In our efforts to assist the provider community to achieve HIPAA compliance, MassHealth has developed several tools that have been added to our over all automated solutions, and will continue to develop additional tools to encompass ongoing changes in the health care industry. MassHealth's mission is to embrace these industry initiatives, adhere to federal mandates, and utilize technological innovations that will enhance the business practice solutions for MassHealth providers.

A key element to meeting these objectives rests with the automation of business practices that move away from paper-based transaction processing. MassHealth encourages those providers who submit their claims on paper to become familiar with our set of automated solutions.

The Provider Online Service Center (POSC) offers a way to check eligibility through the Eligibility Verification System (EVS) feature. This is a particularly useful tool set up to help save providers time by allowing the user to verify member eligibility before a service is offered. Ensuring members have appropriate coverage, before offering services, reduces the chances of claim denials related to member eligibility. You can also use the POSC to check the status of claims submitted to MassHealth.

For information on member eligibility verification and EDI claim status transactions, go to the EVS section of our Web site.

Additional EDI and HIPAA resources

This information is provided by MassHealth.