf of Medicaid recipients for services covered under Medicaid Managed Care programs.
    Worker's Compensation Exemptions
    Payments made under the Worker's Compensation program (established pursuant to M.G.L. c. 152).
    Other Government Exemptions
    Payments for individuals covered under the Federal Employees Health Benefits Act.
    Third Party Liability Exemptions
    Payments, settlements and judgments arising out of third party liability claims for bodily injury paid under the terms of property or casualty insurance policies.
    Other Exemptions
    All other exempt private sector payments pursuant to 114.6 CMR 11.05 (1) (b) and 114.6 CMR (1) (C).

    Total Exemptions
    Sum of all exempt payments entered into Medicare Exemptions, Medicaid Exemptions, Worker's Compensation Exemptions, Other Government Exemptions, Third Party Liability Exemptions and Other Exemptions. This column is automatically calculated by the application.

    Net Payment Subject to Surcharge
    Total Payments column minus Total Exemptions column. This column is automatically calculated by the application.

    Save payment information
    The application will prompt you to save entered information if you don't do so by using the SAVE BUTTON on the tool bar or the SAVE option from the FILE MENU.

 
Providers Download

This option will provide you with a list of the Hospitals, ASCs and PHOs and matching Org IDs contained in the application. This list can be downloaded and used to create the file for upload submission data. Upload submission data is the alternative to manual data entry for the Hospitals/ASCs/PHOs listed above. It should be noted that the Division assigns Id numbers to the Organizations.
 

 
Line Instructions

Line 1 - Payers will report member months for all products where this is a standard unit of measure, such as managed care plans.

Member Month: The unit of volume measurement used by managed care plans to count the total number of months of coverage for each plan member. Each member month is the equivalent of one member for whom the managed care plan is paid for one month's premium income.

Note: The Division is requesting volume per month not cumulative year to date information.

Line 2 - For products where member month is not a standard unit, payers should report member month equivalents. Payers will convert lives and or subscribers to member equivalents. This should be accomplished by applying a factor to covered lives and or subscribers. Factors will be unique to your products and subscribers.

Covered Lives: The unit of volume measurement used by indemnity plans and third party administrators to count the total number of months of coverage for each plan member. Each member month is the equivalent of one member for whom the indemnity plan or third party administrator is paid for one month's premium income. Note: The Division is requesting volume per month not cumulative year to date information.

Subscribers: The individual who is responsible for payment of premiums or whose employment is the basis for eligibility for membership in a group health plan. Sometimes called member or enrollee. The term subscriber does not refer to covered dependents that are members.

Dependents: Person covered by someone else's health plan. In a payers policy of insurance a person other than the subscriber eligible to receive care because of a subscriber's contract.

Line 3 - This line should be used for units that are not listed above. Please provide an explanation of the unit reported. Again, payers should report member month equivalents. This should be accomplished by applying a factor, which will approximate member months. See description of member months in Line 1. Factors will be unique to your products and subscribers.


Column Instructions

The column instructions are based on the following sections of the Uncompensated Care Pool regulation: 114.6 CMR 11.02, 114.6 CMR 11.06 (l) (a) and 114.6 CMR 11.05 (1) (b).

1. Name - Hospitals, Ambulatory Surgical Centers and Physician-Hospital Organizations whose payments are subject to the Uncompensated Care Pool surcharge. The Division may periodically revise the list of provider names.

2. Total Payments - All payments made for health care services to a Massachusetts Hospital, Ambulatory Surgical Center and Physician-Hospital Organization less any payments for a supplemental Medigap plan (e.g., Medex). Total Payments include Private Sector Payments that are exempt from the surcharge, i.e. Medicare Managed Care payments, Medicaid Managed Care payments, Federal Employee Benefit Payments, Worker's Compensation payments and Property and Casualty payments. Private Sector Payments that are exempt from the surcharge should be included in Column 2 and also reported separately in Columns 3 through 8 as appropriate. For example, payments made under Tufts Secure Horizons plan should be included in the total in Column 2 and separated out in Column 3. Other Exempt payments, such as Worker's Compensation payments, should be included in Column 2 and also included in Column 5. (See column instructions 3 thru 8)

3. Medicare Exemptions - Payments made on behalf of Medicare beneficiaries for services covered under Medicare Indemnity plans or Medicare Managed Care programs including but not limited to:

Medicare MC-Enhance (Pilgrim Product)

Medicare MC-Health New England Medicare Wrap

Medicare MC-HMO Blue for Seniors

Medicare MC-Kaiser Medicare Plus Plan

Medicare MC-Matthew Thornton Senior Plan

Medicare MC-Tufts Medicare Supplement (TMS)

Medicare MC-Fallon Senior Plan

Medicare MC-HPHC 1st Seniority

Medicare MC-Seniorcare Direct/Plus

Blue Care 65

Note: Do not include Medex or other Medigap payments in this column.

4. Medicaid Exemptions - Payments made on behalf of Medicaid recipients for services covered under Medicaid Managed Care programs including:

Current Medicaid Managed Care plans:

Medicaid MC-Boston HealthNet Plan (Boston Medical Center Health Plan)

Medicaid MC-Fallon Community Health Plan

Medicaid MC-Harvard Pilgrim Health Care

Medicaid MC-Mass Behavioral Health Partnership

Medicaid MC-Neighborhood Health Plan

Medicaid MC-Network Health (Cambridge Health Alliance Health Plan)

Recently terminated plans:

Medicaid MC-Community Health Plan (terminated 2/99)

Medicaid MC-HMO Blue (terminated 12/98)

Medicaid MC-Kaiser Foundation Plan (terminated 2/99)

Medicaid MC-Tufts Associated Health Plan (terminated 12/98)

5. Worker's Compensation Exemptions- Payments made under the Worker's Compensation program (established pursuant to M.G.L. c. 152).

6. Other Government Exemptions - Payments for individuals covered under the Federal Employees Health Benefits Act (refer to the Guide to Federal Employees Health Benefits Plans for Federal Civilian Employees, which is available on their web site at http://www.opm.gov/insure The Guide can also be obtained by calling (888) 275-7585.

7. Third Party Liability Exemptions- payments, settlements and judgments arising out of third party liability claims for bodily injury paid under the terms of property or casualty insurance policies.

8. Other Exemptions - All other exempt private sector payments pursuant to 114.6 CMR 11.06 (1) (a) and (1) (b)and (1) (c).

9. Total Exemptions - Sum of all exempt payments entered in columns 3, 4, 5, 6, 7 and 8.

10. Net Payment Subject to Surcharge - Total payments column 2 less column 9.



 
Member Months or Equivalents

The member type, which the user is reporting for, will be chosen from the dropdown list. The dropdown list will contain three member types to chose from, Member Month (MM), Covered Lives/Subscribers Equated to MM and Other. Member months information will be required for the following seven categories: Total Member Months or Equivalents, Medicare Exemptions, Medicaid Exemptions, Worker's Compensation Exemptions, Third Party Liability Exemptions, and Other Exemptions. Total Exemptions and Net Member Months are automatically calculated.

Member Months information can be entered for one or all three member types.

There will be three unit of measurement options to choose from, Member Months (MM), Covered Lives/Subscribers Equated to MM and Other. Member type information can be entered for one, two or all three-member types.

Note: The application is programmed to check for consistency between the member months reported and aggregate net payments subject to the surcharge.

Definitions

Member Months (MM)

The unit of volume measurement used by managed care plans to count the total number of months of coverage for each plan member. Each member month is the equivalent of one member for whom the managed care plan is paid for one month's premium income. Note: the Division is requesting volume per month not cumulative year to date information.

Covered Lives/Subscribers Equated to MM
The unit of volume measurement used by indemnity plans and third party administrators to count the total number of months of coverage for each plan member. Each member month is the equivalent of one member for whom the managed care plan is paid for one month's premium income. Note: The Division is requesting volume per month not cumulative year to date information.

Subscribers:
The individual who is responsible for payment of premiums or whose employment is the basis for eligibility for membership in a group health plan. Sometimes called member or enrollee. The term subscriber does not refer to covered dependents that are members.
Dependent:
Person covered by someone else's health plan. In a payers policy of insurance a person other than the subscriber eligible to receive care because of a subscriber's contract.

Other

This line should be used for units that are not listed above. If "Other" is selected and you did not complete the note section, a system generated message, "Please explain notes for other member type" appears. You cannot save the information until an explanation is provided.

Enter Member Months Information

Member months information will need to be entered into the first seven categories: Total Member Months or Equivalents, Medicare Exemptions, Medicaid Exemptions, Worker's Compensation Exemptions, Other Government Exemptions, Third Party Liability Exemptions, and Other Exemptions. Net Member Months equals the value of Total Member Months or Equivalents (Column 2) minus Columns 3 - 8. Total Exemptions and Net Member Months are calculated automatically by the application. The application will prompt you to save entered information in the event you don't do so by use of the SAVE BUTTON on the tool bar.

 
Upload Submission Data

The Upload Submission Data option is an alternative to manual data entry for companies that have payment information in another system. This will allow you to upload payment information from currently used data sources. Once Payment information has been uploaded you can preview information and print reports using the same process as described above. This should be done to verify that payment information has been uploaded correctly.

Note: Member Months or Equivalent data is not submitted through file upload process. That data must be manually entered into the application.

Creating Upload File

A file will have one record per line using commas as a delimiter between each field. Each record includes the following field names: Total Payments, Medicare Exemptions, Medicaid Exemptions, Worker's Compensation Exemptions, Other Government Exemptions, Third Party Liability Exemptions, Other Exemptions, Total Exemptions, and Net Payments Subject to Surcharge.

Each record represents payment information for a particular Hospital, ASC or PHO. Each record must contain Org_ID of Hospital, ASC or PHO being reported. The Division will provide the Org_ID numbers for Hospitas, ASC and PHO.


For a complete list of the Hospitals, ASCs and PHOs along with Org ID numbers open the Providers Download from the Options Menu.
 

Upload File Format

The Upload file must be in ASCII TEXT format, using a comma as the delimiter, carriage return/line feed combination (CR/LF) for record delimiters and named Upload. Note:
  • There is no name restriction for the file name.
  • No duplicate entries are allowed in the upload file.
  • The last field on the line is not followed by a comma.
  • Null fields are represented by two commas in a row.
  • Leading and trailing spaces on fields will be ignored.
  • File must normally end with a single CtrLf, other wise you will get a null when trying to read a field.

Select Filing/File Upload on the left navigation menu and click on Browse button to navigate to the directory where the upload file is stored and select the Upload.txt.

After selecting the file and click on 'Upload' menu item in the floating tool bar, the application will begin to validate and upload the payments from the file. Once the upload process is completed you will be shown the status of the upload. This status message will give you an evaluation of the upload process like how many records were uploaded, and how many records must still be either uploaded or manually entered into the application.

This screen will also show you the validation errors if they should occur during the upload process. If there are any errors found (usually data omissions or mathematical inconsistencies), make corrections to the file and then reload until all errors are cleared.


Generating Reports

Select 'Reports/Provider Payments' or 'Reports/Member Month Payments' from the left side navigation pane.

This will open pdf reports of all payments made to all providers or member months for the chosen Payer, Month and Year. You can always view pdf reports for payments made to a provider by clicking on PDF button from the floating tool bar while Filing or Browsing the payment information.

 
Reopen Requests

After a web application submission has been completed and closed a user may recognize that adjustments or corrections are needed. Through the same web application the user can create a request to reopen a closed submission. Reopen requests must be reviewed and will be approved or rejected by internal staff. To help ensure a timely review an email notification is automatically generated and sent to the appropriate Division staff. If the request is accepted, the submission is reopened for edit and the monthly report must be resubmitted to the Division after modifications are made.