07/22/14

PROVIDER BILLING REMINDER: MASSHEALTH DME AND OXYGEN PAYMENT AND COVERAGE GUIDELINES TOOL

Pharmacy, DME and Oxygen providers are reminded that the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool has been updated and posted on the Web. To confirm that you are using the most recent version of the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool, go to WWW.MASS.GOV/MASSHEALTHPUBS click on Provider Library and then click on MassHealth Payment and Coverage Guideline Tools.

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

 


07/15/14

MASSHEALTH PROVIDER REVALIDATION CONTINUES FOR CHAIN PHARMACIES

As required by the Affordable Care Act, MassHealth is continuing its Provider Revalidation effort. This process requires that you revalidate your enrollment information for MassHealth under new enrollment screening criteria. You may also be required to submit original signature documentation to support your Revalidation, including a Federally Required Disclosures Form.

Revalidation is a.) being conducted by Provider Type and b.) currently focusing on providers enrolled on or before March 25, 2011. These revalidations will be completed by March 24, 2016.

If you enrolled as a provider after March 25, 2011, you will be revalidated on or before five years from the date of your initial enrollment. Failure to complete the Revalidation will affect your enrollment status and may result in sanctions.

Chain Pharmacies are the next group of provider type that have been mailed Revalidation letters and must complete the Revalidation process on the POSC (Provider Online Service Center) within 45 days of the date on the revalidation letter. If you need access to the POSC, you will need to complete a Data Collection Form (DCF) or request access from the primary user at your practice. Please note: Independent pharmacies will be among the next waves of provider types to be revalidated.

For additional information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation.

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

 

COMMUNITY HEALTH CENTER – TYPE OF BILL 77X – OUTPATIENT CROSSOVER CLAIM DENIALS

MassHealth has systematically reprocessed CHC outpatient crossover claims with adjudication dates on 05/26/2009 through 05/06/2014 that denied in error for Edit 4036-PROV CONTRACT POS RESTRICTION ON PROCEDURE. These reprocessed claims will appear on a future remittance advice.

Please Note: If the claims denied for other valid reasons, providers are responsible to correct the denial and resubmit their claims to MassHealth accordingly. For questions, please contact MassHealth Customer Services Center at 1-800-841-2900 or providersupport@masshealth.net.

 


07/08/14

HEADER-RELATED REMARK CODES IN THE MIA SEGMENT OF THE HIPAA 835

Effective July 1, 2014, MassHealth will be reporting header-related remark codes in the MIA segment of the HIPAA 835. This will be provided when a claim is priced and reported at the header and there are remark codes present. The segment will include up to 5 remark codes.

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

 


07/01/14

NEW NURSING FACILITY RATES TO BE ISSUED JULY 1, 2014

To all Nursing Facility Providers:

Effective July 1, 2014, EOHHS (Executive Office of Health and Human Services) will issue new rates for nursing facility services. These rates reflect the expiration of the FY2014 user fee add-on on June 30, 2014. The expiration of the user fee add-on is consistent with regulation 101 CMR 206.00.

EOHHS will issue new rates for FY2015 as soon as the budget process is completed. These rates would contain applicable add-ons that may be specified in legislation.

If you have any questions, please contact Ron Pawelski, Nursing Facility Program Manager at (617) 222-7546.

 

DO YOU NEED ASSISTANCE WITH REVALIDATION? MASSHEALTH INVITES YOU TO A TUTORIAL WEBINAR

MassHealth is offering a tutorial webinar to all providers who have been mailed letters as part of the federally mandated Revalidation Initiative and need assistance in completing the process. The webinar will provide you step-by-step instructions on how to access your information on the POSC, change/update your profile information and download and complete any original signature documents that may be required. The webinar will be offered twice:

Tuesday, July 1, 2014 from 10-11 AM                    Monday, July 14, 2014 from 10-11 AM

To join the webinar:

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 Service Center at 1-800-841-2900 or by emailing providersupport@mahealth.net.

 

THIRD PARTY LIABILITY REQUIREMENTS FOR INDEPENDENT NURSES

MassHealth reminds all Independent Nurses: you must make diligent efforts to obtain payment first from other resources so that MassHealth is the payer of last resort. Please see All Provider Manual 130 CMR 450.316.

MassHealth will not pay you and will recover any payments from you if it determines that, among other things, you have not made such diligent efforts. “Diligent efforts” is defined as making every effort to identify and obtain payment from all other liable parties, including insurers. Diligent efforts include but are not limited to:

Determining the existence of health insurance by asking the member if he or she has other insurance and by using insurance databases available to the provider;

  1. Verifying the member’s other health insurance coverage via EVS for each date of service and at the time of billing;
  2. Submitting claims to all insurers with the insurer’s designated service code for the service provided;
  3. Complying with the insurer’s billing and authorization requirements;
  4. Appealing a denied claim when the service is payable in whole or in part by an insurer;
  5. Returning any payment received from MassHealth after any available third-party resource has been identified. The provider must bill all available third-party resources before resubmitting a claim to MassHealth.

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

 

REMINDER TO ALL PROVIDERS: KEEP YOUR PROFILE INFORMATION UP-TO-DATE

All providers are reminded: in accordance with MassHealth regulation 130 CMR 450.223(B), you must notify MassHealth in writing within 14 days of any changes in your enrollment information, such as changes in address, phone number, email address, updated licenses or changes in ownership or control (for example, changes in directors board members). Failure to notify MassHealth constitutes a breach of your provider contract and may result in termination of your contract or other sanctions.

This is especially important as MassHealth continues the federally mandated Revalidation initiative. Please make sure that when MassHealth notifies you/your entity that it is time to revalidate that you are able to access your provider profile through the POSC (Provider Online Service Center) and your profile is up-to-date. To submit changes through the POSC, go to http://www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

You may also submit changes in writing to Provider Enrollment and Credentialing, PO Box 9162, Canton MA 02021.

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

 

NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from June 2014:

  • Community Health Center Bulletin 80: Behavioral Health Assessment Claims for Members Under 21
  • Mental Health Center Bulletin 30: Behavioral Health Assessment Claims for Members Under 21
  • School-Based Medicaid Provider Bulletin 27: School-Based Medicaid Program Interim Rates (State Fiscal Year 2014)

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.