This job aid reviews the process of submitting an electronic institutional claim in the Provider Online Service 
Center (POSC) for residential care homes. For specific billing information, refer to the relevant Residential Care 
Home Billing Guide for the UB-04.
This job aid describes how to submit a single institutional claim using the POSC.

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 is displayed.
On the Claim Templates panel:
3.	Click Institutional Claim. The Billing Information panel is displayed. 

Billing Information: Enter Billing and Resident Information
On the Billing Information panel:
4.	Select the Type of Bill from the drop-down list.
5.	Select the Billing Provider ID from the drop-down list. This is the 10-digit identification number/service 
location code assigned to the residential care home by the MassHealth claims processing system.
6.	Enter the Member ID for the claim. This is the resident’s 12-digit identification number. 
7.	Enter the Patient Account #. If you use an account number to identify and track your residents, enter 
this account number in this field. 
8.	Enter the resident’s name in the Last Name and First Name fields.
9.	In the DOB field, enter the resident’s date of birth.
10.	Select the resident’s Gender from the drop-down list.
11.	In the Member Address 1 field, enter the resident’s street address (the street address of the residential 
care home in which the resident lives).
12.	Enter the resident’s City, State, and Zip code in their respective fields. (These are the city, state, and 
zip code for the residential care home in which the resident lives.)




Billing Information: 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 (national provider identifier).
15.	In the Signature on File drop-down list, select whether or not the claim has been signed by the 
residential care home.
Note:  When submitting a POSC claim, this field should always be set to Yes.
16.	In the Assignment of Benefits drop-down list, select whether or not the resident authorizes benefits to 
be paid to the residential care home. 
Note:  When submitting a POSC claim, this field should always be set to Yes.
17.	Select the Claim Filing Indicator from the drop-down list.
Note:  When submitting a POSC claim, this field should always be set to MC-Medicaid. (The actual 
payer is Massachusetts Department of Transitional Assistance (DTA), but the Commonwealth 
uses the MassHealth claims payment system to process claims on behalf of DTA.)
18.	Select the Release of Information from the drop-down list.

Service Information: 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.	Enter the number of Covered Days.
21.	Select the Patient Status from the drop-down list.
22.	Select the Admit Source from the drop-down list.
23.	Enter the Admission Date. Enter the date of the resident’s initial admission to the residential care 
home or the date of the most recent readmission following a three-day hospital stay.

Claims Charges: Enter the Claim Charges
On the Claims Charges panel:
24.	Enter the Total Charges for the claim. 

Extended Services: Enter Occurrence Information (applicable only if entering MLOA –Medical 
Leave and NMLOA - Non Medical Leave information)
25.	Click the Extended Services tab. 
On the List of Occurrences panel:
26.	Click New Item. The Occurrence Code Detail panel is displayed.
On the Occurrence Code Detail panel:
27.	Select the Occurrence Code from the drop-down list.
28.	In the From and To fields, enter the date range for the occurrence code for the claim.
29.	Select the Type of occurrence from the drop-down list.
30.	Click Add to save the Occurrence information.

List of Diagnoses: Enter Diagnosis Information
On the List of Diagnoses panel:
31.	Click New Item. The Diagnosis Code Detail panel is displayed.
On the Diagnosis Code Detail panel:
32.	Enter the Diagnosis Code. This is the ICD-9-CM code that describes the resident’s principal diagnosis. 
Refer to the NUBC Instruction Manual for code values.
33.	Select the Type of diagnosis code from the drop-down list.
34.	Click Add to save the diagnosis code information.
.
Enter Procedure Information (Repeat for each detail line)
35.	Click the Procedure tab. 
On the List of Institutional Services panel:
36.	Click New Item. The Institutional Service Detail panel is displayed.
On the Institutional Service Detail panel:
37.	Enter the Revenue Code.
38.	Enter the number of Units for the claim. This is the number of days for the claim. 
39.	Select the Units of Measurement from the drop-down list. 
40.	Enter the Charges for the claim.
41.	Click Add. 

Confirm Claim
42.	Click the Confirmation tab. 
On the Confirmation panel:
43.	Verify that the claim information is correct.
44.	Once you have ensured the claim is correct, click Submit.
45.	Review the adjudicated claim results as identified on the confirmation page. Verify the claim status. 

Explanation of Benefits (EOB) Codes
On the Explanation of Benefits (EOB) panel:
46.	Review any EOB codes that may appear. If the claim status is denied, correct any errors and resubmit 
the claim. 
47.	Click Close.


NewMMIS Job Aid: Submit a Residential Care Home Claim
MassHealth Provider Online Service Center	1 of 4	Revised: August 4, 2010
													    v. 1.1
Provider Online Service Center - Submit a Referral
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