05/20/14

MASSHEALTH PROVIDER REVALIDATION CONTINUES

As required by the Affordable Care Act, MassHealth is continuing 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 is a.) being conducted by Provider Type and b.) is 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.

The following is the next group of provider types 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:

  • 05 Psychologist
  • 06 Podiatrist
  • 21 Family Planning
  • 28 Substance Abuse
  • 61 Independent Nurse
  • 97 Group Practices comprised of Provider Types 05, 06 (Psychologist, Podiatrist)

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.

 

BEYOND THE ALLOWABLE: IMPROVING THE PRIOR AUTHORIZATION PROCESS FOR CONTINUED THERAPY - FRIDAY, JUNE 6, 2014 WEBINAR

MassHealth knows that you are committed to providing quality therapy services for your patients. The Prior Authorization Unit Clinical Reviewers have the same goal in mind: ensuring that MassHealth members are getting the therapy services they need.

Please join us for an informative and interactive Webinar presentation -,June 6, 2014, 12:00 PM-1:30 PM - on the Prior Authorization process for Physical, Occupational and Speech Therapy providers. During the Webinar, we will review:

  • MassHealth Regulations related to Therapy Services
  • Prior Authorization process for Therapy Services
  • How to thoroughly complete a Request and Justification Form to ensure request approval
  • For those who still submit PAs via paper: information on how to submit PAs via the POSC.

To register, please go to: http://onlinetraining.umassmed.edu/pa_therapy_webinar/event/registration.html. Or, please email priorauthorization@umassmed.edu and the registration link will be emailed to you directly. Or, please call the PAU at 1-800-862-8341 for registration assistance.

 

ONE CARE PLAN BILLING AND VOIDS

Providers are reminded to check the EVS (Eligibility Verification System) to determine if a member is enrolled in an ICO (Integrated Care Organization), also known as a One Care Plan. Providers must bill the member’s ICO/One Care Plan for services rendered.

MassHealth will void FFS (Fee-For-Service) claims for members enrolled in One Care Plans with dates of service from October 2013 through March 2014, previously paid to the provider types identified above. Providers should re-submit One Care member claims for payment to the ICO/One Care Plan where the member or members are enrolled.  ICOs/One Care Plans have been notified and will expect claims from affected providers.  Contact information for billing the ICOs/One Care Plans is listed below.

Fallon Total Care: 1-855-508-4715

Network Health/Unify: 888-257-1985

Commonwealth Care Alliance: 1-800-306-0732 (option #5)

MassHealth members should not be billed for any services after the FFS claims are voided. Claims must be re-submitted to the member’s ICO/One Care Plan for payment. If you have questions, contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

 


05/13/14

IMPORTANT REMINDER TO NURSES PROVIDING CONTINUOUS SKILLED NURSING SERVICES

This is a friendly reminder to nurses of the importance of detailed and comprehensive documentation of CSN (continuous skilled nursing) services. Your documentation must be individualized and provide details about the complexity of services, the comprehensive assessments, and the nursing care you provide to support the skilled needs of the member, per the care plan.

Please refer to the Independent Nurse Manual Subchapter 4 program regulations, 130 CMR 414.417 (B) – “Recordkeeping Requirement and Utilization Review: In order for a medical record to completely document a service to a member, the record must disclose fully the nature, extent, quality and necessity of the nursing services furnished to the member. When the information contained in a member’s record does not provide sufficient documentation for the service, the MassHealth agency may disallow payment.”

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

 


05/06/14

ICD-10 VENDOR TESTING SCHEDULE UPDATE

All providers participating in ICD-10 Beta Testing are advised that testing has now been extended through May 30, 2014.

Also, Vendor Testing, originally scheduled for May 13 through June 13, 2014, has now been re-scheduled to run from July 7 through August 29, 2014. Interested providers should please contact MassHealth ICD-10 EDI Department directly at 855-295-4047 or edi@mahealth.net.

To stay current with the latest ICD-10 updates, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/icd10-implementation.html.

For questions, please contact the MassHealth Customer Service Center 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 April 2014:

  • Long-Term Care Facility Bulletin 108: Annual Accounting for Personal Needs Account

Provider Transmittal Letters from April 2014:

  • MHC-47: Revised Regulations, Service Codes, and Descriptions

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.