04/15/14

COVERAGE OF RESTORATIVE ADULT DENTAL SERVICES

MassHealth is covering additional restorative services (fillings) for adults, effective for dates of service beginning March 1, 2014.

MassHealth will pay for the following restorative services for all members, including those age 21 and older:

  • D2140 - Amalgam restorations
  • D2150 - Amalgam restorations
  • D2160 - Amalgam restorations
  • D2161 - Amalgam restorations
  • D2332 - Resin-based composite restorations
  • D2335 - Resin-based composite restorations
  • D2391 - Resin-based composite restorations
  • D2392 - Resin-based composite restorations
  • D2393 - Resin-based composite restorations
  • D2394 - Resin-based composite restorations

Please refer to MassHealth Dental Bulletin 43 at www.mass.gov/eohhs/docs/masshealth/bull-2014/den-43.pdf.  For questions, please contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net.

 

NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from March 2014:

  • All Provider Bulletin 243: New Coverage Type: MassHealth CarePlus
  • All Provider Bulletin 242: Provider Revalidation
  • Community Health Center Bulletin 79: MassCor Online Eyeglass Order System
  • Dental Bulletin 43: Coverage of Restorative Adult Dental Services
  • Physician Bulletin 97: MassCor Online Eyeglass Order System
  • Vision Care Bulletin 17: MassCor Online Eyeglass Order System

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (www.mass.gov/masshealthpubs).


04/08/14

IMPORTANT MESSAGE REGARDING ICD-10

On April 1, 2014 the bill H.R. 4302, Protecting Access to Medicare Act of 2014 was signed into law. A component of the law states that HHS (Department of Health and Human Services) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015.  Based upon this change, MassHealth is evaluating the impact of the delay on MassHealth and will provide more information as soon as it becomes available. In the interim, MassHealth will continue to test ICD-10 transactions with its trading partners.

 

DIAGNOSIS EDITS

Providers are advised that their claims will deny with the following edits if the claims are submitted with a diagnosis code that is not covered on the date of service:

  • 4188- DIAG CODE NOT COVERED FOR DOS
  • 4189- SECOND DIAG CODE NOT COVERED FOR DOS
  • 4190- THIRD DIAG CODE NOT COVERED FOR DOS
  • 4191- FOURTH DIAG CODE NOT COVERED FOR DOS
  • 4192- FIFTH DIAG CODE NOT COVERED FOR DOS
  • 4193- SIXTH DIAG CODE NOT COVERED FOR DOS
  • 4194- 7 - 24 DIAG CODE NOT COVERED FOR DOS

For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

 

EARLY INTERVENTION SERVICE CODE T1024 (40 UNITS COUNTING METHOD)

Effective with DOS (Dates of Service) January 1, 2014, MassHealth will no longer use the previous rolling calendar year methodology to count the 40 maximum units allowed per member per 12-month period for service code T1024-EARLY INTERVENTION ASSESSMENT.

MassHealth will now count the 40 units maximum for T1024 using the standard calendar year (January 1 through December 31) method. For example, if a claim for service T1024 is submitted with the first DOS of February 1, 2014, then MassHealth will begin counting up to 40 units in the calendar year period beginning February 1, 2014 and ending December 31, 2014. January 1, 2015 will start a new calendar year where MassHealth will begin counting another 40 units toward the next 12-month period.

MassHealth will systematically reprocess previously adjudicated claims for T1024 due to Edit 8155 (limit 40 units in 12 months per member) for DOS January 1, 2014 and following, on future remittance advices. No action is required on the part of the provider.

For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

 


04/01/14

LETTERS REGARDING PHYSICIAN ELIGIBILITY FOR SECTION 1202 RATES

This is a reminder to all physicians who received a letter from MassHealth, dated February 28, 2014 regarding ACA Section 1202 Physician Eligibility:

Please complete and return the Physician Certification and Attestation Form pdf format of aca-1202 doc format of Physician Certification and Attestation Form . You must confirm your eligibility for Section 1202 rates. Otherwise, MassHealth will begin the process to terminate this eligibility and recover any Section 1202 payments that have been made to your group practice.

Please return the completed form to:

MassHealth PEC
P.O. Box 9162
Canton MA 02021 

OR by FAX to 1-617-988-8974.

For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

 

ORTHOTICS AND PROSTHETICS CLAIMS ADJUSTMENTS

Orthotics and Prosthetics providers are reminded: Following EOHHS’s adoption of revised rates on June 21, 2013, MassHealth has started reprocessing claims where the fees were increased and providers received an incorrect amount. The claims will adjust according to the rate change and will pay the difference. This only affects paid claims, not denied claims.

Providers do NOT need to resubmit claims to receive the fee increase. Claims are being reprocessed systematically.

We apologize for any inconvenience. For questions regarding this change, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

 

TEMPORARY MASSHEALTH MEMBER COVERAGE

MassHealth and the Health Connector are pleased to confirm that, effective February 1, 2014, temporary coverage is being provided to individuals who submitted MassHealth applications in January for subsidized coverage. This temporary coverage will continue until at least June 30, 2014, unless the individual’s application is processed sooner. Individuals with temporary coverage can seek services from any provider that accepts MassHealth.

No ID card will be issued. Individuals will receive a letter containing a Member ID that confirms MassHealth Standard Fee-for-Service temporary coverage; they must present this letter to providers as confirmation of coverage.  In addition, Providers should always verify eligibility via EVS on the POSC (Provider Online Service Center).

For more details and answers to frequently asked questions about temporary coverage, please go to: www.mass.gov/masshealth.  Under “News and Updates,” click on “Temporary Coverage Expansion Update.” Or contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.


This information is provided by MassHealth.