Important. Please Read NewMMIS Notices - by Function

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The POSC is a Web-based portal that includes the functions described below. Providers are encouraged to use the POSC to accomplish these tasks independently. Regularly accessing the many online tools available on the POSC can help improve your efficiency when completing the business transactions you need to conduct with MassHealth. From the Online Services panel of the MassHealth home page (www.mass.gov/masshealth), click on Provider Online Service Center.

POSC Functions:
-enroll as a MassHealth provider and manage profile information, such as changes to provider profile (see Manage Provider Information);
-add to and update subordinate accounts (see Administer Account);
-perform direct data entry (DDE) real-time, continuous, interactive claims processing, verify member eligibility, submit batch claim, check claim status, resubmit DDE (see Manage Claims and Payments);
-manage service authorizations: enter, update, and inquire about preadmission screening (PAS), prior authorization (PA), and Primary Care Clinician (PCC) referrals; request nonemergency transportation for members; and upload and download batch service authorizations (see Manage Service Authorizations);
-view publications such as forms for downloading, transmittal letters and bulletins, news, training registration and materials, and MassHealth regulations; access links to mass.gov (news,  publications, related updates) (see Reference Publications);
-view notifications, including any new EOHHS notices, Broadcast Messages, contracts, letters and documents (for example, view PAS, PA and PCC notices), reports, metrics, and financial data; generate financial and claim denial reports; and download remittance advices (see Manage Correspondence and Reporting);
-enroll and disenroll members for Senior Care Options (SCO) and Program of All-inclusive Care for the Elderly (PACE), and submit Management Minutes Questionnaires (MMQ) (see Manage Members); and
-change password and manage Subordinate User accounts (see Administer Account).

Several online job aids offer instruction for these functions. You can access these job aids on the MassHealth Web site (www.mass.gov/masshealth). Select the Information for MassHealth Providers link, click New Medicaid Management Information System (NewMMIS and the Provider Online Service Center (POSC). Click Using the POSC for the First Time, and then click Get Trained.

As a Provider Online Service Center subordinate user, you have been authorized certain access capabilities by the designated primary user at your provider location. Depending on your access, you will be able to perform certain POSC functions such as entering, submitting, and retrieving transactions. You can view the complete list of services from the Provider Services panel after logging into the POSC from the MassHealth home page (www.mass.gov/masshealth). Once you enter your username and password, you can select from this list those tasks that you have been authorized to perform.

The primary user is the administrator for your Provider Online Service Center (POSC) account and the individual who has the authority to assign and maintain subordinate identifications (IDs). If you have issues or questions about passwords and permissions for POSC access and functions, you should contact your primary user.  

If you need instruction for any POSC functions or to obtain a general overview of the POSC and its services, please refer to the POSC job aids. To access the job aids, select the Information for MassHealth Providers link and click New Medicaid Management Information System (NewMMIS and the Provider Online Service Center (POSC). Click Using the POSC for the First Time, and then click Get Trained. Some of the references related to these functions can be found under the headers: Provider Information & Navigation, Eligibility Verification, Editing Claims Post Submission, and Referrals.

MassHealth encourages you to use these resources to help you effectively manage your daily business tasks. You should always make every effort to consult these references and enlist your primary user to complete any POSC-related functions before contacting MassHealth Customer Service.

MassHealth has posted the following publications on the MassHealth Web site.
Provider Bulletins from January 2012
- School-Based Medicaid Bulletin 21: Medicaid National Correct Coding Initiative (NCCI) for School-Based Medicaid Providers

Transmittal Letters from January 2012
- Transmittal Letter ALL-190: Revised Administrative and Billing Instructions
- Transmittal Letter ALL-189: Change in Pharmacy Copayment Calendar-Year Maximum
- Transmittal Letter ALL-188: Revised Appendix A to Reflect Changes in Phone and Fax Information for Some MassHealth Business Units
- Transmittal Letter EIP-19: Revised Service Codes and Descriptions
- Transmittal Letter RHB-20: Service Codes and Descriptions
- Transmittal Letter SHC-18: Service Codes and Descriptions
- Transmittal Letter THP-25: Service Codes and Descriptions

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our Web site, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

As a result of system compliance issues that are occurring on HIPAA 5010 837 Medicare Crossover claim files received from the Medicare Coordination of Benefits Contractor (COBC), there has been a delay with the processing of some Medicare crossover claims. MassHealth is working with Medicare and the COBC to resolve these errors as soon as possible. Providers should not submit these crossover claims to MassHealth. Once the issue has been resolved, these claims will be processed and appear on future remittance advices (RA). Please continue to check Broadcast Messages and your RA for future updates on this matter. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

RA MESSAGES THAT HAVE BEEN REQUESTED FOR EXTENDED RUN THROUGH 2/10/12:

Effective January 1, 2012, MassHealth implemented changes to meet the Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 5010 federal requirements. As of January 1, 2012, MassHealth only accepts electronic transactions in the new HIPAA mandated 5010 format. If you have not completed testing for 5010, it is important that you complete this as soon as possible, to avoid impact to claims payment. For assistance on testing, call MassHealth at 1-855-253-7717 through January 31, 2012.

Beginning February 1, 2012, all issues (testing and production file submissions) should be directed to MassHealth Customer Service at 1-800-841-2900.

If you are seeking additional assistance or training on how to use MassHealth’s Provider Online Service Center (POSC) claims functionality to better understand the HIPAA changes and how they may impact you, please send an email to providersupport@mahealth.net. A representative can help assist you on the use of the POSC and provide additional training as needed.

Reminder: Please be sure to submit the relevant 5010 data elements when submitting 5010 transactions in production to avoid unnecessary denials during implementation. MassHealth has posted a document that outlines common testing issues that will help submitters avoid encountering these issues in production. Please review the document (Most Common 5010 Trading Partner Testing Errors) located under the Frequently Asked Questions header on the 5010 Web site (www.mass.gov/masshealth/5010).

If you upload a batch file to MassHealth, please ensure you follow-up approximately 15 minutes later, to validate you have received a 999 (formerly known as a 997) file acknowledgement. A 999A file acknowledgement means your file has been received successfully by MassHealth. A 999R file acknowledgement means your file was received but not processed. Review the MassHealth Companion Guide to review why you received a 999R. If you do not receive any 999 file acknowledgement file, then your file was not recognized by MassHealth. Review the ISA of your file to confirm you have submitted your file correctly. For assistance, email us at EDI@mahealth.net or contact us at 1-800-841-2900, options 1, 8, 3.

Please note that on January 1, 2012, MassHealth converted to the HIPAA 5010-mandated electronic transaction format. As previously communicated, MassHealth only accepts electronic transactions in the new HIPAA 5010 format. Please refer to All Provider Bulletin 222, for details about the implementation and requirements of this transition.

We strongly urge you to check your files to ensure you are submitting only 5010 required data on your files. You can verify that your claims were successfully processed in the 5010 format by logging into the Provider Online Service Center (POSC) and entering the appropriate information for a claim status inquiry.

Please continue to check the Most Common 5010 Trading Partner Testing Errors document, located under the Frequently Asked Questions header on the 5010 Web site (www.mass.gov/masshealth/5010) for updates on common testing issues that will help submitters avoid encountering issues in production.

January 20, 2012, was the last day of business for the MassHealth Enrollment Center (MEC) located in Revere. The MEC has moved to Chelsea. The new MEC address is:
MassHealth Enrollment Center
45-47 Spruce Street
Chelsea, MA 02150.

During the week of January 23, 2012, MassHealth will post on its Web site a revised Appendix B for all provider manuals. Information about this posting and additional information about the MEC move can be found in Transmittal Letter ALL-191. You can access this important transmittal letter from the MassHealth online Provider Library at www.mass.gov/masshealthpubs.

Authorized provider types will use a new data element “Total Noncovered Amount” to report noncovered charges on HIPAA 5010 claims, for specific TPL exception conditions described in your MassHealth provider manual TPL appendix. Providers who are authorized to use a “Total Noncovered Amount” when reporting specific TPL exception conditions are listed below, with their related TPL appendix noted in parentheses:

- Acute Inpatient Hospitals (Appendix D)
- Chronic Disease and Rehabilitation Inpatient Hospitals (Appendix D)
- Community Health Centers (Appendix D)
- Home Health Agencies (Appendix D)
- Mental Health Centers (Appendix D)
- Nursing Facilities (Appendix G)
- Psychiatric Inpatient Hospitals (Appendix D)

The exception instructions are located in the Supplemental Instructions for Claims with Other Insurance in theAppendix section of each provider manual as noted. You can access the provider manuals from the online provider library at www.mass.gov/masshealthpubs.

Provider manual TPL appendices contain specific MassHealth billing instructions for members who have Medicare or commercial insurance. The TPL appendices supplement instructions contained in the HIPAA Implementation Guides and MassHealth Companion Guides and Billing Guides. Providers who are not authorized to use the new 5010 field “Total Noncovered Amount” should report the HIPAA adjustment reason code provided by the other insurer on their MassHealth claim submission to indicate the other insurer has not paid the claim.

NCCI/MUE requests for review may be submitted electronically on the Provider Online Service Center (POSC) through direct data entry (DDE).
Please refer to All Provider Bulletin 209 (April 2011: Medicaid National Correct Coding Initiative) for instructions and required documentation.

Providers should use the Attachment tab to upload all documents related to the NCCI/MUE request. Only delay reason code 11 (Other) may be used when submitting a NCCI/MUE request.
NCCI/MUE requests will appear in a suspend status on your remittance advice (RA) with edit 829 (NCCI appeal/special handle under review) while your request is under review. Approved and denied requests will appear on a future RA. A final notice of denial will be sent if a request is denied.

If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

On 12/21/11 the Centers for Medicare and Medicaid Services (CMS) notified MassHealth that Medicare did not have the capability to complete conversion of HIPAA 4010A1 837 run out claims to HIPAA Version 5010 for some Coordination of Benefits Agreement (COBA) trading partners that implemented HIPAA Version 5010 on 1/1/12. The affected 4010A1 run out claims (both institutional and professional) were most likely received by Medicare between 12/16/11 and 12/23/11.

MassHealth communicated on several occasions that it would not process 4010A1 837 claim files received after 1/1/12. However, providers may submit their crossover claim directly to MassHealth for payment consideration if their 4010A1 run out claim was received by Medicare between 12/16/11 and 12/31/11 and there is a remaining MassHealth member liability on the claim. Affected claims should be submitted to MassHealth using 837 batch submissions or via the Provider Online Service Center (POSC) using direct data entry (DDE). If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

REMINDER TO LONG TERM SERVICES AND SUPPORTS PROVIDERS: DO NOT BILL CLAIMS UNTIL YOU HAVE REVIEWED YOUR MANAGEMENT MINUTES QUESTIONNAIRE (MMQ) SUMMARY RESPONSE 

When uploading a batch MMQ file, you must first verify that you have received notification that the batch has been successfully accepted.  Please also review the MMQ Summary Response to validate that the MMQ file has been processed correctly. The summary response is sent the day following the MMQ file submission. Therefore you should only submit a claim after reviewing the MMQ summary response to ensure correct claims adjudication. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.netor 1-800-841-2900.

All Provider Bulletins 212 (May 2011: Important Claims Submission Policy Changes) and 217 (September 2011: Waiver Policy for Claim Submissions) announced an important change in the claims submission policy. Effective January 1, 2012, all MassHealth claims must be submitted electronically unless a provider has an approved electronic claim submission waiver.

Effective January 1, 2012, MassHealth will implement a 90-day grace period of the claims submission policy to allow providers additionaltime to convert to electronic claims submission and to apply for the electronic claim submission waiver. MassHealth will issue an all provider bulletin in January that further explains this grace period.

If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Psych providers are not consistently reporting the ICD-9-CM diagnosis code(s) according to the instructions outlined in the UB-04 Billing Guide. MassHealth requires providers to enter the ICD-9-CM diagnosis code(s) corresponding to all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received or the length of stay. Providers should refer to the UB-04 Billing Guide for additional information on submitting both electronic and paper claims. If you have additional questions, contact MassHealth Customer Service at providersupport@mahealth.net or 800-841-2900.

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Authorized provider types will use a new data element “Total Noncovered Amount” to report noncovered charges on HIPAA 5010 claims, for specific TPL exception conditions described in your MassHealth provider manual TPL appendix. Providers who are authorized to use a “Total Noncovered Amount” when reporting specific TPL exception conditions are listed below, with their related TPL appendix noted in parentheses:

- Acute Inpatient Hospitals (Appendix D)
- Chronic Disease and Rehabilitation Inpatient Hospitals (Appendix D)
- Community Health Centers (Appendix D)
- Home Health Agencies (Appendix D)
- Mental Health Centers (Appendix D)
- Nursing Facilities (Appendix G)
- Psychiatric Inpatient Hospitals (Appendix D)

The exception instructions are located in the Supplemental Instructions for Claims with Other Insurance in theAppendix section of each provider manual as noted. You can access the provider manuals from the online provider library at www.mass.gov/masshealthpubs.

Provider manual TPL appendices contain specific MassHealth billing instructions for members who have Medicare or commercial insurance. The TPL appendices supplement instructions contained in the HIPAA Implementation Guides and MassHealth Companion Guides and Billing Guides. Providers who are not authorized to use the new 5010 field “Total Noncovered Amount” should report the HIPAA adjustment reason code provided by the other insurer on their MassHealth claim submission to indicate the other insurer has not paid the claim.

On 12/21/11 the Centers for Medicare and Medicaid Services (CMS) notified MassHealth that Medicare did not have the capability to complete conversion of HIPAA 4010A1 837 run out claims to HIPAA Version 5010 for some Coordination of Benefits Agreement (COBA) trading partners that implemented HIPAA Version 5010 on 1/1/12. The affected 4010A1 run out claims (both institutional and professional) were most likely received by Medicare between 12/16/11 and 12/23/11.

MassHealth communicated on several occasions that it would not process 4010A1 837 claim files received after 1/1/12. However, providers may submit their crossover claim directly to MassHealth for payment consideration if their 4010A1 run out claim was received by Medicare between 12/16/11 and 12/31/11 and there is a remaining MassHealth member liability on the claim. Affected claims should be submitted to MassHealth using 837 batch submissions or via the Provider Online Service Center (POSC) using direct data entry (DDE). If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.