INDEPENDENT NURSES-PLAN OF CARE REQUIREMENTS
Independent Nurses are reminded: When you co-vend with other providers (home health agencies or nurses) to deliver CSN (continuous skilled nursing services), you and the other provider(s) are each responsible for obtaining orders from the member’s physician for CSN and the plan of care. Independent Nurses should not provide nursing care to members, using physician orders and a plan of care issued to another home health agency or nurse provider.
Please refer to 130 CMR 414.412 (A-E) for Plan of Care requirements. For questions, contact MassHealth Customer Service at 1-800-841-2900 or email@example.com.
NURSING FACILITY HOSPICE DAY OF DISCHARGE BILLING CLARIFICATION
Nursing Facilities are reminded that, in accordance with 130 CMR 437.424 (B)(3), Hospice Providers must bill for hospice room and board on the day of hospice discharge when the member is to remain in the nursing facility.
Also, Hospice providers are reminded to enter Status Code 30 on the claim, indicating that the member will remain in the nursing facility after discharge from hospice.
EXAMPLE: If a member is discharged from hospice on 11/06, the member remains in the hospice sequence through 11/06. If the nursing facility bills for NF services on 11/06, the claim will deny. The nursing facility is paid hospice room and board on the day of hospice discharge. The nursing facility can begin billing for NF services the day after Hospice discharge, as in this example, 11/07.
For questions, please contact MassHealth Customer Service at 1-800-841-2900 or firstname.lastname@example.org.
MONTHLY MMQ SUBMISSION REMINDER
Nursing Facility providers are reminded: you must submit your monthly MMQs (Management Minute Questionnaires) no later than the 15th of every month. If you have questions about your MMQ submission, please contact MassHealth Customer Service for assistance at email@example.com or call 800-841-2900. Your issues and inquiries will be properly triaged for review and resolution.
AVAILABLE THIS FALL: VIEWING VOIDS AND ADJUSTMENTS ON THE 835
MassHealth providers will soon be able to view voids and adjustments on the 835 at both the detail line level and the header level. The level of detail of the voids and adjustments will be based upon the level of detail of the original payment. Please ensure that your systems and your business operations are able to support this change. Providers interested in testing the new recoupment modifications can do so by contacting the EDI team at 1-800-841-2900 or firstname.lastname@example.org.
NURSING HOME MMQ ISSUES
Nursing Home providers are reminded: if you have questions or issues with MMQs (Management Minute Questionnaires), please contact MassHealth Customer Service for assistance at email@example.com or call 800-841-2900. Your issues/inquiries will be properly triaged for review and resolution.
NURSE PRACTITIONER AND NURSE MIDWIFE CLAIMS ADJUSTMENTS
Due to a systems issue, some claims for Nurse Practitioners and Nurse Midwives were paid incorrectly. The original claims were either underpaid or overpaid and are being adjusted to reflect the correct payment. The adjustments may appear on this remittance advice or a future remittance advice. For questions, please contact Customer Service at firstname.lastname@example.org or 800-841-2900.
MEDICARE PART B DENIED SERVICES THAT REQUIRE MANUAL PRICING
MassHealth has identified certain Medicare Part B crossover claims that were paid the full billed amount in error. The affected claim lines were denied by Medicare and were not manually priced as required by MassHealth. These claims have been adjusted with Edit 410 – MEDICARE DENIAL ON CROSSOVER CLAIM. The adjustments will appear on this or future remittance advices.
Providers can re-bill these affected crossover claims by going on the Provider Online Service Center (POSC) and attaching the required documentation to support manual pricing via Direct Data Entry (DDE).
For questions, please contact MassHealth Customer Service at email@example.com or 1-800-841-2900.
This information is provided by MassHealth.