01/29/13
BILLING FOR INFLUENZA VACCINE – NOTICE FOR PHYSICIANS, GROUP PRACTICES AND INDEPENDENT NURSE PRACTITIONERS
In response to the flu vaccine crisis, MassHealth wants to inform physicians, group practices and independent nurse practitioners that you will be reimbursed for privately-purchased flu vaccine if you exhaust your state-provided supply from local boards of health or the Massachusetts Department of Public Health (MDPH).
In accordance with 130 CMR 433.443 (c)(2)(a), reimbursement for privately-purchased vaccine can be obtained by using the following codes: 90655, 90656, 90657, 90658, 90660, 90661 and 90662.
For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
BILLING FOR INFLUENZA VACCINE – NOTICE FOR COMMUNITY HEALTH CENTERS
In response to the flu vaccine crisis, MassHealth wants to inform community health centers that they will be reimbursed for privately-purchased flu vaccine if they exhaust their state-provided supply from local boards of health or the Massachusetts Department of Public Health (MDPH).
Reimbursement for privately-purchased vaccine can be obtained by using the following codes: 90655, 90656, 90657, 90658, 90660, 90661 and 90662.
For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
BILLING FOR INFLUENZA VACCINE – NOTICE FOR LIMITED SERVICES CLINICS
In response to the flu vaccine crisis, MassHealth wants to inform limited services clinics that they will be reimbursed for privately-purchased flu vaccine if they exhaust their state-provided supply from local boards of health or the Massachusetts Department of Public Health (MDPH).
Reimbursement for privately-purchased vaccine can be obtained by using the following codes: 90655, 90656, 90657, and 90658.
For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
NOTICE TO PROVIDERS SUBMITTING DIRECT DATA ENTRY (DDE) CLAIMS USING DELAY REASON CODE 11
All Provider Bulletin 225, dated April 2012, communicates the circumstances in which to use each Delay Reason Code when submitting Direct Data Entry (DDE) claims via the Provider Online Service Center (POSC). Delay Reason Code 11 – OTHER includes, but is not limited to, NCCI/MUE related reviews and special circumstances. DDE claims for submissions of Final Deadline Appeals (9) or 90-Day Waiver Requests (1, 4 or 8) should be submitted with the appropriate Delay Reason Code, as noted. Additionally, claims submitted with TPL attachments, Sterilization forms, Hysterectomy forms or Invoices are not required to submit with Delay Reason Code 11 unless the circumstance is specifically outlined in the bulletin referenced above.
Please remember to include a brief cover letter as to why special handling is needed and include the supporting documentation, as well as any applicable remittance advices, with your DDE claim submission. Erroneous selections of Delay Reason Codes may cause delays in claims processing or result in claims denials.
Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. Click on Provider Bulletins, then 2012 Bulletins, then April. For questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
01/22/13
PART B CROSSOVER CLAIMS – ERRONEOUS PAYMENTS
MassHealth has identified some Part B crossover claims that erroneously paid between 01/01/2012 - 06/30/2012. These claims were for members who had active Medicare supplemental coverage on file on the date of service. Since the claim contained no supplemental insurance adjudication details, it should have denied for edit 2564 – MEMBER HAS SUPPLEMENTAL INSURANCE – DETAIL.
These claims have been reprocessed and will appear as denied on this or subsequent remittance advices. Providers must make diligent efforts to identify and obtain payment from all insurers prior to billing MassHealth as stated in the TPL regulations (130 CMR 450.316).
For questions, please contact MassHealth Customer Service at providersupport@mahealth.netor call 1-800-841-2900.
CROSSOVER CLAIMS - MEDICARE NEGATIVE PAYMENT
MassHealth will not process a crossover claim that contains a negative Medicare payment. Providers whose claims have denied for edit 442 - MEDICARE PAID AMOUNT NOT NUMERIC should submit their claims to MassHealth with a zero Medicare paid amount for the coordination of benefits (COB) information. The claims can be submitted via 837 batch or direct data entry (DDE). For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
PROVIDER PROFILE MAINTENANCE FOR GROUP PRACTICES
Any change in your relationship with MassHealth must be communicated immediately to Provider Enrollment and Credentialing to maintain accurate information on your provider file. This includes adding and removing individual providers to your group practice. This is especially important as we begin to prepare for revalidation as required by the Affordable Care Act (ACA).
Providers should update their information using the Provider Online Service Center (POSC). You may access the POSC by going to www.mass.gov/masshealth, then selecting the Provider Online Service Center link under Online Services. MassHealth cannot provide a list of the members of your group.
If you are not familiar with how to update your file on the POSC, you may access the job aids by going to www.mass.gov/masshealth, then select the link for Medicaid Management Information System (MMIS) and the Provider Online Service Center (POSC), then select the link Need Additional Information or Training?, then select the Get Trained link. The job aid is under Provider Profile Maintenance.
For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or at 800-841-2900.
01/15/13
SUBSTANCE ABUSE SERVICE CODE H0020 DENIALS FOR EDIT 5930
MassHealth understands that due to the October CMS NCCI quarterly update, MMIS has been denying Substance Abuse provider claims for service code H0020 (alcohol and/or drug services methadone administration and/or service) when more than one unit is billed, with denial edit 5930 (MUE units exceeded). MassHealth has reviewed this matter and has implemented a change to the billing procedures so that H0020 may only be used to bill Methadone Administration. Counseling services provided as part of the Methadone program should be billed separately with the codes listed below.
The new codes allowed for counseling are:
- H0004 TF - Behavioral Health counseling and therapy (Methadone/Opioid counseling) per 15-minute unit (individual counseling, intermediate level of care, four units maximum per day)
- T1006 HR - Alcohol and/or substance abuse services (Methadone/Opioid counseling) per 30-minute unit (family/couple counseling, two units maximum per day)
- H0005 HQ - Alcohol and/or drug service group counseling by a clinician (Methadone/ Opioid counseling) per 45-minute unit (two units maximum per day)
The following codes, previously allowed for counseling, will no longer be valid effective January 16, 2013: H0020 TF, H0020 HR and H0020 HQ.
Providers who have denied claims with service code H0020 due to the MUE quarterly update must resubmit their claims using the new substance abuse counseling codes and modifiers. Updates to subchapter 6 of the Provider Manual are forthcoming. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
CHRONIC DISEASE AND REHABILITATION HOSPITAL UMP POST-PAYMENT REVIEWS
The Chronic Disease and Rehabilitation Hospital Utilization Management Program (UMP) will begin post-payment reviews this month on inpatient claims. The UMP will send written correspondence to the hospitals identified for the post-pay review, listing the claims being reviewed.
The UMP will also request that hospitals submit medical records as needed, in accordance with MassHealth regulation at 130 CMR 450.205. Medical record requests will continue on a monthly basis. If you have any questions regarding the review process, please contact Martina McCormack, UMP Manager, at 617-847-3748.
NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB
MassHealth has posted the following publications on the MassHealth website:
Provider Bulletins from December 2012
- Nursing Facility Bulletin 135: Updates to Nursing Facility Pay for Performance (NF P4P) Program for Fiscal Year (FY) 2013
- All Provider Bulletin 230: Section 1202 Rates for Physicians Who Provide Primary Care Service
You can download a copy of a bulletin or transmittal letter 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 website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.
01/01/13
PROVIDER ONLINE SERVICE CENTER (POSC) SECURITY
The POSC was designed with security protocols that allow access to a provider’s information by only authorized individuals. This process is accomplished with the assignment of a primary user for each provider. The primary user then has the responsibility to grant subordinate permissions to provider staff for the functions they need. The primary user is also required to maintain user IDs by removing access for those who leave the provider or change job functions.
Maintaining subordinate access is a requirement that is mandated by regulation to notify MassHealth of any change in information. If a primary user no longer has that role, the provider must assign a new primary user and remove the previous user’s access as necessary. Providers are not permitted to continue to use the primary user ID of someone who is no longer employed. Providers should audit their primary user(s) and subordinate(s) to be certain that they are up-to-date.
NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB
MassHealth has posted the following publications on the MassHealth website:
Provider Bulletins from December 2012
- All Provider Bulletin 230: Section 1202 Rates for Physicians Who Provide Primary Care Service
You can download a copy of a bulletin or transmittal letter 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 website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.