Before you can test, you must call MassHealth Customer Service at 1-800-841-2900. Select Option 1, then Option 8, then Option 3, and speak directly to a representative in the Electronic Data Interchange (EDI) unit. You may alternatively send an e-mail to email@example.com.You must contact the EDI unit by phone or e-mail before submitting any test files. Any test files submitted without prior knowledge and coordination by the EDI unit will not be monitored for review of results.
When you contact MassHealth's EDI Unit, the EDI representative will need the following information from you in order to coordinate the test.
- Name and associated contact information, including e-mail and phone number
- User ID (Call MassHealth Customer Service if you do not have one. Validate that the user ID has access to the provider ID of the provider who wants to test and the proper role authorities (for example, claims submission and manage member eligibility).)
- Provider ID (If you are a provider, call MassHealth Customer Service if you do not have one. If you are a billing intermediary or software vendor, contact your client to get the provider ID.)
- Submitter ID (if applicable)
- Type of transaction(s) you want to test
- 270/271 Eligibility Verification
- 276/277 Claim Status
- 837I & 837P Transactions
- 835 Remittance Advice (We do not test 835 remittance advices, but we can validate the results on file.)
- Date you anticipate you will need to start testing
- Date you need to complete testing by (if applicable)
If you are submitting a transaction to MassHealth, your transactions will be processed against our production environment. You must not submit any more than 10 test claims to provide a representative set of the various types of business conducted for the site. MassHealth Customer Service will be required to review, monitor, and respond to file submissions-much as they currently do in standard TPT-until the provider reaches the standard threshold (80% of claims pass) to complete trading partner testing.
Steps to follow to ensure successful testing with MassHealth
1. You must inform MassHealth's EDI unit that you want to test electronic X12 transactions with MassHealth. If you plan to submit with an approved billing intermediary or software vendor, you do not have to test with MassHealth directly. However, you must provide the information listed above before testing can begin with your billing intermediary or software vendor. You may contact the MassHealth EDI unit by phone at 1-800-841-2900. Select Option 1, then Option 8, and then Option 3). You may also send an e-mail to firstname.lastname@example.org.
2. MassHealth will update your testing profile in NewMMIS so that we can track the results of the testing process with you. MassHealth will update your file to ensure the following.
- The trading partner is authorized to submit production transactions that testing occurred for.
- The relationship links between the provider and any billing agency are established, including setting up an alternative submitter ID and/or alternative receiver ID for the 835.
- If you intend to submit void and replace and COB claims as part of your normal course of business with MassHealth, then those type of claims must be included in the provider's test sample Approval of an 837 claim submission does not automatically approve a provider for COB.
- NPI and taxonomy are set up correctly. (Taxonomy is only required when deemed necessary by MassHealth.)
3. The trading partner should notify MassHealth Customer Service's EDI team when a file is submitted.
- MassHealth Customer Service EDI team will monitor the test based upon the day the file was submitted and the receipt names that you identify are on the test file.
- Complete validation for pre-compliance (validates the first level of compliance) and validation for compliance (provider will receive 997A, 997R.) If you do not receive a 997, then the file did not pass HIPAA pre-compliance, as there may be an issue with the ISA used on the transaction. For example, test files submitted with ISA 15 = "T" in this production environment will be rejected and a 997 will not be generated. MassHealth Customer Service will contact you about the error.
- If a file fails compliance, MassHealth Customer Service will track the results, contact you, and work with you to correct the issues.
- If a file passes compliance and reaches adjudication, MassHealth Customer Service will review the file, discuss the results with you, and identify any billing changes that need to be made for future submissions. A minimum of 80% of transactions must pass. (For claims, 80% must pay; for eligibility transactions, 80% of transactions must receive an eligibility response.
- If you have a single NPI or multiple NPIs that map to multiple service locations, MassHealth will validate that the claims are mapping to the correct provider ID/service location.
- All test results will be communicated to the trading partner and documented by MassHealth Customer Service.
- If you have any questions about this process, please contact MassHealth Customer Service at 1-800-841-2900. Select Option 1, then Option 8, then Option 3, and speak directly to a representative in the EDI unit. You may alternatively send an e-mail to email@example.com.
This information is provided by MassHealth .