Current information for pharmacists about the MassHealth Pharmacy program

Number 27
April 20, 2007

Pharmacy Facts

MassHealth Pharmacy Program

www.mass.gov/masshealth/pharmacy
 
• Editor: Vic Vangel • Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey, 
James Monahan, Chuck Young • 
 
National Provider Identifier (NPI) 

All MassHealth pharmacy claims must be submitted using the pharmacy’s 
NPI number as the pharmacy identifier beginning on May 23, 2007. 
When using the NPI number as the pharmacy identifier, the service 
provider ID qualifier (NCPDP-field 202-B2) must be entered as 01. 
Pharmacies may submit claims using their NPI number beginning May 1st, 
but submission with an NPI number becomes mandatory beginning May 23, 2007. 
MassHealth will continue to accept the prescriber’s DEA number as the 
prescriber identifier. The prescriber’s DEA number will continue to be 
the preferred prescriber identifier on a MassHealth pharmacy claim. 
At this time MassHealth will not accept a prescriber’s NPI number 
on a pharmacy claim. 


Payment Error Rate Measurement (PERM) 

Pharmacy providers need to be aware that Massachusetts was selected 
to participate in the federal implementation of the Payment Error 
Rate Measurement (PERM) project during 2007. The Centers for Medicare 
& Medicaid Services (CMS) implemented the PERM project to measure 
improper payments in the Medicaid program. The Improper Payments 
Information Act (IPIA) directs federal agency heads to conduct 
annual reviews of programs that are susceptible to erroneous payments. 
The PERM project requires states to work with CMS in developing a 
national payment error rate to comply with the IPIA. Massachusetts 
will work closely with CMS and their partners to support this 
federal project. Pharmacy providers who have claims selected as 
part of the PERM project will be contacted by CMS representatives 
to provide information so that CMS can determine the validity of 
payments made. Once the pharmacy receives the documentation request, 
the information must be submitted electronically or in hard copy 
within 90 days. All providers will receive a document with more 
details about this project. 
 
For more information about PERM go to the CMS Web site at 
http://www.cms-perm.org/. 
 

MassHealth Drug List Update Effective April 17, 2007 

The following products will be payable through the 
Pharmacy Online Processing System (POPS) beginning on 
April 17, 2007. They will be listed in a new section 
of the MassHealth Drug List titled Non-Drug Product List 
in the near future. 

Euflexxa (hyaluronate) – PA  
Hyalgan (hyaluronate) – PA 
Orthovisc (hyaluronan) – PA  
Supartz (hyaluronate) – PA  
Synvisc (hylan polymers) – PA  
 
 
 
Please direct any questions or comments 
(or to be taken off of this fax distribution) 
to  Victor Moquin of ACS at 617-423-9830. 
www.mass.gov/masshealth/pharmacy