ATTESTATION OF COMPLIANCE LETTER MAILING
MassHealth recently mailed out its ANNUAL ATTESTATION OF COMPLIANCE form along with a cover letter. This form is intended for MassHealth provider entities that make or receive at least $5 million in Medicaid payments annually. If you received this mailing in error, MassHealth asks that you please disregard it and apologizes for any inconvenience.
If you have questions, please contact MassHealth Customer Service at firstname.lastname@example.org or call 1-800-841-2900.
REMINDER TO KEEP PROVIDER PROFILE INFORMATION UP-TO-DATE
All providers are reminded: in accordance with MassHealth regulation 130 CMR 450.223(B), you must notify MassHealth in writing within 14 days of any change of information submitted in your original enrollment application including, but not limited to, changes in ownership or control, changes in address, criminal convictions or license status. Failure to notify MassHealth constitutes a breach of the provider contract and may result in termination of the provider contract or other sanctions. The absence of notification constitutes confirmation of no changes.
Any changes must be submitted to MassHealth and such changes do not become effective until the request has been processed.
To submit changes through the POSC (Provider Online Service Center), go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile. You may also submit changes, in writing, to Provider Enrollment and Credentialing, PO Box 9118, Hingham MA 02043.
For questions, please contact MassHealth Customer Service at email@example.com or call 1-800-841-2900.
ADMISSION DATES ARE REQUIRED FOR INPATIENT CLAIMS
Providers are reminded: You are required to input the admission date on both 1500 and UB-04 claim types when the place of service is an Acute Inpatient hospital, Inpatient Psychiatric facility, Chronic Inpatient hospital or a Skilled Nursing facility. MassHealth will begin to enforce this standard compliance requirement in December.
If you have any questions regarding this change, please contact MassHealth Customer Service at 1-800-841-2900 or firstname.lastname@example.org.
ADJUSTMENTS FOR ACA SECTION 1202 RATES FOR PHYSICIANS WHO PROVIDE PRIMARY CARE SERVICES
MassHealth has identified overpayments and, in some cases, underpayments of ACA Section 1202 rates on certain Evaluation and Management and Vaccine Administration claims submitted from January 1, 2013 to May 4 2013, due to an error in preliminary Section 1202 rates released by CMS.
MassHealth previously systematically adjusted claims processed from April to May 2013 to pay the corrected 1202 rate. MassHealth will now begin releasing claims processed from January through March 2013 that have been systematically adjusted to pay the corrected 1202 rates. These claims will appear on remittance advices in the coming weeks. We apologize for the inconvenience. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or email@example.com.
ALL PROVIDERS - BILLING FOR SERVICES TO MEMBERS ENROLLED IN HOSPICE
All providers are reminded to check the MassHealth Eligibility Verification System (EVS) to determine if a member is enrolled in hospice prior to rendering services.
In accordance with 130 CMR 437.412 (B) Waiver of Other Benefits, except for members described in 130 CMR 437.412 (A) (2), upon electing to receive hospice services, a member waives all rights to MassHealth benefits for the following services for the duration of the election of hospice services: (2) any MassHealth services that are related to the treatment of the terminal illness for which hospice services were elected, and (3) any MassHealth services that are equivalent or duplicative of hospice services with certain exceptions cited in 130 CMR 437.412 (B).
Claims for members enrolled in hospice submitted by non-hospice providers may be suspended with Edit 2018 – MEMBER ENROLLED IN HOSPICE, in order to determine if the services are related to the treatment of the terminal illness or equivalent or duplicative of hospice services. Claims from non-hospice providers where non-compliance with130 CMR 437.412 (B) (2) & (3) is found will be denied with Edit 2018 – MEMBER ENROLLED IN HOSPICE. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or firstname.lastname@example.org.
THIRD PARTY CLAIMS – OTHER INSURER REMITTANCE DATES REQUIRED
Providers are reminded that MassHealth requires the other insurer remittance date when billing third party claims. This remittance date is found on the other insurer’s EOB (Explanation of Benefits). For 837I transactions, this information is entered in Loop 2330B, DTP03 segment. For 837P transactions, this information is entered in Loop 2430, DTP03 segment. For claims submitted through the POSC (Provider Online Service Center), this information is entered in the Remittance Date field.
The remittance date should not match either the EOB date of any other insurer or the service date(s) on the claim. Submitting claims with duplicate EOB dates may result in denials for the following two new edits:
- 2507 DUPLICATE EOB DATES AT THE HEADER
- 2560 DUPLICATE EOB DATES AT THE DETAIL
Claims denying with these edits may be rebilled using the correct EOB/adjudication dates for all payers. For questions, please contact MassHealth Customer Service at email@example.com or call 1-800-841-2900.
OUT-OF-STATE HOSPITAL PROVIDERS – NOTICE OF RATE UPDATE
Out-of-State Acute Inpatient and Acute Outpatient Hospital providers please note: in accordance with MassHealth regulations 130 CMR 450.233 (D), new rates have taken effect for claims with dates of service 10/01/13 and thereafter.
To view the rates, go to www.mass.gov/eohhs/gov/laws-regs/. Click on the link to “MassHealth Regulations and Publications”, then click on “Special Notices for Hospitals”, and then click “Rates of Out-of-State Acute Hospital Services Effective October 01, 2013.” For questions, please contact MassHealth Customer Service at 1-800-841-2900 or firstname.lastname@example.org.
NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB
MassHealth has posted the following publications on the MassHealth website:
Provider Bulletins from September 2013:
- All Provider Bulletin 237: Primary Care Clinician (PCC) Plan Referral Process and Requirements
Transmittal Letters from September 2013:
- ALL-203: Integrated Care Organizations
- DEN-91: Revised Regulations about Dental Sealants
- NF-60: Integrated Care Organizations
- PCA-19: Integrated Care Organizations
You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (www.mass.gov/masshealthpubs).
AVAILABLE OCTOBER, 2013: VIEWING VOIDS AND ADJUSTMENTS ON THE 835
Effective Monday, September 30, 2013, MassHealth will begin generating voids and adjustments on the 835 at both the detail line level and the header level. Providers will begin to see this change reflected on the 835 during October 2013.
Reversal transactions, identified by the CLP02 field equal to 22, have always been reported at the header level, even if the original payment was reported at the detail level. As of 09/30/13, reversal 835 transactions will mirror original payments. If original payment was reported at the claim detail, the reversal will be reported at the detail. Likewise, reversals will be reported at the header if original payments were reported at the header.
For further details, please see the ASC X12N Health Care Payment/Advice (835) Implementation Guide, section 18.104.22.168, Reversals and Corrections.