03/25/14

LETTERS REGARDING PHYSICIAN ELIGIBILITY FOR SECTION 1202 RATES– RESPONSE DUE MARCH 30, 2014

This is a reminder to all physicians who received a letter from MassHealth, dated February 28, 2014 regarding ACA Section 1202 Physician Eligibility:

Please respond to the letter by March 30, 2014 by completing and returning the Physician Certification and Attestation Form available at www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf. You must confirm your eligibility for Section 1202 rates. Otherwise, MassHealth will begin the process to terminate this eligibility and recover any Section 1202 payments that have been made to your group practice.

Please return the completed form by March 30, 2014 to:

MassHealth PEC
P.O. Box 9162
Canton MA 02021

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

 

MINOR CHANGES TO MMIS DDE (DIRECT DATA ENTRY) SCREENS

MassHealth is now phasing in MMIS modifications to support the ICD-10 implementation this coming October.

Effective April 1, 2014, providers that use the POSC (Provider Online Service Center) will begin to see minor changes in the DDE (Direct Data Entry) screens, including changes in drop-down menus, the addition of ICD radio buttons and changes in field length among these minor modifications.

Please do not attempt to use these fields until implementation. Although they are viewable, these functionalities will be disabled until implementation in October.

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

 

REPROCESSED LONG TERM CARE CLAIMS

MassHealth will be reprocessing Long Term Care claims from the recent retro run for dates of service 07/01/2012 through 07/31/2012. These claims denied for EDIT 2528 – LTC-POTENTIAL MEDICARE 1ST 100 DAYS, EDIT 2556 – LTC-POTENTIAL MEDICARE C 1ST 100 DAYS and EDIT 2557 – LTC-POTENTIAL PRIVATE INSURANCE. These reprocessed claims will appear on a future remittance advice.

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

 

1202 RATE UPDATES FOR 2014

MassHealth is in the process of updating the calendar year 2014 Section 1202 rates. Further information, including the time frame for adjusting claims, will be forthcoming.

 

IMPORTANT NOTICE: EVSPC WINDOWS OPERATING SYSTEM SUPPORT TO CHANGE APRIL 8TH

MassHealth’s proprietary EVSpc software is currently supported only on Windows XP and Windows Vista. Effective April 8, 2014, Microsoft will no longer support Windows XP.

MassHealth recommends that providers NOT USE Windows XP after April 8, 2014 because the EVSpc software may not function correctly and MassHealth WILL NOT be able to provide support. MassHealth will not upgrade the software to any other Operating Systems.

Providers currently using Windows Vista may continue to use the tool.  Providers using Windows XP should begin to leverage the DDE (Direct Data Entry) and batch inquiry options on the POSC. You may also acquire an external trading partner to submit eligibility transactions on your behalf.

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

 

IMPORTANT MESSAGE: INCORRECT FAX NUMBER IN MEMBER BOOKLETS

This is an important message for all organizations and staff who assist individuals with submitting verifications or subsidized applications for MassHealth or Health Connector coverage. Your immediate action is required.

An incorrect fax number is listed on the inside front cover of the Member Booklet for Health Coverage and Help Paying Costs (ACA-1 Packet (Rev. 01/14)).

The Correct Number is:  617-887-8770.

If you have the Member Booklets referenced above, please call MassHealth Customer Service at 1-800-841-2900 to receive a replacement shipment, and/or correction labels you can place over the incorrect number on all copies of the Member Booklets in your inventory.

 

MASSHEALTH IS THE PAYER OF LAST RESORT

All providers are reminded: MassHealth is the payer of last resort. Providers must make diligent efforts to obtain payment from other resources prior to billing MassHealth. Providers may submit coordination of benefits (COB) claims with a remaining patient responsibility to MassHealth according to MassHealth billing instructions.

MassHealth liability is the lesser of (1) the member’s liability including co-insurance, deductibles and co-payments, or (2) the provider’s charges or maximum allowable amount payable under the MassHealth payment methodology, whichever is less, minus the insurance payment. Please see All Provider Regulations 130 CMR 450.316, 450.317, and 450.318.

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

 


03/19/14

MASSHEALTH PROVIDER REVALIDATION HAS BEGUN

All providers are advised that MassHealth, as required by the Affordable Care Act, has begun its provider revalidation effort. The 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.

This revalidation initiative will be conducted by provider type and will initially focus on providers enrolled on or before March 25, 2011, and will be completed by March 24, 2016.

Then, providers enrolled after March 25, 2011 will be revalidated on or before five years from the date that they were initially enrolled.

The following provider types 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:

  • 02 Optometrist
  • 03 Optician
  • 04 Ocularist
  • 16 Chiropractor
  • 43 Prosthetics
  • 47 Orthotics
  • 50 Audiologist

Failure to complete the revalidation will affect your enrollment status and may result in sanctions. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

 

ADMISSION DATES REQUIRED FOR INPATIENT CLAIMS - ADVISORY

MassHealth reminded providers back in November that an admission date is required on claim submissions when the place of service is an Inpatient hospital, Inpatient Psychiatric facility, Skilled Nursing facility or a Comprehensive Inpatient Rehabilitation facility.

However, last fall, the Medicare intermediary requested a modification to the industry-standard HIPAA compliance software used by MassHealth that requires the admission date for inpatient services. This change inadvertently impacted the processing of some professional claims. MassHealth is working with its software vendor to modify the MMIS to ensure that MassHealth only applies the admit date compliance editing to the appropriate claims. The change will be implemented on or before March 31, 2014.

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

 


03/11/14

HOSPICE CLAIMS THAT PREVIOUSLY DENIED DUE TO CONFLICT WITH NCCI EDITS

On October 1, 2013, CMS (Centers for Medicare and Medicaid Services) reversed the decision to deny hospice claims for members in nursing facilities when Procedure Code T2042-ROUTINE CARE was billed in conjunction with Procedure Code T2046-ROOM AND BOARD on the same DOS (Date of Service), under the NCCI (National Correct Coding Initiative).

Claims were denied using the following edits:

  • 5927 – NCCI-ANOTHER SERVICE PREV PAID-SAME CLAIM
  • 5928 – NCCI-ANOTHER SERVICE PREV PAID-OTHER CLAIM
  • 5929 – NCCI-CONFLICT WITH OTHER SERVICE PREV PAID

Providers are advised to re-submit to MassHealth any affected claims for dates of service April 1, 2013 to October 1, 2013 that were denied with edits 5927, 2928 and 5929. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

 

UPDATED EFT ENROLLMENT/MODIFICATION REQUEST FORM NOW AVAILABLE

All MassHealth providers are advised that the EFT (Electronic Funds Transfer) Enrollment/Modification Form has been updated and is available on the MassHealth web site at: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/eft-1.pdf. Please begin using this new form immediately if you are enrolling or you need to modify current EFT information.

Please discard any previous version of the EFT Request form.  Only the newest version, marked “EFT-1 (Rev. 02/14)” in the lower left corner, will be accepted from April 1, 2014 on. All other forms will be rejected.

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

 


03/04/14

PERSONAL CARE ATTENDANT (PCA) NEW HIRE ORIENTATION

Effective March 1, 2014, Fiscal Intermediaries will be able to submit claims to MassHealth for PCAs (Personal Care Attendants) who have completed the PCA New Hire Orientation Program.

The service code for billing the PCA New Hire Orientation is: T1020 U3 - Personal Care Services, per diem, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment.  (Code may not be used to identify services provided by home health aide or certified nurse assistant.) (Use only to bill for PCA New Hire Orientation Program.) (Current P.A. for PCA services required for each member.)

Updates to Subchapter 6 of the PCA Provider Manual are forthcoming. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

 

HOME HEALTH CLAIMS SUBMITTED WITH TOB (TYPE OF BILL) 033X

Home Health Care providers are reminded that MassHealth, in accordance with CMS guidelines, no longer accepts Home Health claims submitted with TOB (Type of Bill) 033X with dates of service from October 1, 2013 forward.  All claims submitted with TOB 033X will be denied.

The National Uniform Billing Committee (NUBC) has redefined 032X Type of Bill to mean “Home Health Services under a Plan of Treatment.” This revision allows for “one Type of Bill code for all home health services provided under a home health plan of care.” Providers are advised to update their billing to reflect this change. Please reference your NUBC manual for additional information. This change does not apply to Crossover claims.

Updates to the MassHealth UB-04 Billing Guide are forthcoming. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.


This information is provided by MassHealth.