12/10/13

UPDATED COMMUNITY HEALTH CENTER RATES

Please be advised that EOHHS (Executive Office of Health and Human Services) has updated the MassHealth Community Health Center Rates, pursuant to regulation 101 CMR 304.00.

These updated rates are effective for dates of service as of October 1, 2013. MassHealth will process mass retro rate adjustments in future Remittance Advices. No further action is required by Community Health Center Providers

To view the updated rates, go to www.mass.gov/eohhs/gov/laws-regs/hhs/. Click on EOHHS Regulations; then click Provider Payment Rates (by Provider Type) and then CHC Providers (Ambulatory Care).

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

 

VERIFICATION TESTING/SOBER HOME LABORATORY REQUESTS

Providers are reminded that, in accordance with 130 CMR 450.307 (Unacceptable Billing Practices), MassHealth does not permit duplicative billing, including the submission of multiple claims for the same service by the same provider or multiple providers. This includes verification laboratory testing using the same specimen or another body fluid, which is duplicative and therefore not a covered procedure.

Also, in accordance with 130 CMR 401.411 (Non-Covered Services and Payment Limitations), MassHealth does not pay for drug screen tests performed for residential monitoring purposes since that purpose does not satisfy the requirement that laboratory tests must be medically necessary. This includes requests signed by a MassHealth authorized prescriber, if the purpose of the test is to comply with a sober home’s residential monitoring policy. Please review Clinical Laboratory Program Bulletin 9 (February 2013) for more information on drug screen-related quantitative test edits, sober home requests and laboratory requests: www.mass.gov/eohhs/docs/masshealth/bull-2013/lab-9.pdf.

For questions, please 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:

Transmittal Letters from November 2013:

  • HHA-48: Revised Regulations  
  • IN-27: Revised Regulations  

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

 

IMPORTANT ANNOUNCEMENT - PROVIDER OPERATIONS CHANGES

On January 1, 2014, MAXIMUS’s Customer Service Center (CSC) will assume direct responsibility for MassHealth Provider Enrollment & Credentialing (PEC), Electronic Data Interchange (EDI) and Provider Relations (including Provider Outreach & Training). With this transition, Hewlett Packard Enterprise Services (HPES) will no longer provide subcontract services to support these functions.

From December 16-31, 2013, CSC will finalize the transition of these functions from HPES.  During this two-week period, there may be some delay in the processing of provider enrollment applications, provider profile updates, paper claims data entry, voids and 90-day waivers in order to complete this transition.

For details on how this transition may affect you, including key dates, “what is changing” and “what will remain the same”, go to www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ or www.mass.gov/eohhs/gov/departments/masshealth/.