• Editor: Vic Vangel • Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey, James Monahan, Chuck Young • 

Claims Processing Update 

1. Family Planning Products for MCO Members 

MassHealth will notify pharmacies when the pharmacy 
submits a claim for a family planning product to 
MassHealth for a member who is enrolled in one of the 
four MassHealth Managed Care Organizations (MCO). 
MassHealth will pay the claim for a family planning 
product. Alternatively, if the member has coverage 
through one of the MCOs, the pharmacy may bill the 
MCO instead. The message you will see is: 

You may bill MCO (name), #######, directly, 
(Phone #), but are not required to do so. Bill only 
one payer for each family planning service 
provided. 

2. Member Date of Birth 

MassHealth will soon begin sending messages back to 
pharmacies if the member date of birth submitted on a 
pharmacy claim does not match what MassHealth has on 
record in the member file. MassHealth has noted an 
increase in the number of claims where a prescription 
claim is being submitted with a child’s RID # instead of a 
parent’s RID # or vice versa because of similar names on 
a MassHealth card. The message you will see is: 

The date of birth entered does not match the 
date of birth on file with MassHealth. 

When you see this message we ask that you verify the 
member RID # and date of birth and reprocess the 
claim with correct information, if necessary. 

 

3. Prescriptions from Mid-Level Practitioner 
Reminder 

The law stipulates that any prescription issued by a nurse 
practitioner (See M.G.L. c. 112, section 80(E)), or 
physician assistant (See M.G.L. c. 112, section 9(E)) 
must include the name of the supervising physician. 

4. Prescription Origin Codes 

Every claim submitted to MassHealth needs to contain a 
valid prescription origin code in NCPD field 419-DJ. 
These values are: 

1-Written 

2-Telephone 

3-Electronic 

4-Facsimile 

If a pharmacy receives a prescription that is not tamper 
resistant and the pharmacist telephones the prescriber to 
verify authenticity, the pharmacist may use a prescription 
origin code of 1. The pharmacist must document this call 
on the prescription. 

 



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 

Number 36 

April 2, 2008