08/19/14

NEW FAX NUMBER FOR MASSHEALTH HOSPICE ELECTION FORMS

Effective immediately, all Hospice providers must use a new fax number to submit Hospice Election Forms on behalf of MassHealth members who seek to elect hospice services, revoke or terminate hospice services or change hospice providers.

The new fax number is: 617-886-8402.

You may also mail Hospice Election forms to:

MassHealth Hospice Unit
UMMS-CHCF
29 Main St., Ste. 320
Charlestown MA 02129

Hospice Election forms must be completed fully and submitted under separate cover for each member.

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

 

IMPORTANT NOTIFICATION: EVSPC WILL TERMINATE IN DECEMBER 2014

MassHealth will terminate the use of EVSpc on December 31, 2014 and will no longer provide support for the software tool after that date. The software is no longer compatible with the EVS functionality on the POSC (Provider Online Service Center). Providers that use the EVSpc software will not receive key eligibility messages related to MassHealth members’ coverage. Providers are strongly encouraged to stop using the EVSpc immediately and transition to one of the following POSC or telephone access methods:

  • DDE (Direct Data Entry)
  • Submit a Health Care Benefit Inquiry & response (270/271) batch file transaction in accordance with MassHealth specifications
  • Engage a vendor to generate your Health Care Benefit Inquiry batch files
  • Check eligibility by calling the Provider AVR (Automated Voice Response) system at 1-800-554-0042

The tool will no longer be available for download. The December 31, 2014 termination date will provide ample time for providers to transition to one of the POSC access methods.

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

 


08/12/14

HOMEBOUND ASSESSMENT WEBINAR FOR HOME HEALTH AGENCIES – AUGUST 22, 2014

MassHealth invites all Home Health Agency providers to an informative webinar on Friday, August 22, 2014 from 11:00 AM – 12 Noon. TPL (Third Party Liability) leaders will review how to best use the Homebound Assessment form, as defined in HHA Bulletin 48 (September 2012). The webinar will review:

  • Using the form to submit cases that do not meet homebound requirements for Medicare coverage
  • General procedures for submitting the form
  • How MassHealth evaluates your submitted form
  • Updates to the traditional Medicare Appeals TPL Initiative

To join the webinar on Friday, August 22, 2014, 11:00 AM – 12 Noon, please go to:

Audio Login

Toll-Free (US & Canada): 866-740-1260
Toll: 303-248-0285
Access Code: 4725653

Web Login

Meeting URL:http://www.readytalk.com/?ac=4725653
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800-843-9166 or help@readytalk.com
Access Code: 4725653

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

 

LETTERS REGARDING PHYSICIAN ELIGIBILITY FOR SECTION 1202 RATES

This is a message to all physicians in group practices who have not responded to a letter from MassHealth, dated August 1, 2014, 2014 regarding ACA Section 1202 eligibility for physicians that have not returned the Physician Certification and Attestation Form:

As of September 30, 2014, MassHealth will no longer pay group practices the Section 1202 rates for services provided by physicians for whom we do not receive a completed Physician Certification and Attestation Form by August 29, 2014.

Additionally, MassHealth will calculate and recover any Section 1202 payments that have been made to group practices since January 1, 2013 for services provided by physicians who do not attest to 1202 eligibility and did not return a completed Physician Certification and Attestation Form.

Physicians who are eligible under Section 1202 should complete the Physician Certification and Attestation Form available at http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf by August 29, 2014.

Completed forms should be returned to MassHealth PEC, P.O. Box 9162, Canton MA 02021or 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.

 


08/05/14

MASSHEALTH SPAD PRICING METHODOLOGY CHANGE

Effective October 1, 2014, as part of the ACUTE HOSPITAL RATE YEAR 2015 RFA, MassHealth will be changing its SPAD (Standard Payment Amount per Discharge) pricing methodology to the APR/DRG (All Patient Refined/Diagnosis Related Group) and APAD (Adjudicated Payment Amount per Discharge) pricing methodology.  MassHealth successfully completed pilot testing with a select group of providers using this redesigned payment methodology.

We are now opening the TPT (Trading Partner Testing) phase of the Inpatient Hospital Payment Method Redesign implementation to all hospitals through September 30, 2014.

MassHealth requests that you schedule a test date as soon as possible. We strongly encourage you to try to submit your first test file before Friday, August 8, 2014. To schedule a test date, please send an email to edi@mahealth.net or call 800-841-2900.

 

BED HOLD DAYS WILL INCREASE TO TWENTY DAYS

All nursing facility providers are advised: Effective September 1, 2014, the number of allowable MLOA (Medical Leave of Absence) days, also known as Bed Hold Days, will increase to 20 days.

Currently, per regulation 130 CMR 456.425, up to ten (10) MLOA days are allowed per an acute hospital stay. Effective September 1, 2014, MassHealth will allow up to 20 MLOA days. Any existing MLOA events that commenced prior to that date will fall under the previous policy of ten (10) MLOA days. MLOA applies to Acute, Chronic Disease, Psychiatric and Rehabilitation hospitals.

All other policy provisions consistent with regulation 130 CMR 456.400 will remain in effect. The payment rate for MLOA days will remain at $80.10 per day. A provider bulletin on this change in allowed MLOA days will be issued at a later date.

Please contact Ron Pawelski at 617-222-7546 or at Ronald.Pawelski@state.ma.us with any questions you may have about this policy change.

 

ORTHOTICS & PROSTHETICS PAYMENT & COVERAGE GUIDELINE TOOL IS NOW UPDATED

Orthotics and Prosthetics providers: Please be advised that the Masshealth Orthotics/Prosthetics Payment and Coverage Guideline Tool has been updated and posted on the web. To confirm that you are using the most recent version of the applicable Tool, go to www.mass.gov/masshealthpubs, click on Provider library and then on Masshealth Payment and Coverage Guideline Tool.

Also, please see the attachment on the Orthotics/Prosthetics Payment and Coverage Guideline Tool, v.11.  The Attachment tab must be open in the POSC (Provider Online Service Center) to view deferral reasons.

You are also reminded that clarified Operating Standards for the Prior Authorization process are in effect as of August 4, 2014. These standards apply to Orthotics and Prosthetics providers and have been documented in collaboration with the MassHealth PAU (Prior Authorization Unit).

For questions, please contact the PAU at PriorAuthorization@umassmed.edu or 1-800-862-8341. You may also contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

 

DME/OXY PAYMENT & COVERAGE GUIDELINE TOOL IS NOW UPDATED

Pharmacy, DME and Oxygen providers: Please be advised that the Masshealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web. To confirm that you are using the most recent version of the applicable Tool, go to www.mass.gov/masshealthpubs, click on Provider Library and then on Masshealth Payment and Coverage Guideline Tool.

Also, please see attachment on the DME/OXY Payment and Coverage Guideline Tool, v.19.  The Attachment tab must be open in the POSC (Provider Online Service Center) to view deferral reasons.

You are also reminded that clarified Operating Standards for the Prior Authorization process are in effect as of August 4, 2014. These standards apply to DME, Oxygen and Respiratory, Orthotics and Prosthetics providers and have been documented in collaboration with MassHealth’s PAU (Prior Authorization Unit).

For questions, please contact the PAU at PriorAuthorization@umassmed.edu or 1-800-862-8341. Or you may contact MassHealth Customer Service 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 July 2014:

  • Adult Foster Care Bulletin 10: Adult Foster Care Providers' Responsibilities for Members' Health and Safety

Transmittal Letters from July 2014:

  • ALL-207: Revised Appendices W and Z
  • AOH-32: 2014 HCPCS

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


This information is provided by MassHealth.