05/30/17

EARLY INTERVENTION SPECIALTY CODE PRIOR AUTHORIZATION REQUESTS

For Early Intervention (EI) providers that have determined a member has a medical need for EI specialty (EIS) services that exceeds the maximum allowable number of units for six hours per day, and the member meets the EPSDT criteria as described in 130 CMR 450.140, the EI provider may request prior authorization (PA) review from MassHealth. Services above the EI maximum allowable should not be provided before a PA approval confirming medical necessity has been received.  

The Provider Online Service Center (POSC) allows EI providers to enter PA requests directly through the portal. MassHealth has been made aware that EI providers who have attempted to enter these PA request via the POSC have experienced issues. Providers who were experiencing these issues may be having trouble partially due to the provider’s selections while entering a PA in POSC. EI providers are reminded to select EARLY INTERVENTION under the Therapy Services assignment in order to avoid any issues with entering PA requests. Providers may also submit PA requests on paper by completing the MassHealth Prior Authorization Request form (PA-1) and mailing the form and the above supporting documentation to the address provided on the PA-1 form.

As a reminder, EI providers must submit a completed PA with all of the information and the appropriate documentation based on the member’s medical necessity. PA requests cannot be based on the scheduling needs of the provider.  EIS providers should not be requesting PA requests directly from MassHealth. EI providers who are coordinating the care of the member should be the source of the PA request. Please reference Transmittal Letters EIP-19 and EIP-20 for PA and submission requirements. 

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

 

EFFECTIVE JUNE 19, 2017: CHANGES TO PCC PROVIDER ONLINE SERVICE CENTER REFERRALS PROCESS

Effective June 19, 2017, MassHealth will implement a change in the PCC Provider Online Service Center Referrals Process.  As detailed in MassHealth’s All Provider Bulletin 265, issued in March 2017, and superseded by All Provider Bulletin 268, posted on Wednesday, May 24, 2017, PCCs which are CHCs, HLHCs, OPDs, group practices, and Indian Health Services must choose an individual MassHealth-participating physician or nurse practitioner on-staff at the PCC entity/service location as the individual referring provider when making a PCC referral. This change will go into effect on June 19, 2017.

MassHealth has scheduled three webinars to review the process and answer any provider questions. The webinars will be held on June 7, 2017; June 13, 2017 and June 21, 2017.  To enroll in a webinar session, please register at the MassHealth Learning Management System (LMS) via www.masshealthtraining.com and create your profile.  Once you are registered, select the preferred course date and time available.

Please note: The Informational Messaging that appears on certain claims with dates of service on or after March 7, 2016 (last year) that do not meet the ordering, referring, and prescribing provider requirements is separate and distinct from the POSC changes detailed above.  MassHealth will continue to process these claims with an Informational Message and will notify providers in advance when the decision has been made to set the edits to deny.   

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

 

 


05/23/17

NEW LONG-TERM SERVICES AND SUPPORTS THIRD-PARTY ADMINISTRATOR

The Executive Office of Health and Human Services (EOHHS) has contracted with a Third-Party Administrator (TPA) to augment the administrative capacity of MassHealth to deliver MassHealth Long Term Services and Supports (LTSS) on a fee-for-service basis to eligible MassHealth members.

Details about upcoming changes can be found in All Provider Bulletin 270 at http://www.mass.gov/eohhs/docs/masshealth/bull-2017/all-270.pdf and on the MassHealth Innovations website at www.mass.gov/hhs/masshealth-innovations.

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

 


05/16/17

MASSHEALTH TIMEFRAMES FOR BILL PAYING FOR NURSING FACILITY PROVIDERS

MassHealth will be modifying the timeframes for paying Nursing Facility claims for May dates of service received by MassHealth in May or June. The payment schedule will be modified by approximately 2 weeks.  Please see the modified payment schedule outlined below.

  • RA DATE: 07/05/2017                                       
  • PAYMENT DATE CHECKS: 07/07/2017
  • PAYMENT DATE EFT: 07/10/2017

Claims for June dates of service will go back to the regular schedule. (Remittance Advice (RA) dated the third Tuesday of the month)

  • RA DATE: 07/18/2017
  • PAYMENT DATE CHECKS: 07/21/2017
  • PAYMENT DATE EFT: 07/24/2017

MassHealth is mindful of the difficulties imposed by fiscal management decisions and appreciates your patience and understanding.

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

 

NEW ACCESSIBILITY RESOURCES FOR PROVIDERS WEBPAGE

MassHealth announces a new Accessibility Resources for Providers webpage on the MassHealth website. This webpage includes links to state and federal resources and other guidance for providers to improve access to healthcare services, equipment, and facilities for individuals with disabilities. MassHealth will periodically update this webpage to include additional guidance and announce new accessibility initiatives as such information becomes available. The web page has a user friendly URL: www.mass.gov/masshealth/accessibility for easy navigation to the page.

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

 


05/09/17

NEW UPDATED VERSION OF THE ORT/PRT PAYMENT & COVERAGE GUIDELINE TOOL

REMINDER – Orthotic and Prosthetic providers be advised that the MassHealth Orthotics and Prosthetics 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”.

Orthotic and Prosthetic providers are also reminded that procedures code L1851 and L1852 were added to the MassHealth Orthotics and Prosthetics Payment and Coverage Guidelines Tool.

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

 

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 AAC+ markup has been changed from 20% to 30% for service codes A9274, A9276, A9277 and A9278.

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

 


05/02/17

IMPLMENTATION DATE UPDATE TO ALL PROVIDER BULLETIN 265: CHANGES TO PCC PROVIDER ONLINE SERVICE CENTER REFERRALS PROCESS

On Monday, March 27th MassHealth had planned to implement a change in the PCC Provider Online Service Center Referrals Process.  As detailed in MassHealth’s All Provider Bulletin 265, CHCs, HLHCs, OPDs and group practices were to now choose an individual MassHealth-participating physician or nurse practitioner on-staff at the PCC entity/service location as the individual referring provider when making a PCC referral.

A decision was made to further delay this change to the POSC until June 1, 2017 to allow additional time to finalize a revised Provider Bulletin describing the change and for outreach and training to help PCCs that are organizations and group practices prepare for this change.  Until then, please continue to obtain PCC referrals as you have in the past.  At this time, there is no requirement to select an individual referring provider. Please leave the “Individual Referring Provider ID/LOC” field and the “Individual Referring Provider NPI” field blank.

Please note: The Informational Messaging that appears on certain claims with dates of service on or after March 7, 2016 (last year) that do not meet the ordering, referring, and prescribing provider requirements is separate and distinct from the POSC changes detailed above.  MassHealth will continue to process these claims with an Informational Message and will notify providers in advance when the decision has been made to set the edits to deny.   

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

ALL PROVIDER BULLETIN 267: FINGERPRINT BASED CRIMINAL BACKGROUND CHECKS

Section 6401 of the Affordable Care Act requires a fingerprint-based criminal background check as part of screening and enrollment requirements for certain “high risk” providers and all persons with a 5% or greater direct or indirect ownership interest in such providers. See All Provider Bulletin 267, or the following page on the MassHealth website for more information: https://tinyurl.com/nyv8wez

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

 

TO HOSPICE PROVIDERS

When hospice providers bill for service intensity add-on (SIA) during the last seven days of life (codes G0299 and G0155) they are required to attach a document with the member’s name, MassHealth ID, and verification of the member’s date of death. 

Providers are no longer required to attach documentation of medical necessity for this service (SIA). Link to the new rates for October 1, 2016 – September 30, 2017: http://www.mass.gov/eohhs/docs/eohhs/eohhs-regs/adminbull-2016/ab-16-20.pdf

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

 

MEDICARE CROSSOVER CLAIMS BILLED WITH CPT CODES 90847 AND 90853

MassHealth will be adjusting Medicare Crossover claims with dates of service on and after 06/01/2014 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 will be 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.

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


This information is provided by MassHealth.