CHILDREN’S MEDICAL SECURITY PLAN PROGRAM CHANGES
The Children’s Medical Security Plan (CMSP) covers certain medical, dental and behavioral health services for eligible members. Effective July 1, 2017, MassHealth will directly manage CMSP, and UniCare will no longer serve as the administrator for CMSP. UniCare will continue to process CMSP non-pharmacy claims for dates of service that occurred prior to July 1, 2017. The current CMSP pharmacy processing and business rules remain unchanged.
Transmittal Letter ALL-221 at http://www.mass.gov/eohhs/docs/masshealth/transletters-2017/all-221.pdf describes changes that will result from the change in the administration of CMSP, and further details about CMSP claims submission during the transition period. Only those MassHealth provider types described in Transmittal Letter ALL-221 are eligible to provide CMSP services.
If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail firstname.lastname@example.org.
RETRO RATE ADJUSTMENTS FOR HOSPICE PROVIDERS
Please be advised that the most recent remittance advice (RA) may contain rate adjustments resulting from the certification of revised FFY17 rates (October 1, 2016) by the Executive Office of Health and Human Services. Please review this RA for accuracy. Proposed corrections must be submitted to the MassHealth LTSS Provider Service Center 60 days from the date of this RA at email@example.com or by calling 1-844-368-5184. For more information, refer to the POSC Job aid, View Remittance Advice Reports, on the Get Trained web page at https://tinyurl.com/zzkhak6.
For questions, please contact the MassHealth LTSS Provider Service Center at firstname.lastname@example.org or call 1-844-368-5184.
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”.
The following changes were made to procedure code A9276 Requirements and Limits:
1 unit = each, Max 10 units per month based on the following manufacture:
- Dexcom – 1 per week, 52 per year. (1 last 7 days)
- MiniMed – 10 per month, 120 per year. (1 last 3 day)
- Medtronic Enlite System – 5 per month, 60 per year.
If you have any questions regarding this change, please contact the MassHealth Customer Service Center at 1-800-841-2900 or email@example.com.
NEW APPLICATION PROCESS FOR DURABLE MEDICAL EQUIPMENT PROVIDERS
MassHealth is streamlining its application process for Durable Medical Equipment (DME) providers. As of May 31, 2017, DME providers will no longer need to submit a Letter of Intent (LOI) prior to receiving and completing a MassHealth provider application for DME, in accordance with 130 CMR 409.404.
Please contact the LTSS Provider Service Center at 1-844-368-5184 or by email at firstname.lastname@example.org for questions or to request an application, 8:00 a.m. to 6:00 p.m. ET, Monday through Friday, excluding holidays. Or, go to the MassHealth LTSS Provider Portal at www.masshealthltss.com.
MEDICARE CROSSOVER CLAIMS BILLED WITH CPT CODES 90847 AND 90853
MassHealth has adjusted Medicare Crossover claims with dates of service on and after 01/01/2015 through adjudication date 03/23/2017 that were billed with procedure codes 90847 or 90853. The affected Medicare crossover claims previously paid the Medicare patient responsibility but have been adjusted to pay the lesser of the MassHealth allowed amount minus the Medicare payment or the patient responsibility per All Provider Regulations CMR: 450.318 (c).
These adjusted claims will appear on future remittance advices. Medicare Crossover claims adjudicated on or after 03/24/2017 are adjudicating and pricing correctly.
Mental Health Centers, please note that the MassHealth allowed amount for these services was increased effective 7/1/2013. See POSC message ‘Special Instructions for Mental Health Centers’ posted on 06/20/2016 for background.
All 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 email@example.com.
POSC CLAIMS SUBMISSION ISSUE (DDE ONLY) – RESOLVED
Please be aware that starting late morning on Wednesday, June 7th until 2:30PM on Wednesday providers submitting Direct Data Entry (DDE) claims may have experienced submission issues. During this time DDE claims either could not be submitted or they were submitted but were not issued an ICN. Providers who encountered such issues or are unsure if the claim processed successfully may resubmit the claims. Batch HIPAA 837 claims and all other POSC services were not impacted. We apologize for any inconvenience this may have caused for our providers.
If you have questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or firstname.lastname@example.org. LTSS providers may contact the LTSS Provider Service Center at 1-844-368-5184 or by email at email@example.com.
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), Certified Nurse Practitioners (CNPs), 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 CNPs 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 CNPs 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: http://www.mass.gov/eohhs/gov/laws-regs/masshealth/masshealth-proposed-regs.html
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 remain in effect: 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, 2017; 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.
AVR UPDATE – IMPORTANT MESSAGE FOR ALL MASSHEALTH PROVIDERS
MassHealth will sunset its antiquated Automated Voice Response (AVR) system this June. The AVR, which is currently used by providers to check member eligibility, will no longer be available on or after July 3, 2017. Providers are encouraged to utilize the Provider Online Service Center (POSC) direct data entry (DDE) or to submit the 270/271 Eligibility Inquiry and Response transaction to check member eligibility.
If you have any questions regarding the sun-setting of the AVR, please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net.