MMIS POSC Job Aid: 
Institutional Claims Submission with MassHealth


This job aid reviews the process of submitting an electronic institutional claim in the Provider Online Service 
Center (POSC). For specific billing information, providers should reference the relevant Billing Guides, available 
at: www.mass.gov/masshealthpubs (click the Provider Library to access a specific guide).
Please Note: A previously submitted electronic claim that requires a correction to the procedure code, revenue 
coder or service date must be submitted via Direct Data Entry (DDE).

This job aid describes how to:
*	Submit a single institutional claim for a member who only has MassHealth coverage.

Access Enter Single Claim
From the Provider Online Service Center home page:
1.	Click Manage Claims Payments.
2.	Click Enter Single Claim. The Claim Templates panel displays.
On the Claim Templates panel:
3.	Click Institutional Claim. The Billing Information panel displays.

Billing and Service: Enter Billing and Member Information
On the Billing Information panel:
4.	Select the Type of Bill from the drop-down.
5.	Select the Billing Provider ID from the drop-down.
6.	Enter the Member ID for the claim.
7.	Enter the Patient Account #.
8.	Enter the member’s name in the Last Name and First Name fields.
9.	In the DOB field, enter the member’s date of birth.
10.	Select the member’s Gender from the drop-down.
11.	In the Member Address 1 field, enter the member’s street address.
Note:  Additional address information, for example apartment numbers, can be entered in the Member 
Address 2 field.
12.	Enter the member’s City, State, and Zip code in their respective fields.



Billing and Service: Enter Provider and Benefit Information
On the Billing Information panel:
13.	In the Attending Phys Last Name and Attending Phys First Name fields, enter the name of the 
Attending Physician associated with the claim.
14.	Enter the Attending Phys NPI.
15.	In the Assignment of Benefits drop-down, select whether or not the member authorizes benefits be 
paid to the provider.
Note:  When submitting a Medicaid claim, this field should always be set to Yes.
16.	Select the appropriate value in the Provider Accepts Assignment drop-down.
17.	Select the Claim Filing Indicator from the drop-down.
18.	Select the Release of Information from the drop-down. 

Billing and Service: Enter Service Information
On the Service Information panel:
19.	In the From Date and Through Date fields, enter the date range for the claim.
20.	Select the Patient Status from the drop-down.
21.	Select the Admit or Visit Source from the drop-down.
22.	Select the Admission or Visit Type from the drop-down.
23.	Enter the Admission Date.
24.	Select the Admission Hour from the drop-down.
Note:  The Admission Hour field uses the 24-hour clock (military time).  
25.	Select the Discharge Hour from the drop-down.
Note:  The Discharge Hour field uses the 24-hour clock (military time).  
If applicable, select the appropriate code from the Delay Reason Code drop-down.

When submitting a 90-Day Waiver Request, enter one of the following Delay Reason Codes:
 
1-Proof of Eligibility Unknown or Unavailable
4-Delay in Certifying Provider
8-Delay in Eligibility Determination

When submitting a Final Deadline Appeal Request, enter Delay Reason Code: 
 
9-Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation
 
When submitting a NCCI/MUE Review Request or a Special Handle claim, enter Delay Reason Code:
 
11-Other
 

Billing and Service: Enter the Claim Charges
On the Claims Charges panel:
26.	Enter the Total Charges for the claim. 

Extended Service: Enter Occurrence Information
27.	Click the Extended Services tab. 
On the List of Occurrences panel:
28.	Click New Item. The Occurrence Code Detail panel displays.
On the Occurrence Code Detail panel:
29.	Select the Occurrence Code from the drop-down.
30.	In the Date fields, enter the date range for the claim.
31.	Select the Type of occurrence from the drop-down.
32.	Click Add to save the Occurrence information. 

Extended Service: Enter Value Code Information
On the List of Values panel:
33.	Click New Item. The Value Code Detail panel displays.
On the Value Code Detail panel:
34.	Select the Value Code from the drop-down.
35.	In the Amount field, enter the amount of the claim that Medicaid is paying.
36.	Click Add to save the Value Code information. 

Extended Service: Enter Diagnosis Information
On the List of Diagnoses panel:
37.	Click New Item. The Diagnosis Code Detail panel displays.
On the Diagnosis Code Detail panel:
38.	Enter the Diagnosis Code.
39.	Select the Type of diagnosis code from the drop-down.
40.	Click Add to save the Diagnosis Code information.
Note: You must add Principal diagnosis and Admitting when applicable. 

Enter Procedure Information
41.	Click the Procedure tab. 
On the List of Institutional Services panel:
42.	Click New Item. The Institutional Service Detail panel displays.
On the Institutional Service Detail panel:
43.	Enter the Revenue Code.
44.	When applicable enter HCPCS Procedure Code and associated modifier and date information.
45.	Enter the number of Units for the claim.
46.	Select the Units of Measurement from the drop-down.
47.	Enter the Charges for the claim.
48.	Enter Drug Identification information if the HCPC code entered on the claim is for drug charges.  
Complete the following fields, as appropriate:
*	NDC – enter the complete 
ID number of drug
*	Units of Measurement
 
*	Units
*	Rx Qualifier
*	Rx Number

49.	Click Add.
Add Attachments
50.	Click the Attachments tab. 
On the List of Attachments panel:
51.	Click New Item. The Attachments Detail panel displays.
On the Attachments Detail panel:
52.	Select the Report Type from the drop-down.
53.	Select the Transmission Code of the report from the drop-down.
54.	Click Browse.  The Choose file window displays.
55.	Navigate to the file you want to attach and click Open.
56.	Click Add/Upload.  
Confirm Claim
57.	Click the Confirmation tab. 
On the Confirmation panel:
58.	Verify that the claim information is correct.
59.	Once you have ensured the claim is correct, click Submit.



Claim Status Response
On the Claim Status Response panel:
60.	Review the status of the claim, including EOB codes that may appear.
61.	Click Close.


MMIS POSC Job Aid: 
Institutional Claims Submission with MassHealth
MassHealth Provider Online Service Center	1 of 5	Revised: October 19, 2011
v2.6
Provider Online Service Center - Submit a Referral
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