01/28/14

MASSHEALTH REPROCESSING PHARMACY CLAIMS IN PAYMENT CYCLES

MassHealth has identified TPL (third party liability) pharmacy claims in a recent audit that were affected by an incorrect pricing methodology. The time span for the TPL pricing issue includes dates of service from February 1, 2006 through December 15, 2012. These claims are now being systematically adjusted.

The POPS (Pharmacy On-line Processing System) reimbursement logic was not comparing MassHealth’s “Allowed Charge” to the provider’s “Submitted Charge” before subtracting “Other Payer Amount” and comparing it to “Patient Responsibility.” The overpayment should be the difference between “Allowed Charge” and “Provider Charge.”

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

 

IMPORTANT INFORMATION: PROVIDER REVALIDATION STARTS MARCH 2014

All providers are advised that MassHealth will begin its Revalidation effort in March 2014. Section 6401(a) of the Affordable Care Act requires Medicare and Medicaid to revalidate your provider enrollment information at least every five years with new screening criteria.

This revalidation initiative will initially focus on providers enrolled on or prior to March 25, 2011, and will be completed by March 24, 2016. Providers enrolled after March 25, 2011, will be revalidated on or before five years from the date that they were initially enrolled.

The process will require that you revalidate your enrollment information for MassHealth and complete and return a Federally Required Disclosures form. See 42 CFR 455.414, Section 6401 of the Affordable Care Act (ACA) and 42 CFR 455.104 (c)(1)(iii).

Failure to complete the revalidation will affect your enrollment status and ability to receive MassHealth claim payments.

Additional information about the Revalidation initiative is forthcoming. Please continue to check www.mass.gov/masshealth.

 


01/21/14

ICD-10 TRADING PARTNER TESTING

All MassHealth providers are reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2014, as required by federal law.

MassHealth is continuing to prepare for ICD-10 implementation and, to that end, invites you to participate in planned trading partner testing in the second quarter of 2014. Details on the testing timeline, requirements and instructions will be announced shortly. As we prepare for the testing, MassHealth EDI Analysts will be outreaching our trading partners over the next several months to gather preliminary information and assess provider readiness for ICD-10.

For more details, please read MassHealth All Provider Bulletin 241. Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. Click on Provider Bulletins, then 2014 Provider Bulletins.

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

 

ICD-10 READINESS SURVEY

ICD-10 is coming! And MassHealth is very interested in how you are preparing for this October 1, 2014 implementation.

A readiness survey has been developed to gather key information and enable MassHealth to better anticipate the needs of our providers and to coordinate effectively with billing intermediaries, clearinghouses and software vendors.

Please complete the ICD-10 Readiness Survey at http://webapps.ehs.state.ma.us/reviewsurvey/ReviewSurvey.aspx?id=381 no later than January 31, 2014. Please make every effort to review and submit your entry within the timeframe requested.

If you have any questions about the survey, please contact MassHealth Customer Service at 1- 800-841-2900 or providersupport@mahealth.net.

 

ATTENTION ALL DENTAL PROVIDERS WHO USE CDT SERVICE CODES AND SUBMIT CLAIMS TO DENTAQUEST

All MassHealth Dental Providers billing CDT service codes should disregard the Message Text “Update to Important Announcement: Provider Operations Changes.” These changes do not affect MassHealth dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Dental providers should continue to refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, prior authorizations, claims, electronic claims, provider complaints and fraud, and provider enrollment.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

 


01/14/14

UPDATE TO IMPORTANT ANNOUNCEMENT: PROVIDER OPERATIONS CHANGES

MassHealth advised all providers last month that, during the period from December 16-31, 2013, all Provider Services functions would transition from Hewlett Packard Enterprise Services (HPES) to the MAXIMUS MassHealth Customer Service Center (CSC). The transition is now complete effective January 2, 2014, and we want to remind you of four changes that impact you as a provider:

PROVIDER ENROLLMENT AND CREDENTIALING – Please use this new mailing address to submit new enrollment applications, provider file updates or correspondence:

MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton MA 02021

PAPER CLAIMS - If you are authorized to submit paper claims, the new P.O. Box is:

MassHealth
Attn: Original Paper Claims Submissions
P.O. Box 9152
Canton MA 02021

PAPER PRIOR AUTHORIZATIONS - Effective immediately, please send PA-1 request forms to:

MassHealth
Attn: Prior Authorization
100 Hancock Street, 6th Floor
Quincy MA 02171

Some MassHealth Customer Service Center staff/positions and their direct contact information have changed. However, regular contact information remains the same: MassHealth CSC’s main phone number at 1-800-841-2900, the Provider Support mailbox at providersupport@mahealth.net and the EDI Support mailbox at edi@mahealth.net.

 

EFT/ERA OPERATING RULE IN EFFECT JANUARY 1, 2014

On January 1, 2014, MassHealth implemented the EFT/ERA Operating Rule in accordance with Section 1104 of the Administrative Simplification provisions of the ACA (Affordable Care Act).

Providers who enroll or modify an existing EFT arrangement on or after January 1, 2014 must complete the new EFT Enrollment/Modification Form, available at the MassHealth EFT web page. Go to www.mass.gov/masshealth, click on the Information for MassHealth Providers link, then Insurance (Including MassHealth), then MassHealth, then ACA, and then ACA Operating Rules.

Contact your financial institution to ensure it supports the new CCD+ Addenda file format used to transmit payment information.

Also effective January 1, 2014, providers who sign up to receive the 835 ERA (Electronic Remittance Advice) or modify the receiver of the 835 must complete the new ERA Enrollment Modification form, available on the MassHealth ACA Operating Rules Web page. Go to www.mass.gov/masshealth, click on the Information for MassHealth Providers link, then Insurance (Including MassHealth), then MassHealth, then ACA, and then ACA Operating Rules.

Providers can view the TRN (Re-association Trace Number) segment on the 835. MassHealth will continue to provide the voucher number and the invoice/remittance advice number to enable providers to re-associate the remittance and the payment. Providers may also view the new CARCs (Claims Adjust Reason Codes) and RARCs (Remittance Advice Remark Codes) on the 835.

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:

Provider Bulletins from December 2013:

  • Managed Care Organization Bulletin 3: Current Procedural Terminology (CPT) Codes and Payment to Providers for Behavioral Health Services
  • All Provider Bulletin 240: Temporary Coverage for Applicants for Subsidized Health Insurance
  • Nursing Facility Bulletin 137: Nursing Facility Pay for Performance Program for Fiscal Year 2014

Transmittal Letters from December 2013:

  • AIH-49: Revisions to MassHealth Regulations-Affordable Care Act
  • ALL-205: Revisions to Regulations for the Affordable Care Act
  • AOH-31: Revisions to MassHealth Regulations-Affordable Care Act
  • CHC-99: Revisions to MassHealth Regulations-Affordable Care Act
  • CHC-98: 2013 HCPCS and Vaccine Codes
  • FAS-27: Revisions to MassHealth Regulations-Affordable Care Act
  • FPA-50: Revisions to MassHealth Regulations-Affordable Care Act
  • HHA-49: Revisions to MassHealth Regulations-Affordable Care Act
  • IDTF-13: Revisions to MassHealth Regulations-Affordable Care Act
  • LAB-42: Revisions to MassHealth Regulations-Affordable Care Act
  • PHM-60: Revisions to MassHealth Regulations-Affordable Care Act
  • PHY-140: Revisions to MassHealth Regulations-Affordable Care Act
  • PHY-139: 2013 HCPCS
  • POD-70: Revisions to MassHealth Regulations-Affordable Care Act
  • POD-69: 2013 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.