BEHAVIORAL HEALTH SERVICES REMINDER
This is a reminder for the following provider types: PT 26 – Mental Health Centers, PT 28 – Substance Use Disorder Treatment Programs, PT 05 – Psychologists, PT 65 – Psychiatric Day Treatment, and PT 20 – Community Health Centers.
Claims involving behavioral health services require providers to cost avoid those claims when members are enrolled with the MassHealth Behavioral Health Vendor, MBHP. Claims for these members should not be directly billed to MassHealth.
Providers are reminded to reference 130 CMR 450.124: Behavioral Health Services in the All Provider Regulations.
For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or firstname.lastname@example.org.
UPDATED APPROVED VENDOR LIST NOW AVAILABLE ON WEB
All providers are advised: MassHealth has posted its newly-updated approved, HIPAA-compliant Vendor List to the web.
To access this new list and a helpful list of “Questions to ask your Vendor”, please go to: https://tinyurl.com/ydf8w26j.
Providers or vendors with questions about the approved vendor list process can contact MassHealth EDI (Electronic Data Interchange) at MassHealth Customer Service: 1-800-841-2900 or at email@example.com.
ORDERING, REFERRING AND PRESCRIBING INITIATIVE UPDATE
MassHealth started informational messaging to providers in March 2016 on most professional claims that required an ordering provider NPI if they did not meet Ordering/Referring/Prescribing (ORP) requirements. As a next step in this initiative, informational messaging will begin running on all claims that require orders, referrals or prescriptions, including Medicare crossover claims, starting August 1, 2017.
Messaging will appear on any impacted claim that
- does not have the ordering/referring/prescribing (ORP) NPI on the claim; or
- has an ORP NPI but that ORP provider is not enrolled with MassHealth; or
- has an ORP NPI from a provider type not authorized to order, refer or prescribe services.
The informational messages allow billing providers to understand the scenarios in which an authorized enrolled ORP provider’s NPI is required on a claim.
It is critical that providers comply as quickly as possible with these important requirements as MassHealth will begin to deny claims that do not meet the ORP requirements later in the calendar year.
For information about the ORP requirements, including impacted claims and billing instructions, please see Provider Bulletin 259.
If you have any questions about the informational messaging or about the ORP requirements, please contact Customer Service:
Non-LTSS provider should contact the MassHealth Customer Service Center by e-mail at firstname.lastname@example.org, by fax at 617-988-8974, or by phone at 1-800-841-2900.
LTSS providers should contact the LTSS Provider Service Center by phone at 1-844-368-5184 or by email at email@example.com.
REPORTING OF HIPAA CLAIM ADJUSTMENT GROUP CODES (CAGC) AND CLAIM ADJUSTMENT REASON CODES (CARC) ON MASSHEALTH COB CLAIMS
All providers are reminded that claims containing Coordination of Benefits (COB) information must be submitted to MassHealth with valid HIPAA Claim Adjustment Group Codes (CAGCs) and Claim Adjustment Reason Codes (CARCs) as reported on the other insurers’ explanation of benefits (EOB).
MassHealth is not liable for payment of claims for which a member is not liable. Refer to CMR 450.316: Third-Party Liability: Requirements and CMR 450.317: Third-Party Liability: Payment Limitations on Claim Submission.
Providers are reminded to reference All Provider Bulletin 256 RE: The Overpayment Disclosure Process for information on how to report and return overpayments received from MassHealth.
For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or firstname.lastname@example.org.
NEW UPDATED VERSION OF THE DME/OXY PAYMENT & COVERAGE GUIDELINE TOOL
REMINDER – Pharmacy, DME and Oxygen providers be advised 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 applicable Tool, go to http://www.mass.gov/eohhs/gov/laws-regs/masshealth/, click on “Provider Library” and then on “MassHealth Payment and Coverage Guideline Tools”.
Procedure code update:
Place of service 30 & 31 were removed for procedure code K0552 Supplies for external non-insulin infusion pump, syringe type cartridge, sterile, each.
- New codes added pursuant to Administrative Bulletin 17-06, effective January 1, 2017
- A4224 Supplies for maintenance of insulin infusion catheter, per week (1 unit = 1 week (max is 4 per month))
- A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
If you have any questions regarding these changes, please contact LTSS Provider Service Center at email@example.com or call 1-844-368-5184.
AUTHORIZED PT-1 FORM REMINDER
MassHealth receives and processes paper Prescription for Transportation (PT-1) forms used by providers on behalf of covered members to request authorization for transportation to a medical appointment when the provider is unable to submit the form electronically. The current version is PT-1 (Rev. 05/09).
Requests for transportation submitted using any other version of the form will be rejected. A sample of the PT-1 form can be found at: www.mass.gov/eohhs/docs/masshealth/bull-2009/all-192.pdf
MassHealth is moving toward paperless PT-1 submission in 2018. To ensure compliance, to expedite submission of your PT-1 request, and to avoid rejection of an unauthorized PT-1 form, request access to the Customer Service Web Portal now by requesting a User ID at: https://tinyurl.com/y8mwap8m
If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail firstname.lastname@example.org.
FILE INVALID ERROR
A recent change to the MMIS system resulted in some Provider Online Service Center (POSC) users to receive an error when uploading files through Internet Explorer (IE) browser.
To correct the issue you will need to make a change to the IE browser setting. The MMIS file upload issue appears to occur when the MMIS web site is part of the IE “Trusted sites” and the Trusted sites zone has the “Include local directory path when uploading files to a server” setting set to “Enabled”.
NOTE: If it is necessary to maintain the MMIS web site in the trusted sites, the only solution to the file upload issue would be to change the “Include local directory path when uploading files to a server” setting to “Disabled” so that the file uploads work properly.
If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail EDI@mahealth.net.
TO HOME HEALTH AGENCY PROVIDERS
There will be four Home Health Provider Outreach Forums the week of July 17th.
Please register for one of the following forums:
Monday, July 17, 2017 (Capacity 97)
11:00 am - 1:00 pm
UMass Medical School, Shrewsbury
333 South St
Register for the Shrewsbury session here: https://www.masshealthltss.com/s/training
Wednesday, July 19, 2017 (Capacity 200)
1:30 pm – 3:30 pm
Lawrence Public Library
51 Lawrence St
Lawrence, MA 01841
Register for the Lawrence session here: https://www.masshealthltss.com/s/training
Thursday, July 20, 2017 (Capacity 100)
2:00pm - 4:00pm
1 Ashburton Place
Boston, MA, 02108
21st floor /McCormick Conference Rooms: 2 and 3
Register for the Boston session here: https://www.masshealthltss.com/s/training
Friday July 21, 2017 (Capacity 97)
Tri-Valley Elder Services
10 Mill St
Dudley, MA 01571
Register for the Dudley session here: https://www.masshealthltss.com/s/training
During the open forums, MassHealth will discuss topics including MassHealth updated regulations, Guidelines on Medical Necessity for Home Health Regulations, Third Party Administrator update, Prior Authorization and Required Documentation. The same information will be presented at each forum
Space is limited. Please register early!
For questions, please contact LTSS Provider Service Center at email@example.com or call 1-844-368-5184
UPDATED MESSAGE: NEW PROVIDER TYPES – MID LEVELS
Effective August 1, 2017, MassHealth regulations will be amended to expand the types of providers eligible to participate in MassHealth to include all categories of state licensed advanced practice registered nurses and physician assistants. The regulations will also allow physician assistants to serve as primary care clinicians. As a result, all Physician Assistants (PAs), Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNSs), Psychiatric Clinical Nurse Specialists (PCNSs), Nurse Practitioners and Nurse Midwives (NMWs) working for a group practice must participate in the MassHealth program in order for the group practice to receive payment for their services. PAs must work for a group practice with at least one physician in order to be eligible to participate in MassHealth. CRNAs, PCNSs, and CNSs will also be able to participate independently in MassHealth, and NPs and NMWs will continue to be able to do so. Physicians will no longer be able to bill using the physician’s NPI for services of any of these provider types, with the exception of NPs that are employed by an individual physician.
Updates to regulations found in 130 CMR 433.000, 450.000 and 508.000 for mid-level providers can be found at: https://tinyurl.com/yboz6dtq
Some other highlights of these new regulations include:
- The following modifiers will be deactivated effective 8/1/17: HN (physician assistant) and SB (nurse midwife).
- The following modifiers must be used when billing for anesthesia effective 8/1/17: AA, QK, QY, QX, and QZ.
- The following modifier remains in effect nurse practitioners who work for an independent physician ONLY: SA (Nurse Practitioner)
For Anesthesia billing, effective 8/1/17 Medical Direction by a physician is payable to a physician. Medical Supervision by a physician is not payable under MassHealth. See physician regulations at 130 CMR 433.454 (C) and (D) for definition of medical direction and medical supervision.
Payment for Physician Assistants will be made to MassHealth participating group practices that have at least one physician as a member. Group Practices without a physician member cannot bill for PA services.
To assist providers with the provider enrollment process and the billing changes under these new regulations, MassHealth will be hosting 4 webinar sessions (June 20, July 13, 2017; July 25, 2017; and August 15, 2017). To register for one of these webinars please visit www.masshealthtraining.com.
For questions or to request the application, please contact the MassHealth Customer Service Center by e-mail at firstname.lastname@example.org or by phone at 1-800-841-2900.