11/19/13

HOME HEALTH ADVANCED BENEFICIARY NOTICE CHANGES ON DECEMBER 9, 2013

Home Health Agency providers are reminded: effective December 9, 2013, CMS will discontinue HHABN Form CMS-R-296 (Home Health Advanced Beneficiary Notice), replacing it with ABN Form CMS-R-131 (Advanced Beneficiary Notice of Non-Coverage).

The new ABN form does not allow a dual-eligible beneficiary to choose the option to bill Medicaid. Therefore, you should direct the beneficiary to choose Option 2. Under Section H, you should pre-print the following language: “We will bill your Medicaid plan. We will bill Medicare only if your Medicaid plan instructs us to do so.” This allows MassHealth, as payer of last resort, the right to exercise any appeals to Medicare.

For questions regarding the new ABN form, please contact your MAC (Medicare Administrative Contractor) and/or CMS (Centers for Medicare and Medicaid).

 

EFT/ERA OPERATING RULE GOES INTO EFFECT JANUARY 1, 2014

All providers are reminded: effective January 1, 2014, MassHealth will implement the EFT/ERA Operating Rule in accordance with Section 1104 of the Administrative Simplification provisions of the ACA (Affordable Care Act).

Providers that enroll or modify an existing EFT arrangement will be required to complete the new EFT enrollment modification form. Contact your financial institution to ensure that it is ready to support the new CCD+Addenda file format used to transmit payment information.

Providers can view the TRN (Re-association Trace Number) segment on the 835.  MassHealth will continue to provide the voucher number and the invoice/remittance advice number to enable providers to re-associate the remittance and the payment. Providers may view the new CARCs (Claims Adjust Reason Codes) and RARCs (Remittance Advice Remark Codes) on the 835.

Providers that sign up to receive the 835 ERA (Electronic Remittance Advice) or modify the receiver of the 835 must also complete the new ERA enrollment modification form.

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

 


11/12/13

REMINDER: BUNDLING OF PROCEDURE CODES NOT ALLOWED

Pharmacy, DME and Oxygen providers are reminded that MassHealth does not allow the bundling of procedure codes if there are existing procedure codes for that service or product. Providers are also reminded that altering a manufacturer’s invoice is not allowed. This includes crossing out or whiting out any information on the manufacturer’s invoice.

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

 

 

REMINDER: MASSHEALTH IS THE PAYER OF LAST RESORT

Providers of Pharmacy, DME, Oxygen and Respiratory, Prosthetics and Orthotics are reminded: MassHealth is the payer of last resort and providers, therefore, cannot bill MassHealth members. Please refer to 130 CMR 450.203 (A)(B) – PAYMENT IN FULL which states, in part, that no provider may solicit, charge, receive or accept any money, gift or other consideration from a member.

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

 


11/05/13

NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB

 

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from October 2013:

  • All Provider Bulletin 238: Introduction to the One Care: MassHealth plus Medicare Program  
  • School-Based Medicaid Bulletin 26: School-Based Medicaid Program Interim Rates (State Fiscal Year 2014) 

Transmittal Letters from October 2013:

  • ALL-204: Revised Appendix Y

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (www.mass.gov/masshealthpubs).