Messages from the Week of September 18, 2017

September 18, 2017

To Home Health Agency Providers

In July 2017, MassHealth released Transmittal Letter All-222 (TL All-222) which outlines the changes to the MassHealth regulations 130 CMR 450.000 and 130 CMR 433.000. The changes have expanded the types of licensed practitioners that can enroll as MassHealth providers, including all advanced practice registered nurses.  In addition, the changes allow designated mid-level medical practitioners to serve as a member’s primary care clinician.  These changes were effective as of August 1, 2017.

Providers participating in MassHealth’s Home Health program should continue to follow their provider specific regulations, 130 CMR 403.000, regarding medical practitioners allowed to order home health services and sign a member’s plan of care.

The MassHealth LTSS Provider Service Center is open 8 am to 6 pm ET, Monday through Friday, excluding holidays. LTSS providers should direct their questions about these changes or other MassHealth LTSS provider questions to the LTSS Third Party Administrator (TPA) as follows:

Phone: Toll-free 1-844-368-5184
Email: support@masshealthltss.com
Mail: MassHealth LTSS, PO Box 159108, Boston, MA 02215
Fax: 1-888-832-3006

LTSS Provider Portal: Trainings, general information, and future enhancements will be available at www.MassHealthLTSS.com.

Messages from the Week of September 11, 2017

September 11, 2017

Edit 4814 – Inpatient Claim under Review

Effective September of 2017 MassHealth will begin suspending acute inpatient hospital claims for newborn members in order to ensure that claims are processed under the correct benefit plan, including Managed Care Organizations.  The claims will suspend for Edit 4814 – INPATIENT CLAIM UNDER REVIEW.  These claims will be manually reviewed and adjudicated within thirty days of receipt.  MassHealth expects that this new claim process will reduce the administrative burden on providers by ensuring that the correct payer reimburses hospitals for these services.  MassHealth expects that the processing time for these claims will not be affected. 

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

Messages from the Week of September 4, 2017

September 5, 2017

To Home Health Agency Providers

On July 14, 2017, MassHealth promulgated 101 CMR 350.00: Home Health Services, which increased the reimbursement rates for the codes below.

Code: G0299
Rate: $89.21
Unit: Per Visit
Service: Services of an RN in home health setting (one through 30 calendar days)

Code: G0300
Rate: $89.21
Unit: Per Visit
Service: Services of an LPN in home health setting (one through 30 calendar days)

Some MassHealth providers who submitted claims for services provided on or after July 14, 2017 were reimbursed their previous rate in error. MassHealth has identified and adjusted these claims systematically. Providers will receive payment and see these claims on remits in the coming weeks.

If you have any questions regarding these changes, please contact the LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

Update to ORT/PRT Payment and Coverage Guideline Tool

Please be advised that the following procedure codes have been removed from the MassHealth Orthotics and Prosthetics Payment and Coverage Guidelines Tool: L6025, L7260 and L7261.

To confirm that you are using the most recent version of the applicable Tool, go to www.mass.gov/masshealth, click on “Provider Library” and then on “MassHealth Payment and Coverage Guideline Tools”.

If you have any questions regarding this change, please contact the LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

Messages from the Week of August 28, 2017

August 28, 2017

Medicare Social Security Number Removal Initiative (SNNRI) Trading Partner Testing Update

In accordance with the Medicare Social Security Number Removal Initiative (SNNRI), effective April 1, 2018, MassHealth will begin to accept the new 11 digit Medicare Beneficiary Identifier (MBI) on all relevant transactions. This includes Direct Data Entry (DDE) via the POSC. The MBI will replace the 11 digit Health Insurance Claim Number (HICN). During Medicare’s transition period, between April 1, 2018 and December 31, 2019, MassHealth will accept either the MBI or HICN. Please note that if an HICN is submitted during this transition period, MassHealth will return the MBI on all response transactions if the new number is known to MassHealth.

Trading partners that exchange transactions directly with MassHealth should not need to make any systems changes to send or receive the 11 digit alpha-numeric number to/from MassHealth.  Therefore, MassHealth does not intend to require trading partners to test the changes. 

If you have any concerns about this approach or strongly believe that MassHealth should test with you, please contact the MassHealth EDI team immediately at 1-800-841-2900 or EDI@MAHealth.net, but no later than September 15, 2017.

HN Modifier

Effective with dates of service on or after August 1, 2017, claims submitted with the HN modifier may have inappropriately denied.  MassHealth is in the process of identifying the denied claims and will reprocess them within the next two weeks.  Please do not resubmit your denied claims, MassHealth will re-adjudicate those that have denied due to the HN modifier issue.

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

Provider Contracts for Entities (GEN-16) and Individuals (GEN-15)

Effective immediately, the Provider Contracts for Entities and Individuals have been updated to include the document number and the revision date on all pages.  MassHealth has made this change as a result of receiving old versions of the contract signature pages along with new versions of the document itself.  The contracts can be found on the MassHealth website on the MassHealth Provider Forms page: https://tinyurl.com/kxb82pd

Please discontinue use of any old versions immediately. 

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

New Mailing Addresses for MassHealth Provider-Related and Claims-Related Documents

An upcoming provider bulletin, set to be released in the beginning of September 2017, will introduce two new Post Office (P.O.) boxes that must be used for mail correspondence for providers, including non-billing providers who order, refer, and prescribe services. The address changes do not apply to Long Term Services and Supports (LTSS) providers, with the exception of submitting paper claims. The full list of LTSS providers can found in All Provider Bulletin 270, with along with the address for LTSS correspondence.

The new MassHealth Provider Enrollment and Credentialing P.O. box address is the following: 

MassHealth
Attn: Provider Enrollment and Credentialing
P.O. Box 121205
Boston, MA  02112-1205 

The new MassHealth Claims P.O. box address is the following:

MassHealth
Attn: Claims
P.O. Box 120010
Boston, MA  02112-0010 

For a limited time, MassHealth will continue to receive and process documentation mailed to the previous P.O. boxes in Canton, MA, but we encourage all providers to immediately use the new addresses.   

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

Messages from the Week of August 7, 2017

August 7, 2017

To Home Health Agency Providers

On July 14, 2017, MassHealth promulgated 101 CMR 350.00: Home Health Services, which increased the reimbursement rates for the following codes:

Code: G0299
Rate: $89.21
Unit: Per Visit
Service: Services of an RN in home health setting (one through 30 calendar days)

Code: G0300
Rate: $89.21
Unit: Per Visit
Service: Services of an LPN in home health setting (one through 30 calendar days)

Currently, MassHealth is experiencing IT issues and providers who submitted claims for services provided on or after July, 14, 2017 are being reimbursed at their previous rate.  All claims submitted with the correct modifiers are not affected, and are being reimbursed at the correct rate.

MassHealth is working to correct this error, and will reprocess all affected claims so they are reimbursed at the correct rate.

If you have any questions regarding these changes, please contact LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

To Hospice Providers Regarding Service Intensity Add-On (SIA) Billing

Providers are required to bill the last seven days of life for SIA separately for each day of service for a maximum of 16 units each day.

REMINDERS:

The SIA rate is an addition to the Routine Home Care (RHC) rate when all of the following criteria are met: 1) The day is a RHC level of care day 2) The RHC day occurs during the last 7 days of the member’s life, and the patient is discharged expired 3) Direct patient care is furnished by a registered nurse (RN) or social worker that RHC day.  Additionally, the SIA rate will equal the continuous home care hourly payment rate, for a minimum of 15 minutes and up to 4 hours per day. The time of a social worker’s phone calls is not eligible for an SIA rate payment.

Codes:
Services of a registered nurse: G0299
Services of social worker: G0155

If you have any questions regarding these changes, please contact LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

Messages from the Week of July 31, 2017

July 31, 2017

New Updated Version of the DME/OXY Payment and 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”.

New added modifiers to procedure code A9900:

A9900 U3 Miscellaneous DME supply, accessory and/or service component of another HCPS code (MassHealth Members only, Supplies for maintenance of insulin, each.)

A9900 U4 Miscellaneous DME supply, accessory and/or service component of another HCPS code (MassHealth Members only, Supplies for external insulin infusion pump, syringe type cartridge, sterile each.)

If you have any questions regarding these changes, please contact LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

Messages from the Week of July 24, 2017

July 24, 2017

Behavioral Health Services Reminder

This is a reminder for the following provider types: PT 26 – Mental Health Centers, PT 28 – Substance Use Disorder Treatment Programs, PT 05 – Psychologists, PT 65 – Psychiatric Day Treatment, and PT 20 – Community Health Centers. 

Claims involving behavioral health services require providers to cost avoid those claims when members are enrolled with the MassHealth Behavioral Health Vendor, MBHP. Claims for these members should not be directly billed to MassHealth.

Providers are reminded to reference 130 CMR 450.124: Behavioral Health Services in the All Provider Regulations.

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

Updated Approved Vendor List Now Available on Web

All providers are advised: MassHealth has posted its newly-updated approved, HIPAA-compliant Vendor List to the web.

To access this new list and a helpful list of “Questions to ask your Vendor”, please go to: https://tinyurl.com/ydf8w26j.

Providers or vendors with questions about the approved vendor list process can contact MassHealth EDI (Electronic Data Interchange) at MassHealth Customer Service: 1-800-841-2900 or at edi@mahealth.net.

Ordering, Referring and Prescribing Initiative Update

MassHealth started informational messaging to providers in March 2016 on most professional claims that required an ordering provider NPI if they did not meet Ordering/Referring/Prescribing (ORP) requirements. As a next step in this initiative, informational messaging will begin running on all claims that require orders, referrals or prescriptions, including Medicare crossover claims, starting August 1, 2017.

Messaging will appear on any impacted claim that

1)  does not have the ordering/referring/prescribing (ORP) NPI on the claim; or
2)  has an  ORP NPI but that  ORP provider is not enrolled with MassHealth; or
3)  has an  ORP NPI from a provider type not authorized to order, refer or prescribe services.

The informational messages allow billing providers to understand the scenarios in which an authorized enrolled ORP provider’s NPI is required on a claim. 

It is critical that providers comply as quickly as possible with these important requirements as MassHealth will begin to deny claims that do not meet the ORP requirements later in the calendar year.

For information about the ORP requirements, including impacted claims and billing instructions, please see Provider Bulletin 259.

If you have any questions about the informational messaging or about the ORP requirements, please contact Customer Service.

Non-LTSS provider should contact the MassHealth Customer Service Center by e-mail at providersupport@mahealth.net, by fax at 617-988-8974, or by phone at 1-800-841-2900.

LTSS providers should contact the LTSS Provider Service Center by phone at 1-844-368-5184 or by email at support@masshealthltss.com.

Messages from the Week of July 17, 2017

July 17, 2017

Reporting of HIPAA Claim Adjustment Group Codes (CAGC) and Claim Adjustment Reason Codes (CARC) on MassHealth COB Claims

All providers are reminded that claims containing Coordination of Benefits (COB) information must be submitted to MassHealth with valid HIPAA Claim Adjustment Group Codes (CAGCs) and Claim Adjustment Reason Codes (CARCs) as reported on the other insurers’ explanation of benefits (EOB).

MassHealth is not liable for payment of claims for which a member is not liable. Refer to CMR 450.316: Third-Party Liability: Requirements and CMR 450.317: Third-Party Liability: Payment Limitations on Claim Submission.

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.

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

New Updated Version of the DME/OXY Payment and 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”.

Procedure code update:

Place of service 30 & 31 were removed for procedure code K0552 Supplies for external non-insulin infusion pump, syringe type cartridge, sterile, each.

New codes added pursuant to Administrative Bulletin 17-06, effective January 1, 2017:

A4224 Supplies for maintenance of insulin infusion catheter, per week (1 unit = 1 week (max is 4 per month))

A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each

If you have any questions regarding these changes, please contact LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

Messages from the Week of July 10, 2017

July 12, 2017

System Maintenance

To allow for system maintenance, the MMIS POSC, the internal MMIS application, and MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable on Sunday, July 16th, 2017 from 03:00 AM to 08:00 AM.  MAP, CBHI and member and eligibility web services will also be impacted.

We apologize for any inconvenience this may cause.  Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.   EHS users with questions, please contact the EHS Customer Support Center at 617-994-5050 or email SystemsSupporthelpdesk@Massmail.state.ma.us.

July 10, 2017

Authorized PT-1 Form Reminder

MassHealth receives and processes paper Prescription for Transportation (PT-1) forms used by providers on behalf of covered members to request authorization for transportation to a medical appointment when the provider is unable to submit the form electronically.  The current version is PT-1 (Rev. 05/09). 

Requests for transportation submitted using any other version of the form will be rejected. A sample of the PT-1 form can be found at: www.mass.gov/eohhs/docs/masshealth/bull-2009/all-192.pdf

MassHealth is moving toward paperless PT-1 submission in 2018. To ensure compliance, to expedite submission of your PT-1 request, and to avoid rejection of an unauthorized PT-1 form, request access to the Customer Service Web Portal now by requesting a User ID at: https://tinyurl.com/y8mwap8m

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

File Invalid Error

A recent change to the MMIS system resulted in some Provider Online Service Center (POSC) users to receive an error when uploading files through Internet Explorer (IE) browser.

To correct the issue you will need to make a change to the IE browser setting. The MMIS file upload issue appears to occur when the MMIS web site is part of the IE “Trusted sites” and the Trusted sites zone has the “Include local directory path when uploading files to a server” setting set to “Enabled”. 

NOTE: If it is necessary to maintain the MMIS web site in the trusted sites, the only solution to the file upload issue would be to change the “Include local directory path when uploading files to a server” setting to “Disabled” so that the file uploads work properly. 

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

Messages from the Week of July 3, 2017

July 5, 2017

To Home Health Agency Providers

There will be four Home Health Provider Outreach Forums the week of July 17th

Please register for one of the following forums:

During the open forums, MassHealth will discuss topics including MassHealth updated regulations, Guidelines on Medical Necessity for Home Health Regulations, Third Party Administrator update , Prior Authorization and Required Documentation.  The same information will be presented at each forum

Space is limited.  Please register early!

For questions, please contact LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184

Updated Message: New Provider Types – Mid Levels

Effective August 1, 2017, MassHealth regulations will be amended to expand the types of providers eligible to participate in MassHealth to include all categories of state licensed advanced practice registered nurses and physician assistants. The regulations will also allow physician assistants to serve as primary care clinicians. As a result, all Physician Assistants (PAs), Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNSs), Psychiatric Clinical Nurse Specialists (PCNSs),  Nurse Practitioners and Nurse Midwives (NMWs) working for a group practice must participate in the MassHealth program in order for the group practice to receive payment for their services. PAs must work for a group practice with at least one physician in order to be eligible to participate in MassHealth. CRNAs, PCNSs, and CNSs will also be able to participate independently in MassHealth, and NPs and NMWs will continue to be able to do so. Physicians will no longer be able to bill using the physician’s NPI for services of any of these provider types, with the exception of NPs that are employed by an individual physician.

Updates to regulations found in 130 CMR 433.000, 450.000 and 508.000 for mid-level providers can be found at: https://tinyurl.com/yboz6dtq

Some other highlights of these new regulations include:

The following modifiers will be deactivated effective 8/1/17: HN (physician assistant) and SB (nurse midwife).

The following modifiers must be used when billing for anesthesia effective 8/1/17: AA, QK, QY, QX, and QZ.

The following modifier remains in effect nurse practitioners who work for an independent physician ONLY: SA (Nurse Practitioner)

For Anesthesia billing, effective 8/1/17 Medical Direction by a physician is payable to a physician. Medical Supervision by a physician is not payable under MassHealth.  See physician regulations at 130 CMR 433.454 (C) and (D) for definition of medical direction and medical supervision.  

Payment for Physician Assistants will be made to MassHealth participating group practices that have at least one physician as a member. Group Practices without a physician member cannot bill for PA services.

To assist providers with the provider enrollment process and the billing changes under these new regulations, MassHealth will be hosting 4 webinar sessions (June 20, July 13, 2017; July 25, 2017; and August 15, 2017).  To register for one of these webinars please visit www.masshealthtraining.com.

For questions or to request the application, please contact the MassHealth Customer Service Center by e-mail at providersupport@mahealth.net or by phone at 1-800-841-2900.

Messages from the Week of June 26, 2017

June 26, 2017

Children’s Medical Security Plan Program Changes

The Children’s Medical Security Plan (CMSP) covers certain medical, dental and behavioral health services for eligible members. Effective July 1, 2017, MassHealth will directly manage CMSP, and UniCare will no longer serve as the administrator for CMSP. UniCare will continue to process CMSP non-pharmacy claims for dates of service that occurred prior to July 1, 2017. The current CMSP pharmacy processing and business rules remain unchanged.

Transmittal Letter ALL-221 at http://www.mass.gov/eohhs/docs/masshealth/transletters-2017/all-221.pdf describes changes that will result from the change in the administration of CMSP, and further details about CMSP claims submission during the transition period. Only those MassHealth provider types described in Transmittal Letter ALL-221 are eligible to provide CMSP services.

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

Retro Rate Adjustments for Hospice Providers

Please be advised that the most recent remittance advice (RA) may contain rate adjustments resulting from the certification of revised FFY17 rates (October 1, 2016) by the Executive Office of Health and Human Services.  Please review this RA for accuracy.  Proposed corrections must be submitted to the MassHealth LTSS Provider Service Center 60 days from the date of this RA at support@masshealthltss.com or by calling 1-844-368-5184. For more information, refer to the POSC Job aid, View Remittance Advice Reports, on the Get Trained web page at https://tinyurl.com/zzkhak6.

For questions, please contact the MassHealth LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

Messages from the Week of June 12, 2017

June 12, 2017

New Updated Version of the DME/Oxy Payment and 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 following changes were made to procedure code A9276 Requirements and Limits:

1 unit = each, Max 10 units per month based on the following manufacture:

  • Dexcom – 1 per week, 52 per year. (1 last 7 days)
  • MiniMed – 10 per month, 120 per year. (1 last 3 day)
  • Medtronic Enlite System – 5 per month, 60 per year.

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 Application Process for Durable Medical Equipment Providers

MassHealth is streamlining its application process for Durable Medical Equipment (DME) providers.  As of May 31, 2017, DME providers will no longer need to submit a Letter of Intent (LOI) prior to receiving and completing a MassHealth provider application for DME, in accordance with 130 CMR 409.404. 

Please contact the LTSS Provider Service Center at 1-844-368-5184 or by email at support@masshealthltss.com for questions or to request an application, 8:00 a.m. to 6:00 p.m. ET, Monday through Friday, excluding holidays. Or, go to the MassHealth LTSS Provider Portal at www.masshealthltss.com.

Medicare Crossover Claims Billed with CPT Codes 90847 and 90853

MassHealth has adjusted Medicare Crossover claims with dates of service on and after 01/01/2015 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 have been 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.

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

POSC Claims Submission Issue (DDE ONLY) – Resolved

Please be aware that starting late morning on Wednesday, June 7th until 2:30PM on Wednesday providers submitting Direct Data Entry (DDE) claims may have experienced submission issues. During this time DDE claims either could not be submitted or they were submitted but were not issued an ICN. Providers who encountered such issues or are unsure if the claim processed successfully may resubmit the claims. Batch HIPAA 837 claims and all other POSC services were not impacted. We apologize for any inconvenience this may have caused for our providers.

If you have questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net. LTSS providers may contact the LTSS Provider Service Center at 1-844-368-5184 or by email at support@masshealthltss.com.

New Provider Types – Mid Levels

Effective August 1, 2017, MassHealth regulations will be amended to expand the types of providers eligible to participate in MassHealth to include all categories of state licensed advanced practice registered nurses and physician assistants. The regulations will also allow physician assistants to serve as primary care clinicians. As a result, all Physician Assistants (PAs), Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNSs), Psychiatric Clinical Nurse Specialists (PCNSs), Certified Nurse Practitioners (CNPs), and Nurse Midwives (NMWs) working for a group practice must participate in the MassHealth program in order for the group practice to receive payment for their services. PAs must work for a group practice with at least one physician in order to be eligible to participate in MassHealth. CRNAs, PCNSs, and CNSs will also be able to participate independently in MassHealth, and CNPs and NMWs will continue to be able to do so. Physicians will no longer be able to bill using the physician’s NPI for services of any of these provider types, with the exception of CNPs that are employed by an individual physician.

Updates to regulations found in 130 CMR 433.000, 450.000 and 508.000 for mid-level providers can be found at:

http://www.mass.gov/eohhs/gov/laws-regs/masshealth/masshealth-proposed-regs.html

Some other highlights of these new regulations include:

The following modifiers will be deactivated effective 8/1/17: HN (physician assistant) and SB (nurse midwife).

The following modifiers must be used when billing for anesthesia effective 8/1/17: AA, QK, QY, QX, and QZ.

The following modifier remain in effect: SA (Nurse Practitioner)

For Anesthesia billing, effective 8/1/17 Medical Direction by a physician is payable to a physician. Medical Supervision by a physician is not payable under MassHealth.  See physician regulations at 130 CMR 433.454 (C) and (D) for definition of medical direction and medical supervision. 

Payment for Physician Assistants will be made to MassHealth participating group practices that have at least one physician as a member. Group Practices without a physician member cannot bill for PA services.

To assist providers with the provider enrollment process and the billing changes under these new regulations, MassHealth will be hosting 4 webinar sessions (June 20, 2017; July 13, 2017; July 25, 2017; and August 15, 2017).  To register for one of these webinars please visit www.masshealthtraining.com.

For questions or to request the application, please contact the MassHealth Customer Service Center by e-mail at providersupport@mahealth.net or by phone at 1-800-841-2900.

Messages from the Week of June 5, 2017

June 8, 2017

POSC Claims Submission Issue (DDE Only) - Resolved

Please be aware that starting late morning on Wednesday, June 7th until 2:30PM on Wednesday providers submitting Direct Data Entry (DDE) claims may have experienced submission issues. During this time DDE claims either could not be submitted or they were submitted but were not issued an ICN. Providers who encountered such issues or are unsure if the claim processed successfully may resubmit the claims. Batch HIPAA 837 claims and all other POSC services were not impacted. We apologize for any inconvenience this may have caused for our providers.

If you have questions, please contact the MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net. LTSS providers may contact the LTSS Provider Service Center at 1-844-368-5184 or by email at support@masshealthltss.com.

June 5, 2017

AVR Update – Important Message for All MassHealth Providers

MassHealth will sunset its antiquated Automated Voice Response (AVR) system this June. The AVR, which is currently used by providers to check member eligibility, will no longer be available on or after July 3, 2017.  Providers are encouraged to utilize the Provider Online Service Center (POSC) direct data entry (DDE) or to submit the 270/271 Eligibility Inquiry and Response transaction to check member eligibility. 

If you have any questions regarding the sun-setting of the AVR, please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net.

Messages from the Week of May 29, 2017

May 29, 2017

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.

Messages from the Week of May 22, 2017

May 22, 2017

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.

Messages from the Week of May 15, 2017

May 15, 2017

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.

Messages from the Week of May 8, 2017

May 8, 2017

New Updated Version of the ORT/PRT Payment and 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 and 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.

Messages from the Week of May 1, 2017

May 5, 2017

System Maintenance

To allow for system maintenance, the MMIS POSC and the internal MMIS application will be unavailable tonight, Friday May 5th, 2017 from 7:00PM until 9:30PM.

We apologize for any inconvenience this may cause. 

Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.   EHS users with questions, please contact the EHS Customer Support Center at 617-994-5050 or email SystemsSupporthelpdesk@Massmail.state.ma.us

May 1, 2017

Implementation 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.

Messages from the Week of April 24, 2017

April 24, 2017

Billing Tips for Delay Reason Code 11

MassHealth has identified that providers are selecting delay reason code 11 unnecessarily upon submission of claims with required attachments through the Provider Online Service Center (POSC).  Providers are reminded that when submitting electronic claims that require attachments with the use of a delay reason code, they must follow procedures communicated in All Provider Bulletin 225, dated April 2012. 

The following claims and attachments have been submitted inappropriately with the use of delay reason code 11:

  • 90 Day Waiver requests – 90 Day Waiver requests should be submitted to the 90 Day Waiver Unit using delay reason codes 1, 4, or 8 as described in all Provider Bulletin 220, dated December 2011.
  • Final Deadline Appeal requests – Final Deadline Appeal requests should be submitted to the Final Deadline Appeals Unit using delay reason code 9, as described in All Provider Bulletin 232, dated February 2013. 
  • Sterilization Forms – These attachments will automatically suspend for review with edit 2617, if applicable.
  • Unlisted codes submitted with Operational Notes, Invoices or Reports – These attachments will automatically suspend for pricing with edit 6000, if applicable.
  • Explanation of Benefits from another insurer or TPL update requests – Please refer to your TPL instructions for the submissions of these attachments or how to request an update to a TPL file.

The use of an incorrect delay reason code will delay claim processing and may result in the denial of your claim.

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

Messages from the Week of April 17, 2017

April 18, 2017

New Updated Version of the DME/OXY Payment and Coverage Guideline Tool

REMINDER – Pharmacy, DME and Oxygen providers be advised that the MassHealth DME/OXY Payment and Coverage Guideline 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”.

Pharmacy, DME and Oxygen providers are also reminded that procedure codes E2609, E2610 and K0005 have been changed from a “Sometime” Prior Authorization to a “Yes” Prior Authorization.

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

NF Direct Care Add-On Compliance – Reporting

UMASS Medical School is still in the process of developing the web application that facilities will use to submit interim data for the FY17 nursing facility direct care add-on program. We anticipate that this web application will be available the week of April 17.  An additional communication will be sent once the web application is launched.

In the meantime, if you have not already done so, each facility must complete the NF direct care registration form, available here: https://tinyurl.com/kxb82pd (under Long Term Care – Nursing Facility).  This form designates a person who will submit data on the facility’s behalf. When the application is launched, each person registered will receive an email with a user ID and temporary password. The registration form should be emailed to NFDirectCare@umassmed.edu.

If you have any additional questions regarding this process, please email NFDirectCare@umassmed.edu.

Messages from the Week of April 10, 2017

April 10, 2017

Appendix W – Behavioral Health Updates

Updates to MassHealth’s list of approved standardized behavioral health screening tools were recently published in Transmittal Letter ALL-219. The updates become effective for dates of service on or after April 17, 2017.

ALL-219 includes the proper codes and modifiers to be used when claiming for the administration of the Edinburgh Postnatal Depression Scale (EPDS). For services delivered on or after April 17, 2017, pediatric providers who are screening an infant’s caregiver for postpartum depression should use CPT code 96110 and not CPT code S3005. For a single date of service, providers may file only one claim for CPT code 96110. 

Updates to provider-specific subchapter 6 and Transmittal Letters on claiming for behavioral health screenings will follow shortly. 

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

Messages from the Week of April 3, 2017

April 3, 2017

Reporting of HIPAA Claim Adjustment Group Codes (CAGC) and Claim Adjustment Reason Codes (CARC) on MassHealth COB Claims

All providers are reminded that claims containing Coordination of Benefits (COB) information must be submitted to MassHealth with valid HIPAA Claim Adjustment Group Codes (CAGCs) and Claim Adjustment Reason Codes (CARCs) as reported on the other insurers’ explanation of benefits (EOB).

MassHealth is not liable for payment of claims for which a member is not liable. Refer to CMR 450.316: Third-Party Liability: Requirements and CMR 450.317: Third-Party Liability: Payment Limitations on Claim Submission.

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.

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

Duplicate Part A Crossover Claims

Due to a systems issue, MassHealth received a duplicate Part A crossover claims file from Medicare on Tuesday, March 28, 2017.  The duplicate claims have been processed by MMIS, and you will see an increase in duplicate claim denials on future remittance advices. We apologize for any inconvenience this may have caused.

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

Messages from the Week of March 27, 2017

March 31, 2017

Important 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 delay this change to the POSC until May 1, 2017. 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 MassHealth customer services at 1-800-841-2900 or e-mail providersupport@mahealth.net.

Messages from the Week of March 20, 2017

March 20, 2017

MassHealth Hospice Election Form HOS-1

Providers are reminded that pursuant to 130 CMR 437.412(C), whenever a MassHealth member seeks to elect or revoke hospice services, to disenroll from hospice services, or to change hospice providers, hospice providers must complete the MassHealth Hospice Election form HOS-1 (Rev 07/14) with the MassHealth member or the member’s representative, according to the instructions on the HOS-1 form. 

The MassHealth Hospice Election form HOS-1 (Rev 07/14) can be accessed on the MassHealth website at the following link: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/hos-1.pdf.

The hospice provider must complete HOS-1 Section A in all cases. The hospice provider completes Section B1 or B2 (Hospice Election), Section C (Hospice Revocation), or Section E (Hospice Change) with the member or the member’s representative.  The hospice provider may complete Section D (Hospice Disenrollment) without the signature of the member or the member’s representative, but Signature of Hospice provider/staff is required.

MassHealth does not pay for any hospice services until a completed MassHealth Hospice Election Form has been submitted and processed.  Completed HOS-1 forms should be submitted prior to billing claims for any hospice services.   Claims submitted prior to receipt and processing of the HOS-1 form by the MassHealth Hospice unit will be denied for edit 2800 – Member not tied to hospice. 

HOS-1 forms must be completed fully and submitted separately for each member by faxing to MassHealth Hospice unit - 617-886-8402.

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

Messages from the Week of March 13, 2017

March 15, 2017

System Maintenance

To allow for system maintenance, the MMIS POSC, the internal MMIS application, and MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable on Sunday, March 19, 2017 from 4AM until 8AM.  MAP, CBHI and member and eligibility web services will also be impacted.

We apologize for any inconvenience this may cause.  Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.   EHS users with questions, please contact the EHS Customer Support Center at 617-994-5050 or email SystemsSupporthelpdesk@Massmail.state.ma.us

March 13, 2017

All Provider Bulletin 265: Changes to PCC Provider Online Service Center Referrals Process

MassHealth’s All Provider Bulletin 265, posted on Friday, March 3rd, outlines changes to the Primary Care Clinician (PCC) Provider Online Service Center (POSC) Referrals Process.  Section 6401(b) of the Affordable Care Act includes requirements related to ordering, referring, and prescribing (ORP) providers. If MassHealth requires a service to be ordered, referred, or prescribed, then ACA Section 6401(b) requires that 1. the billing provider include the ORP provider’s national provider identifier (NPI) on the claim; and 2. the ORP provider be enrolled with MassHealth as a fully participating individual provider or as a nonbilling individual provider.  Under these ordering, referring and prescribing requirements, claims for any service requiring a PCC referral must include the NPI of the individual referring provider in the referral loop of the electronic claim.

The PCC entity/service location is listed as the referring provider on a PCC referral.  As of March 27, 2017, CHCs, HLHCs, OPDs and group practices must 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. This will meet the ordering, referring and prescribing requirements which require the NPI of an individual referring practitioner to be on a claim submitted for the service referred by the PCC.  The POSC referral information panel has been updated so that a CHC, HLHC, OPD or group practice PCC entity/service location must choose an on-staff individual physician or nurse practitioner at the service location of the PCC entity. 

All Provider Bulletin 265 is available to download from the MassHealth web site. Go to http://www.mass.gov/masshealth and select "Provider Library" from the left panel. Click on "Provider Bulletins". Then click on “2017 Bulletins”. Then click on the bulletin to download.

If you have any questions, please contact MassHealth customer services at 1-800-841-2900 or e-mail providersupport@mahealth.net.

Messages from the Week of March 6, 2017

March 6, 2017

Technical Refresh – Important Message for All MassHealth Providers

MassHealth will initiate Phase II of its technical refresh activities in the spring, 2017.  Phase II of this initiative includes the replacement of MassHealth’s back-end HIPAA translator, which will affect the submission of all HIPAA transactions supported by MassHealth:

  • Health Care Benefit Inquiry and Response (270/271),
  • Health Care Claim Status Request and Response (276/277),
  • Health Care Premium Payment (820),
  • Health Care Benefit Enrollment and Maintenance (834),
  • Health Care Claim Payment/Advice (835),
  • Health Care Claim: Institutional (837I) and Professional (837P), and
  • HIPAA (999/TA1) Implementation Acknowledgment for Health Care Insurance.

MassHealth will provide additional information in the coming weeks, regarding the replacement of the HIPAA translator, changes to the submission of standard transactions, timelines, and the trading partner testing schedule.

If you have any questions regarding the technical refresh, please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net. When sending an email, please include your MassHealth Provider ID / Service Location (PIDSL) or your National Provider ID (NPI) number.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

ICD-10 Updates – Reprocessing of Medicare Crossover Claims

All ICD-10 updates were completed as of 01/30/2017.  MassHealth has reprocessed Medicare crossover claims which previously denied for ICD-10 related edits.  These claims will appear on future remittance advices.  If any provider disagrees with the final disposition of their claims please request a review with ICN through Customer Service.

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

Reprocessing of Inpatient Claims

As of 03/03/17, MassHealth has reprocessed 1209 inpatient claims which previously denied for limited edits between 10/01/15-09/30/16 due to the MMIS configuration issues.  For providers who took advantage of the off-line review process offered by MassHealth, it should be expected that denials for duplicate will occur, as those claims would have been paid by the date of this reprocessing.

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

Medicare Crossover Claims Billed for Medically Directed Anesthesia Services

 MassHealth has identified overpayments on Medicare crossover claims billed for medically directed anesthesia services adjudicated prior to 9/1/16.  These anesthesia services were billed with modifier QK, QX, or QY for medically directed services where the qualified non-physician anesthetist and the anesthesiologist are involved in a single anesthesia case. The MassHealth payment on these claims was incorrectly based on 100% of the MassHealth allowable amount instead of 50%.  MassHealth will adjust the affected Medicare Crossover claims with dates of service within 3 years.  These claims will appear on future remittance advices.

Medicare crossover claims adjudicated by MassHealth on or after 9/1/16 are correctly paying 50% of the MassHealth allowed amount for medically directed anesthesia services with modifier QK, QX, or QY.

Medically Directed Modifiers:

QK – Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals;
QX – CRNA service; with medical direction by a physician;
QY – Medical direction of one certified registered nurse anesthetist by an anesthesiologist;

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

Messages from the Week of February 27, 2017

February 27, 2017

Prior Authorization Change to Procedure Code L6880

REMINDER – Orthotics and Prosthetics providers be advised that effective 03/01/2017 the Prior Authorization requirement for procedure code L6880 will change from “Sometimes” to “Yes”. The change will be reflected on the updated Orthotics and Prosthetics Payment and Coverage Guidelines Tool.

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/provider-library/, click on “Provider Library” and then on “MassHealth Payment and Coverage Guideline Tools”.

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

Reminder:  Payment Error Rate Measurement (Perm) Audit

This is a reminder that MassHealth is part of the CMS PERM for FFY 2016 and we are still in the middle of the audit. New batches of Medical Records Request Letters are currently being sent out. We are requesting that providers provide their full name (first & last) and contact information to the auditors. MassHealth is requiring this important basic information in order to follow up with the correct contact person if needed. Providers will have 75 calendar days from the date of the request letter to submit the record. During this 75 calendar day period, reminder phone calls will be made and written requests will be sent to providers if the PERM team has not received the records. Please be sure to respond within the required timeframes and submit information for the correct patients and dates of service. Please make sure that the documents are readable and copy both sides of document when necessary. Please be sure that highlights or other markings do not obscure the medical records. Any “insufficient documentation” submissions will result in another request letter being sent to a particular provider, with 14 calendar days from the date of the request letter to submit the additional or corrected documentation. Thank you for your cooperation and support of this audit.

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

AVR – Important Message for all MassHealth Providers

MassHealth will sunset its antiquated Automated Voice Response (AVR) system this spring. The AVR, which is currently used by providers to check member eligibility, will no longer be available on or after June 4, 2017.  Providers are encouraged to utilize the Provider Online Service Center (POSC) direct data entry (DDE) or to submit the 270/271 Eligibility Inquiry and Response transaction to check member eligibility. 

If you have any questions regarding the sun-setting of the AVR, please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net.

Messages from the Week of February 13, 2017

February 13, 2017

ICD-10 Updates

All ICD-10 updates have been completed as of 01/30/2017.  MassHealth initiated a reprocessing for all affected claims on 01/31/2017.  You will have seen the denials from the reprocessing on the run for the week of 01/30/2017.  All those achieving a paid status shall go through the typical financial cycle which should allow providers to see them on their remits over the next few weeks.  If any provider disagrees with the final disposition of their claims please request a review with ICN through Customer Service.

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

Messages from the Week of February 6, 2017 

February 6, 2017

Reminder:  Prior Authorization Must Have Fee

Pharmacy, DME and Oxygen providers are reminded that when obtaining a Prior Authorization for any AAC+ procedure code(s) that requires manual pricing, the Prior Authorization MUST have a fee for the procedure code(s) that you are billing for. Without a fee on the Prior Authorization your claim(s) will be denied.

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

Pharmacy, DME and Oxygen Providers – Update to Requirements and Limits for Procedure Code A9276

Pharmacy, DME and Oxygen providers be advised: The Requirements & Limits for procedure code A9276 were changed from “1 unit = each, 4 per month. (1 unit per 7 days)” to “1 unit = each, Max 10 units per month based on the following manufacture:                                                  

  • Dexcom – 4 per month (1 last 7 days)
  • MiniMed – 10 per month (1 last 3 days)
  • Enlite – 5 per month (1 last 6 days)”

The MassHealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web.

To confirm that you are using the most recent version of the applicable Tool (V.29.5), go to http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. Click on “Provider Library” and then on “MassHealth Payment and Coverage Guideline Tool”.

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

Messages from the Week of January 30, 2017

January 30, 2017

Reprocessing of Medicare Part B Crossover Claims which Erroneously Denied for Edit 1002

MassHealth has identified Medicare Part B crossover claims adjudicated on or after 9/26/2016 which erroneously denied for edit 1002 DTL PERFORMING PROV NOT ELIG AT SERV LOC FOR PROG.  The affected Part B crossover claims, excluding claims billed by group practice providers, have been reprocessed and will appear on a subsequent remittance advice.  

Group practice providers are reminded to ensure that all individual practitioners comprising the group obtain an individual MassHealth provider number, and meet all the requirements of 130 CMR 450.212(A)(1) through (6).  Medicare Part B crossover claims billed by group practice providers adjudicated on or after 9/26/2016 will be denied for edit 1002 if the rendering provider is not eligible on the date of service.  

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

Pharmacy, DME and Oxygen Providers – Update to Requirements & Limits for Procedure Code A9276

Pharmacy, DME and Oxygen providers, please be advised: Effective 02/01/17, the Requirements & Limits for procedure code A9276 has been changed from “1 unit = each, 31 per month. (1 day supply)” to “1 unit = each, 1 per 7 days. (1 week supply)”.

The MassHealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web.

To confirm that you are using the most recent version of the applicable Tool (V.29.4), go to http://www.mass.gov/eohhs/gov/laws-regs/masshealth/.  Click on “Provider Library” and then on “MassHealth Payment and Coverage Guideline Tools”.

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

 

Messages from the Week of January 23, 2017

January 23, 2017

MassHealth COB Claims Billed with HIPAA Claim Adjustment Reason Code (CARC) 45 Equal to the Claim/Claim Detail Billed Amount – Update

MassHealth Providers were notified on October 17, 2016 that MassHealth had identified erroneously paid claims with adjudication dates from 05/29/2009 through 10/06/2016 containing a CARC “45- Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement” adjustment amount that is equal to the total claim/claim detail billed amount. 

The affected claims with dates of service on and after 2/22/2014 through adjudication date 10/6/2016 were reprocessed and will appear on this and future remittance advices.  All providers are reminded to reference The Overpayment Disclosure Process in All Provider Bulletin 256 to return overpayments for claims with dates of service prior to 2/22/2014.

Any claims submitted with a CARC 45 adjustment amount equal to the total claim/claim detail billed amount will deny appropriately for one of the following edits:

2592 - DETAIL/COMMERCIAL/DENY EDIT FROM TPL DENY TABLE
2593 - DETAIL/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE
2598 - HEADER/COMMERCIAL/DENY EDIT FROM THE TPL DENY TABLE
2599 - HEADER/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE

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

MassHealth Replaces Service Codes Related to Physical Therapy Evaluations and Occupational Therapy Evaluations for School-Based Medicaid Program

MassHealth notifies providers participating in the School-based Medicaid Program (Provider Type 89) that effective January 1, 2017, MassHealth has replaced certain Physical Therapy Evaluations and Occupational Therapy Evaluations codes pursuant to guidance released by the Centers for Medicare & Medicaid Services (CMS) and Section 1834(k)(5) of the Social Security Act.

For Physical Therapy Evaluations, service codes 97001-TM and 97001-TM-U1 have been retired and replaced with the following codes:

  • 97161-TM, Physical therapy evaluation, Low Complexity (related to an IEP) (20 min) (interim rate $20.86)
  • 97161-TM-U1, Physical therapy evaluation, Low Complexity, related to an IEP (20 min) (in private residential school) (interim rate $10.43)
  • 97162-TM, Physical therapy evaluation, Moderate Complexity (related to an IEP) (30 min) (interim rate $20.86)
  • 97162-TM-U1, Physical therapy evaluation, Moderate Complexity (related to an IEP) (30 min) (in private residential school) (interim rate $10.43)
  • 97163-TM, Physical therapy evaluation, High Complexity (related to an IEP) (45 min or more with a maximum of two hours) (interim rate $20.86)
  • 97163-TM-U1, Physical therapy evaluation, High Complexity (related to an IEP) (45 min or more with a maximum of two hours) (in private residential school) (interim rate $10.43)

For Occupational Therapy Evaluations, service codes 97003-TM and 97003-TM-U1 have been retired and replaced with the following codes:

  • 97165-TM, Occupational therapy evaluation, Low Complexity (related to an IEP) (30 min) (interim rate $20.86)
  • 97165-TM-U1, Occupational therapy evaluation, Low Complexity (related to an IEP) (30 min) (in private residential school) (interim rate $10.43)
  • 97166-TM, Occupational therapy evaluation, Moderate Complexity (related to an IEP) (45 min) (interim rate $20.86)
  • 97166-TM-U1, Occupational therapy evaluation, Moderate Complexity (related to an IEP) (45 min) (in private residential school) (interim rate $10.43)
  • 97167-TM, Occupational therapy evaluation, High Complexity (related to an IEP) (60 min or more with a maximum of two hours) (interim rate $20.86)
  • 97167-TM-U1, Occupational therapy evaluation, High Complexity (related to an IEP) (60 min or more with a maximum of two hours) (in private residential school) (interim rate $10.43)

Effective for dates of service on and after January 1, 2017, providers must select the appropriate code and modifier(s) from the list above, and submit claims using the new code and modifier(s).

The affected claims with dates of service on and after 01/01/2017 with the retired codes must be resubmitted using the appropriate new codes within 90 days of the original date of service.  The 90-day timely filing requirement continues to apply to all  claims.

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

Messages from the Week of January 2, 2017

January 3, 2017

To Physical and Occupational Therapy Providers

Service codes 97001 – 97004 (Physical Therapy Evaluation and Re-Evaluation and Occupational Therapy Evaluation and Re-Evaluation) will be retired as of 12/31/2016.  The new evaluation codes are based on patient complexity and the level of clinical decision-making – low, moderate and high complexity.

As of January 1, 2017 providers are asked to use the following codes on their claims:

97001 (Physical Therapy Evaluation) will be replaced with:
97161: PT Eval Low Complex 20 minutes
97162: PT Eval Mod Complex 30 minutes
97163: PT Eval High Complex 45 minutes

97002 (Physical Therapy Re-Evaluation) will be replaced with:
97164: PT Re-Eval Est Plan Care

97003 (Occupational Therapy Evaluation) will be replaced with:
97165: OT Eval Low Complex 30 minutes
97166: OT Eval Mod Complex 45 minutes
97167: OT Eval High Complex 60 minutes

97004 (Occupational Therapy Re-Evaluation) will be replaced with:
97168: OT Re-Eval Est Plan Care

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

Reminder to All Providers: Keep Your Profile Information Up-to-Date

All providers are reminded that in accordance with MassHealth regulation 130 CMR 450.223(B), you must notify MassHealth in writing within 14 days of any changes in your enrollment information, such as changes in address, phone number, email address, updated licenses, group linkages or changes in ownership or control (for example, changes in directors board members). Failure to notify MassHealth constitutes a breach of your provider contract and may result in termination of your contract or other sanctions.

This is especially important as MassHealth continues the federally mandated Revalidation initiative.  Please make sure that when MassHealth notifies you/your entity that it is time to revalidate that you are able to access your provider profile through the POSC (Provider Online Service Center) and your profile is up-to-date.  To submit changes through the POSC, 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 9162, Canton MA 02021.

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

MassHealth Implements APEC Payment Methodology for Acute Outpatient Hospitals

MassHealth replaced the Payment Amount per Episode (PAPE) with the Adjudicated Payment per Episode (APEC) payment methodology for acute outpatient hospitals and hospital licensed health centers on December 30, 2016.  All relevant services with dates of service on or after December 30, 2016 will adjudicate using the new APEC methodology in place of PAPE. ATP and MAXFEE services are not impacted.

If you experience any issues with transitioning to the new APEC payment methodology please contact MassHealth Customer Service at 1-800-841-2900 or by email at providersupport@mahealth.net.

MassHealth COB Claims Billed with HIPAA Claim Adjustment Reason Code (CARC) 45 Equal to the Claim/Claim Detail Billed Amount

MassHealth Providers were notified on October 17, 2016 that MassHealth had identified erroneously paid claims with adjudication dates from 05/29/2009 through 10/06/2016 containing a CARC “45- Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement” adjustment amount that is equal to the total claim/claim detail billed amount.  The affected claims were reprocessed and will appear on this and future remittance advices.

Any claims submitted with a CARC 45 adjustment amount equal to the total claim/claim detail billed amount will deny appropriately for one of the following edits:

2592 - DETAIL/COMMERCIAL/DENY EDIT FROM TPL DENY TABLE
2593 - DETAIL/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE
2598 - HEADER/COMMERCIAL/DENY EDIT FROM THE TPL DENY TABLE
2599 - HEADER/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE

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

Messages from the Week of December 19, 2016

December 19, 2016

Important Message For Acute Outpatient Hospitals – Reminder

MassHealth will replace the Payment Amount per Episode (PAPE) with the Adjudicated Payment per Episode (APEC) payment methodology for acute outpatient hospitals on December 30, 2016.  All PAPE services will adjudicate using the new APEC methodology in place of PAPE on or after this date. ATP and MAXFEE services are not impacted.

Many providers have been actively participating in trading partner testing with the MassHealth EDI Testing Team. Testing will officially end on December 16, 2016.

Please contact the MassHealth Customer Service Center at 800-841-2900 or EDI@MAHealth.net with any questions.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

Messages from the Week of December 5, 2016

December 5, 2016

Bulletin Updates

It is important for Orthotics and Prosthetics providers to review the newly released Orthotics Bulletin 6 and Prosthetics Bulletin 10 when billing for services provided to MassHealth members who have Medicare and MassHealth. Members who have Medicare and MassHealth are known as Dual Eligibles. Federal and state requirements provide that MassHealth is the payer of last resort for any MassHealth member with other insurance, including Dual Eligibles. 

If you have any questions regarding this change, please contact MassHealth Customer Service 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/OXY Payment and Coverage Guideline 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 www.mass.gov/masshealth/pubs, click on “Provider Library” and then click on “MassHealth Payment and Coverage Guideline Tool”.

The following procedure codes have been updated in the tool:

  • DME and Oxygen Providers - Effective 12/01/16 Procedure Codes E2609, E2610 and K0005 now require a Prior Authorization. Procedure Code E0617 (External Defibrillator) is now active and has been added to the DME/OXY Guideline TOOL.
  • Pharmacy, DME and Oxygen providers - Procedure codes E2609, E2610 and K0005 have been changed from a “Sometime” Prior Authorization to a “Yes” Prior Authorization.

It is important for DME and Oxygen providers to review the newly released DME Bulletin 19 and Oxygen Bulletin 15 when billing for services provided to MassHealth members who have Medicare and MassHealth. Members who have Medicare and MassHealth are known as Dual Eligibles. Federal and state requirements provide that MassHealth is the payer of last resort for any MassHealth member with other insurance, including Dual Eligibles. 

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

Independent Clinic/Center Application Redesign

As part of our continuing efforts to improve service to our provider community, MassHealth is redesigning its provider enrollment forms. A new provider enrollment application for Independent Clinics and Centers will be introduced on 1/01/2017.

The Provider Application for Independent Clinic/Center (PE-ICC) will replace the MassHealth Provider Application for Clinics (CLA-001).

With the implementation of the new Provider Application for Independent Clinic/Center, the National Provider Identifier (NPI) Supplement Form is no longer required.  PLEASE DESTROY ANY COPIES OF THE OLD APPLICATIONS. We will not accept the old applications beginning 3/01/2017.  If any outdated applications are received after that date they will be rejected and applicants will be required to reapply using form PE-ICC. You can request the application from the MassHealth Customer Service Center by e-mail at providersupport@mahealth.net or by phone at 1-800-841-2900.

Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374

MassHealth is aware of an issue affecting Medicare crossover claims for dual eligible members (MassHealth and Medicare coverage) who were enrolled in a MassHealth CarePlus benefit plan.

MassHealth reviewed the benefit plan information for these members and made revisions when applicable.  The affected crossovers claims were reprocessed and will appear on this and future remittance advices.  Any reprocessed claims that have denied again for Edit 4371 - Benefit plan claim type restriction on procedure and/or Edit 4374 - Benefit plan claim type restriction on revenue code are adjudicated correctly according to the member benefit plan. 

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

All Provider Bulletins Posted to the MassHealth Web Site

On November 30, 2016, MassHealth posted a provider bulletin to the MassHealth web site regarding the Accountable Care Organizations (ACO) pilot. All Provider Bulletin 262 was posted and is available to download from the MassHealth web site. To access these bulletins, go to http://www.mass.gov/masshealth and select "Provider Library" from the left panel. Click on "Provider Bulletins". Then click on “2016 Bulletins”. Then click on the bulletin to download.

If you have any questions, please contact MassHealth customer services at 1-800-841-2900 or e-mail providersupport@mahealth.net.

Important Message for Acute Outpatient Hospitals — Updated Dates

MassHealth will replace the Payment Amount per Episode (PAPE) with the Adjudicated Payment per Episode (APEC) payment methodology for acute outpatient hospitals on December 30, 2016; this is a postponement from December 1, 2016.  All PAPE services will adjudicate using the new APEC methodology in place of PAPE on or after this date. ATP and MAXFEE services are not impacted.                        

Many providers have been actively participating in trading partner testing with the MassHealth EDI Testing Team. Testing will officially end on December 16, 2016. With testing results, if you have not heard from the MassHealth EDI Testing team, please send an email to EDI@MAHealth.net. If you have questions about your testing results, please send an email to EDI@MAHealth.net and include the claim numbers (ICNs).  Claim numbers are very important for facilitating substantive responses.

Please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net with any questions, or to request testing instructions. When sending an email, please include your MassHealth Provider ID/Service Location (PID/SL) or your National Provider ID (NPI) number.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

Early Intervention Claims Reprocessing Due to Rate Change

Please be advised this remittance advice contains claims that MassHealth reprocessed or adjusted due to the recent Early Intervention rate update. This reprocessing includes Specialty Services claims that were previously denied for edits 1012, 2017, 2614 and timely filing edits: 850 and 851. The adjustments include Specialty Services claims that may have paid incorrectly prior to the rate updates for Early Intervention codes.

In addition, to ease the financial burden for providers, MassHealth will be releasing payment on paid claims earlier than usual for this upcoming financial cycle. Providers should see this reflected in payment dated December 9th, 2016. Please note the early payment of all claims will cause providers to not have payments for a few subsequent remittance advices.

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

Messages from the Week of November 28, 2016

November 28, 2016

Billing Tips for Early Intervention Specialty Code Changes

Effective March 1, 2016, procedure code H2019 SE is no longer valid. Specialty service claims with dates of service March 1, 2016 and later that were previously paid by MassHealth must be billed with the new codes (H2012 U2, H2019 U2, H0031 U2, and H0032 U2). These claims must be adjusted by providers to reflect the correct new code(s).

Providers can immediately begin to adjust these claims.

This message is to aid providers in adjusting early intervention specialty claims previously paid under procedure code H2019 SE with dates of service March 1, 2016 or later.

Replacing a Claim in a Paid Status, with a Change to the Service Code

  • Please use the original ICN (Internal Control Number) for the claim that is being replaced
  • Prepare a replacement claim using your electronic software (837P) or DDE with appropriate lines from the original claim     
    • For 837P electronic claims, this transaction is referred to as void and replace functionality
    • For DDE (Direct Data Entry) through POSC (Provider Online Service Center), this process will take place though the adjustment process (please use the “Replace” button on the Claims Inquiry panel)
  • Delete the line(s) that contain procedure code H2019 SE only
  • Add additional line(s) with the new code and applicable modifier

Note: Do not subtract the original payment from the billed amount, and do not enter it in the “other paid amount”; the processing system will perform the necessary calculation. 

Reminder, adjustments must take place prior to the 12 month final submission deadline. For example, March 1, 2016 must be adjusted prior to March 1, 2017.

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

To Nursing Facility Providers

EOHHS will be offering three Nursing Facility Direct Care Add-On Compliance Training Sessions. See below for dates, times, and links to register. Please only register for one training session as the same content will be presented at each session. Due to capacity limits all interested parties must pre-register. 

MassHealth Nursing Facility Direct Care Add-On Compliance Training Sessions:

Thursday, December 1, 2016
2:00pm to 4:00pm
1 Ashburton Place
Boston, MA 02108
21st Floor, Rooms 2-3
Register for the Dec 1 session here: https://form.jotform.com/DCStraining/nf-direct-care-add-on-training-dec1

Wednesday, December 7, 2016
10:00am to 12:00pm
UMass Medical School - Shrewsbury campus
333 South St
Shrewsbury, MA 01545
Amphitheater
Register for the Dec 7 session here: https://form.jotform.com/DCStraining/nf-direct-care-add-on-training-dec7

Friday, December 9, 2016
2:00pm to 4:00pm
The Tower Center at UMass Center at Springfield
1500 Main Street
Springfield, MA 01115
Classroom 014
Register for the Dec 9 session here: https://form.jotform.com/DCStraining/nf-direct-care-add-on-training-dec9

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

Messages from the Week of November 7, 2016

November 7, 2016

Group Practice Crossover Claims with Ineligible Performing Provider

MassHealth has identified crossover claims submitted by group practice providers which erroneously paid when the performing provider was not eligible on the date of service.  The affected Part B crossover claims will be adjusted and subsequently denied for edit 1002 DTL PERFORMING PROV NOT ELIG AT SERV LOC FOR PROG.  Part B crossover claims adjudicated on or after 9/26/2016 will be denied for edit 1002 if the rendering provider is not eligible on the date of service. 

Group practice providers are reminded to ensure that all individual practitioners comprising the group obtain an individual MassHealth provider number, and meet all the requirements of 130 CMR 450.212(A)(1) through (6).  Providers were previously reminded of these requirements in remittance messages dated in December 26, 2012 and August 16, 2013.   

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

Messages from the Week of October 31, 2016

October 31, 2016

Signatures for Authorization of Transportation Services

Please note that the MassHealth PT-1 form is used to authorize transportation, including sedans and wheelchair vans, for MassHealth members provided through transportation brokers.  The Medical Necessity Form (MNF) is used to document the medical necessity of nonemergency ambulance transportation provided to MassHealth members and nonemergency wheelchair van transportation provided to MassHealth members who reside in institutional settings, who reside in the community and need mobility assistance from transportation provider personnel to exit their residences or to move from their residences to the vehicle, and, in certain circumstances, who are being discharged from inpatient psychiatric hospitals to community-based behavioral health programs.  In all other cases, transportation must be provided through a transportation broker and authorized using a PT-1 form.

MassHealth wishes to emphasize that your signature on these forms serves as an attestation that the transportation being requested is medically necessary and that the request conforms to all applicable MassHealth transportation regulations.  Incomplete forms will not be approved.

MassHealth transportation regulations are found at 130 CMR 407.000.

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

Important Message for Acute Outpatient Hospitals and Hospital Licensed Health Centers – Trading Partner Testing Dates Reminder

Effective for dates of service on or after December 1, 2016, MassHealth is replacing the Payment Amount per Episode (PAPE) payment methodology for acute outpatient hospitals and hospital licensed health centers with the new Adjudicated Payment per Episode of Care (APEC) payment methodology, and all services that are currently paid the PAPE will instead adjudicate using the new APEC methodology.  ATP and MAXFEE services are not impacted.

MassHealth strongly encourages you to participate in trading partner testing, if you haven’t already. MassHealth will accept test files until November 15, 2016. Testing will officially end on November 25, 2016.

The MassHealth EDI Testing Team has outreached to impacted trading partners to help prepare for testing. The EDI Testing Team will assist you throughout the entire testing process. If you have not heard from the MassHealth EDI Testing team, please send an email to EDI@MAHealth.net.

Please contact the MassHealth Customer Service Center at 800-841-2900 or EDI@MAHealth.net with any questions, or to request testing instructions. When sending an email, please include your MassHealth Provider ID / Service Location (PIDSL) or your National Provider ID (NPI) number.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

MassHealth Implements New Connectivity Method Option - Update

MassHealth implemented the Multipurpose Internet Mail Extensions (MIME) version of its new Connectivity Method on September 30, 2016.  This completes MassHealth’s transition to its new Connectivity Method.  Both of the MIME and Simple Object Access Protocol (SOAP) connectivity options are available for use.

The MassHealth Connectivity Method provides a secure, system-to-system connection to MassHealth for sending and receiving the following HIPAA transactions: 270/271, 276/277, 835, 837I, 837P, 820, 834, 999/TA1. Real-time and batch processing are available for these web services.

Providers are not required to adopt the new MassHealth Connectivity Method.  However, MassHealth encourages providers to adopt the new method, if, and when it is feasible.

If you would like a MassHealth Connectivity Companion Guide or have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net.

For additional information about the New Connectivity Method, such as FAQs, please go to the Web Page: http://tinyurl.com/zmf8ph2.

Messages from the Week of October 24, 2016

October 24, 2016

To Home Health Agency Providers

There will be two Home Health Provider Outreach Forums offered in November:

Friday, November 4, 2016
1:00 to 2:30pm
UMass Shrewsbury Campus
333 South St
Shrewsbury, MA 01545
Amphitheater
Capacity 100

Register for the Shrewsbury session here: https://form.jotform.com/62854197653164

Thursday, November 10, 2016
1:00 to 2:30pm
Lawrence Public Library
51 Lawrence Street 
Lawrence, MA 01841
Sargent Auditorium
Capacity 150

Register for the Lawrence session here: https://form.jotform.com/62854063858163

During the 90 minute open forum, MassHealth will discuss topics including MassHealth Regulations, Provider On-line Service Center (POSC), Prior Authorization, and Required Documentation.

Space is limited.  Please register early!

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

Early Intervention Specialty Rate Update

In accordance with 101 CMR 349.00: RATES FOR EARLY INTERVENTION PROGRAM SERVICES, MassHealth wants to inform providers that MMIS is now updated with the appropriate rates for the new ABA codes (H2019 U2, H2012 U2, H0031 U2, and H0032 U2). The update also includes appropriate rates for 3/1/2016 and the recent 10/1/2016 dates of services rates. Providers who need to reference the rates should refer to the rates for Specialty Services, which are governed by 101 CMR 358.00, Rates of Payment for Applied Behavior Analysis (www.mass.gov/eohhs/docs/eohhs/eohhs-regs/101-cmr-358.pdf)

As a reminder, effective immediately, all claims submitted with service code H2019 with modifier SE for dates of service 3/1/2016 and later will be denied.

MassHealth is working to reprocess the claims that were submitted with the new ABA codes with the following denial edits:

  • EDIT 2614 – MNG-CARE SERV SHOULD BE PAID BY MASSHLTH BHVL HLTH
  • EDIT 1012 – RENDERING PROV SPECLTY NOT ELIG TO RENDER PROCEDURE
  • EDIT 2017 – MEMBER SERVICES COVERED BY MCO PLAN - NON SCO/PACE

Information regarding the reprocess of the denials and timely filing process will be forthcoming.

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

Messages from the Week of October 17, 2016

October 17, 2016

MassHealth COB Claims Billed with HIPAA Claim Adjustment Reason Code (CARC) 45 Equal to the Claim/Claim Detail Billed Amount

Providers are reminded that claims containing Coordination of Benefits (COB) information must be submitted to MassHealth with valid HIPAA Claim Adjustment Reason Codes (CARCs) as reported on the other insurers’ explanation of benefits (EOB). MassHealth has identified some erroneously paid claims with adjudication dates from 05/29/2009 through 10/06/2016 containing a CARC “45- Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement” adjustment amount that is equal to the total claim/claim detail billed amount. 

MassHealth is not liable for payment of claims containing a CARC 45 adjustment amount that is equal to the total claim/claim detail billed amount. Beginning 10/07/2016, claims submitted with a CARC 45 adjustment amount equal to the total claim/claim detail billed amount will deny for one of the following edits:

2592 - DETAIL/COMMERCIAL/DENY EDIT FROM TPL DENY TABLE
2593 - DETAIL/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE
2598 - HEADER/COMMERCIAL/DENY EDIT FROM THE TPL DENY TABL
2599 - HEADER/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE

Claims that were erroneously paid by MassHealth will be adjusted on future remittance advices.

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

Inpatient Hospital Claims

For Acute Inpatient claims which have been voided by MassHealth in an effort to receive a full admit through discharge TOB 111 and the claim will now contain dates of service over a year from the date of submission; once the final deadline exceeded denial is received please appeal through the Final deadline appeal process with a delay reason code of 9 as outlined in All Provider Bulletin 221, December 2011.  Please also include a cover letter explaining that the claim was submitted over the year as result of the Acute Hospital process which voids claims and then requires a TOB 111 to capture the entire stay on a single episode.

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

Update – Issue Resolved: Members Auto-Enrolled in MCO’S

Please note that the issue of members with active long term care segments being auto-enrolled into a Managed Care Organization has been resolved. Affected claims have been reprocessed. If you have a claim that was erroneously denied and has not been reprocessed, please resubmit the claim.

Please contact the MassHealth Customer Service Center at 1 (800) 841-2900 or providersupport@mahealth.net with any questions or concerns.

Personal Care Management (PCM) Agencies—Additional Add-On Code for Consumer Overtime Management Support

REVISED

Administrative Bulletin 16-17, recently issued by MassHealth, provides a code update to 101 CMR 309.00: Independent Living Services for the Personal Care Attendant Program effective October 1, 2016. The code-modifier T1023 – TU is being added for PCM agencies to bill for the provision of skills training services for management of PCA overtime hours during the phase-in of the new regulatory requirements regarding the scheduling and utilization of PCA overtime pursuant to 130 CMR 422.00: Personal Care Services. The overtime management skills training activities associated with T1023 – TU are outlined in Sections 2.2.E.2.h.8 a-e of the PCM contract, added by amendment. PCM agencies may bill this code in addition to the monthly billing of T2022 for the member.

PCM agencies may only bill T1023 – TU for consumers identified on the Fiscal Intermediary overtime utilization report to whom the PCM agencies provided overtime management functional skills training in accordance with Sections 2.2.E.2.h.8 a-e of the PCM agency contract. PCM agencies may only bill T1023 – TU for the months of October, November, and December 2016.  PCM agencies should use the last day of the month or the last eligible PCA program day of the member, whichever is later, as the date of service on the claims for these members.

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

Messages from the Week of October 3, 2016

October 3, 2016

Detailed Claims Review

MassHealth will be conducting detailed claims reviews effective 10/01/2016 for Durable Medical Equipment (DME), Oxygen and Respiratory Equipment, and Pharmacy providers with a DME specialty.  MassHealth will notify providers if follow-up documentation is required. Documentation must be sent via fax within 15 days of the request. The notice will specify the fax number to be used.

In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, effective April 14, 2003, all Protected Health Information (PHI) regarding members will be kept confidential.

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

ICD-CM and PCS Updates

MassHealth is in the process of reviewing and implementing the ICD-10 code updates published by CMS for 10/1/16.  Please bill as appropriate. If you receive a denial for a valid ICD code, MassHealth will systematically reprocess your claims once all of the ICD-10 codes are completely implemented.

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

Messages from the Week of September 26, 2016

September 26, 2016

Timely Filing Regulations for Claims with Other Health Insurance

Providers are reminded to adhere to the timely filing regulations when submitting claims for members with other health insurance (refer to 130 CMR 450.313). All claims submitted with other health insurance (Medicare and commercial insurance) adjudication information must be received within 90 days of the date of the insurer’s explanation of benefits.  Claims exceeding this requirement will be denied for edits 850 BILLING DEADLINE EXCEEDED DETAIL or 852 BILLING DEADLINE EXCEEDED HEADER.

If MassHealth denies the initial timely filed claim, providers may resubmit the corrected claim up to 18 months from the date of service of the claim. Claims exceeding this requirement will be denied for edit 853 FINAL DEADLINE EXCEEDED DETAIL or 855 FINAL DEADLINE EXCEEDED HEADER.   Claims denied for these edits may be appealed if ALL of the appeal criteria are met.  Please reference All Provider Regulations 130 CMR 450.323. 

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

To Home Health Agency Providers

MassHealth invites all Home Health Agency providers to an informative webinar on Wednesday, October 19, 2016 from 1:00 PM–2:30 PM. 

This webinar will be conducted by the Third Party Appeals (TPA) Unit leaders and will review: 

  • Overview/updates to the Third Party Appeal initiative
  • Semi-annual demand bill notification letters and requirements
  • Homebound assessment form submissions/outcomes

To join the webinar on Wednesday, October 19, from 1:00 PM – 2:30 PM please visit: 

Audio Login
Conference Line Phone Number: 508-856-8222
Access Code: 8979

Web Login
Meeting URL:  http://onlinetraining.umassmed.edu/matplhomehealth/

If you have never attended an Adobe Connect meeting before:
Test your connection: http://tinyurl.com/j5fxr8y
Get a quick overview: http://tinyurl.com/77rzqod     
Adobe, the Adobe logo, Acrobat and Adobe Connect are either registered trademarks or trademarks of Adobe Systems Incorporated in the United States and/or other countries.

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

Important Message for Acute Outpatient Hospitals and Hospital Licensed Health Centers – Updated Trading Partner Testing Dates

Effective for dates of service on or after December 1, 2016, MassHealth is replacing the Payment Amount per Episode (PAPE) payment methodology for acute outpatient hospitals and hospital licensed health centers with the new Adjudicated Payment per Episode of Care (APEC) payment methodology, and all services that are currently paid the PAPE will instead adjudicate using the new APEC methodology.  ATP and MAXFEE services are not impacted.

MassHealth encourages you to participate in trading partner testing. MassHealth will accept test files on or after October 3, 2016 until November 15, 2016. Testing will officially end on November 25, 2016.

The MassHealth EDI Testing Team began outreaches to help you prepare for testing. The EDI Testing Team will assist you throughout the entire testing process. If you have not heard from the MassHealth EDI Testing team, please send an email to EDI@MAHealth.net.

Please contact the MassHealth Customer Service Center at 800-841-2900 or EDI@MAHealth.net with any questions, or to request testing instructions. When sending an email, please include your MassHealth Provider ID / Service Location (PIDSL) or your National Provider ID (NPI) number.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

Messages from the Week of September 19, 2016

September 19, 2016

Attention PCC Providers – Referral Change Reminder

This is a reminder that beginning with dates of service on and after October 1, 2016 PCC providers will have to issue referrals for members obtaining the following services: Chiropractic, Hearing Instrument Specialist, Orthotic and Prosthetic Services and Imaging Services conducted at an Independent Diagnostic Testing Facility and Medical Nutrition Therapy/Diabetes Nutrition Management Training. If you have any questions please refer to All Provider Bulletin 260 for more information. You may also contact MassHealth Customer Service Center by e-mail at providersupport@mahealth.net, by fax at 617-988-8974, or by phone at 1-800-841-2900.

PCC Referral Change Reminder

Please remember that beginning with dates of service October 1, 2016 members enrolled in the PCC Plan must have referrals for the following: Chiropractic, Hearing Instrument Specialist, Orthotic and Prosthetic Services and Imaging Services conducted at an Independent Diagnostic Testing Facility and Medical Nutrition Therapy/Diabetes Nutrition Management Training. If you do not have referral for these services, MassHealth will deny the claim. If you have any questions please refer to All Provider Bulletin 260 for more information. You may also contact MassHealth Customer Service Center by e-mail at providersupport@mahealth.net, by fax at 617-988-8974, or by phone at 1-800-841-2900.

Early Intervention Specialty Rate Update

Providers should no longer be billing claims using previous service code H2019 SE.

MassHealth understands that providers submitting the new ABA codes (H2019 U2, H2012 U2, H0031 U2, and H0032 U2) are receiving the denials with the following edits:

  • EDIT 2614 – MANAGED CARE SERVICE SHOULD BE PAID BY RMC
  • EDIT 1012 – RENDERING PROV SPECLTY NOT ELIG TO RENDER PROCEDURE

MassHealth is working to resolve these issues as quickly as possible. Communication regarding when providers should start billing the new ABA codes and guidelines will be forthcoming.

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

Messages from the Week of September 12, 2016

September 15, 2016

System Maintenance

To allow for system maintenance, the MMIS POSC, the internal MMIS application, and MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable on Sunday, September 18th from 12:00 Midnight until 8AM. MAP, CBHI and member and eligibility web services will also be impacted.

We apologize for any inconvenience this may cause.  Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.   EHS users with questions, please contact the EHS Customer Support Center at 617-994-5050 or email SystemsSupporthelpdesk@Massmail.state.ma.us

September 12, 2016

Massachusetts Prescription Awareness Tool (MASSPAT) Now Available

As of August 22, 2016, the Department of Public Health's (DPH's) new Prescription Monitoring Program (PMP) is available to conduct patient prescription data searches.

The MASSPAT has replaced the former MA Online PMP on the Virtual Gateway (VG), and allows licensed prescribers or pharmacists to view the prescription history of a patient for the past year more efficiently.

Providers can now register for and use MASSPAT to conduct patient searches at https://massachusetts.pmpaware.net/login. For additional information please refer to the registration flyer for instructions at http://www.mass.gov/eohhs/docs/dph/quality/drugcontrol/pmp/pharmacy-flyer.pdf  and the PMP website at http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/drug-control/pmp/ for other resources including system tutorials and upcoming webinar dates.

Providers with further questions should contact the PMP helpdesk (available 24/7) at 855-562-4767.

All Provider Bulletins Posted to MassHealth Web Site

On September 2, 2016, MassHealth posted two provider bulletins to the MassHealth web site regarding changes to Primary Care Clinician (PCC) referrals and Managed Care fixed enrollment. All Provider Bulletin 260 and All Provider Bulletin 261 were posted and are available to download from the MassHealth web site. To access these bulletins, go to http://www.mass.gov/masshealth and select "Provider Library" from the left panel. Click on "Provider Bulletins". Then click on “2016 Bulletins”. Then click on each bulletin to download.

If you have any questions, please contact MassHealth customer services at 1-800-841-2900 or e-mail providersupport@mahealth.net.

Messages from the Week of September 5, 2016

September 6, 2016

Important Message for Acute Outpatient Hospitals

MassHealth will replace the Payment Amount per Episode (PAPE) with the Adjudicated Payment per Episode (APEC) payment methodology for acute outpatient hospitals on December 1, 2016. All PAPE services with dates of service on or after this date will adjudicate using the new methodology. ATP and MAXFEE services are not impacted.

MassHealth completed Pilot testing during August 2016 and strongly encourages you to participate in trading partner testing beginning on September 6, 2016 through the end of October 2016.

The MassHealth EDI Testing Team will outreach to you beginning on September 6, 2016 to help you prepare for testing. A variety of test cases are recommended including original claims, adjustments, resubmissions, TPL claims and Medicare crossover claims. The EDI Testing Team will assist you throughout the entire testing process.

Please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net with any questions, or to request testing instructions. When sending an email, please include your MassHealth Provider ID / Service Location (PIDSL) or your National Provider ID (NPI) number.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

To Home Health Agency Providers

The next Home Health Provider Outreach Forum will be:

Friday September 30, 2016
12:30 pm - 2:00 pm
UMass Medical School – Shrewsbury campus
333 South Street
Shrewsbury, MA 01545
Amphitheater
Capacity 100

Register for September HH Outreach Forum here: https://form.jotform.com/DCStraining/hh-provider-outreach-forum-septembe

During the 90 minute open forum, MassHealth will discuss topics including MassHealth Regulations, Provider On-line Service Center (POSC), Prior Authorization, and Required Documentation.

Space is limited.  Please register early!

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

MassHealth Implements New Connectivity Method Option

MassHealth implemented its new Connectivity Method on August 22, 2016.

The MassHealth Connectivity Method provides a secure, system-to-system connection to MassHealth for sending and receiving the following HIPAA transactions: 270/271, 276/277, 835, 837I, 837P, 820, 834, 999/TA1. Both real-time and batch processing are available for these web services. MassHealth implemented the Simple Object Access Protocol (SOAP) option for the new Connectivity Method on August 22, 2016, and is soliciting trading partners to participate in Beta testing the Multipurpose Internet Mail Extensions (MIME) connectivity option. MIME Beta testing will end on September 30, 2016. Providers are not required to adopt the new MassHealth Connectivity Method.  However, MassHealth encourages providers to adopt the new method, if, and when it is feasible.

If you are interested in Beta testing the MIME option or submitting transactions to MassHealth via the new Connectivity Method, or would like a MassHealth Connectivity Companion Guide, please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net. The EDI team will assist you throughout the entire implementation process.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

For additional information about the New Connectivity Method, such as FAQs, please go to the Web Page: http://tinyurl.com/zmf8ph2

Messages from the Week of August 29, 2016

September 1, 2016

Issue Being Resolved: Members Auto-Enrolled in MCO’s

Please note that some Long Term Care facilities are experiencing an issue of members with active long term care segments being auto-enrolled into a Managed Care Organization.  MassHealth is actively researching this issue in order to resolve it as quickly as possible.  Providers should contact the MassHealth Customer Service Center at 1 (800) 841-2900 with any questions or concerns.

August 29, 2016

REVISED

MassHealth Updates the CARC’s & RARC’s List Effective September 10, 2016

MassHealth has completed its review of the June 2016 CORE Code Combination Claim Adjustment Reason Codes and Remittance Advice Remark Codes (CARCs & RARCs) updates and has modified MMIS to adopt these changes effective September 10, 2016. Please review the updated CARCs & RARCs list found at http://tinyurl.com/zpvsj7b. Providers should review the online list for the most up-to-date EOB code combinations.

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

Messages from the Week of August 22, 2016

August 22, 2016

MassHealth Implements New Connectivity Method Option

MassHealth will implement its new Connectivity Method on August 22, 2016. The MassHealth Connectivity Method provides a secure, system-to-system connection to MassHealth for sending and receiving the following HIPAA transactions: 270/271, 276/277, 835, 837I, 837P, 820, 834, 999/TA1. Both real-time and batch processing are available for these web services.   It supports both the Simple Object Access Protocol (SOAP) and Multipurpose Internet Mail Extensions (MIME) connectivity options.

The MassHealth Connectivity Method is an automated process and is ideal for providers that transmit a large volume of HIPAA transactions.  It does not replace the existing Healthcare Transaction Services (HTS) submission method. Providers are not required to adopt the new MassHealth Connectivity Method.  However, MassHealth encourages providers to adopt the new method if and when it’s feasible.

If you or your vendor (billing intermediary/clearinghouse) is interested in submitting transactions to MassHealth via the new Connectivity Method, or would like a MassHealth Connectivity Companion Guide, please contact the MassHealth Customer Service Center at 1-800-841-2900 or EDI@MAHealth.net. The EDI team will assist you throughout the entire implementation process.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

For additional information about the New Connectivity Method, such as an FAQs, please go to the Web Page: http://tinyurl.com/zmf8ph2.

Ordering, referring and Prescribing Initiative Update

The Ordering, Referring and Prescribing (ORP) Initiative is still ongoing.  Once implementing regulations for ORP are promulgated, impacted provider types will be required to apply to enroll with Mass Health, at least as nonbilling providers, in order to obtain or maintain state licensure.  We encourage impacted providers to enroll as soon as possible.  Note that MassHealth is delaying the promulgation of the ORP regulations to align with the promulgation of additional enrollment related regulations, which are still in process. This will avoid duplicate administrative efforts of providers submitting multiple enrollment applications.

If applicable, please submit a MassHealth nonbilling application and contract.  More information, including the impacted provider types and the nonbilling application and contract, can be found on the MassHealth website at the following link: http://tinyurl.com/jjp7v6a

If you have further questions please contact MassHealth Customer Service Center by e-mail at providersupport@mahealth.net, by fax at 617-988-8974, or by phone at 1-800-841-2900.

Messages from the Week of August 15, 2016

August 15, 2016

Payment Error Rate Measurement (PERM) Program Audit

The Payment Error Rate Measurement (PERM) program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002. MassHealth is part of the CMS PERM for FFY 2016. The audit will request copies of medical record for the current PERM Cycle, which begins in October 2015 of the federal fiscal year in review and continues towards the end of the following year in September 2016 (e.g., October 2015 through September 2016). Providers will have 75 calendar days from the date of the request letter to submit the record. During this 75 calendar day period, reminder phone calls will be made and written requests will be sent to providers if the PERM team has not received the records. Please be sure to respond within the required timeframes and submit information for the correct patients and dates of service. Please make sure that the documents are readable and copy both sides of document when necessary. Please be sure that highlights or other markings do not obscure the medical records. Any “insufficient documentation” submissions will result in another request letter being sent to a particular provider, with 14 calendar days from the date of the request letter to submit the additional or corrected documentation. Thank you for your cooperation and support of this audit.

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

Personal Care Management (PCM) Agencies and Fiscal Intermediaries (FI) – MassHealth Personal Care Attendant (PCA) Program Overtime Management Policy

Effective September 1, 2016, a new MassHealth PCA overtime management policy will be implemented for the PCA program. In accordance with MassHealth Regulations (130 CMR 422.418), MassHealth Members are limited to scheduling PCAs to work no more than 40 hours per week.  If a Member requires a PCA to work more than 40 hours per week, the consumer/surrogate must fill out a Non-Emergency Overtime Approval Request form and the Personal Care Management (PCM) Agency must submit the form to MassHealth to obtain approval for non-emergency overtime payment, under the following circumstances:  1) the Member has 40 through 60 hours/week of prior authorization for PCA services and resides with his/her PCA who provides all PCA services (1:1 relationship), of which the Member may receive authorization to schedule his/her PCA to work up to a maximum of 60 hours/week or 2)  the Member requires a PCA to work more than 40 hours per week in order to provide continuity of care and avoid disruption of care (continuity of care).

MassHealth PCA program is working closely with PCMs and Fiscal Intermediaries (FI) on the implementation of this policy. Members should follow up with their PCMs for any questions. PCMs and FIs should continue to follow up with the PCA program staff with any questions.

Messages from the Week of July 25, 2016

July 25, 2016

Updated Early Intervention Rates

Please be advised that the Executive Office of Health and Human Services (EOHHS) has updated the Early Intervention (EI) Rates for MassHealth Early Intervention Providers, pursuant to regulation 101 CMR 349.00. The updated EI rates are effective for dates of service March 1, 2016.

MassHealth is in the process of reviewing EI claims with dates of service 3/1/16 and later paid previous to the rate update, and will systematically reprocess affected claims on future remittance advices. No further action is required by EI Providers.

Please note that Specialty Services rates have not been updated yet and will be handled separately. Future communication will be communicated to EI providers regarding the handling of the EI Specialty Services rate update.

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

Claim Processing Errors on July 19th and July 20th

Please be advised that between July 19, 2016-July 20, 2016, some MassHealth physician claims denied in error for Edit 1002-DTL PERFORMING PROV NOT ELIG AT SERV LOC FOR PROG and Edit 1003 - BILLING PROV NOT ELIG AT SERV LOC FOR PROG BILLED.  The issue that triggered these denials was resolved on July 20th, 2016.  These denied claims will appear on this week’s remittance advice.  MassHealth is reprocessing the affected claims and you will see these reprocessed claims on your remittance advices in the near future.

We apologize for any inconvenience that this issue caused and thank you for your continued service to our MassHealth members. For questions contact the MassHealth Customer Service Center at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

To Home Health Agency Providers

The next Home Health Provider Outreach Forum will be on:  
Date: Tuesday, August 16, 2016
Time: 11:30 am - 12:30 pm ET
Location: 1 Ashburton Place Boston, MA, 02108, 21st floor McCormick
Conference Rooms: 2 and 3, Capacity 100

During the 60 minute open forum, the following topics will be discussed MassHealth Regulations, Provider On-line Service Center (POSC), Prior Authorization, and Required Documentation.

Space is limited.  Please register early!  Register for August HH Outreach Forum

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

Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Wednesday, July 27, 2016
Time: 3:00-4:00 pm ET

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002. This is the last of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2016), hosted by the Centers for Medicare & Medicaid Services (CMS).

Webinar participants will learn about:

-The PERM process and provider responsibilities during a PERM review
-Frequent mistakes and best practices
-Electronic Submission of Medical Documentation (esMD program)

To join the Webinar:

Audio: 1-877-267-1577, Meeting ID# 999 454 534
Webinar: https://meetings.cms.gov/orion/joinmeeting.do?MeetingKey=999454534

Presentation materials will be posted as downloads on the Providers tab of the PERM website at: http://tinyurl.com/j8ld66q

CMS encourages all participants to submit questions not addressed in the session to the dedicated PERM Provider email address at: PERMProviders@cms.hhs.gov or, you may also contact your State PERM Representatives with any questions and for information about education and training in your state.

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

Messages from the Week of July 18, 2016

July 20, 2016

Processing Errors on July 19th and July 20th 2016

We have identified that starting yesterday afternoon (July 19th) some MassHealth physician claims denied in error for 1002-DTL PERFORMING PROV NOT ELIG AT SERV LOC FOR PROG and 1003 - BILLING PROV NOT ELIG AT SERV LOC FOR PROG BILLED.  The issue that triggered these errors has now been resolved. Providers who encountered this edit in error may resubmit the impacted claims. MassHealth will also identify any claims that were impacted and if they are not resubmitted will reprocess them. This issue also created errors when attempting to submit other transactions including Prior Authorizations (PAs) - these issues are now also resolved and providers should be able to submit these transactions cleanly. We apologize for any inconvenience that this issue caused and thank you for your continued service to our MassHealth members. For questions contact the MassHealth Customer Service Center at 1 (800) 841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

July 19, 2016

PCC Referral Submission Issue

Please note the PCC referral submission issue experienced by some providers on 7/18/16 has been resolved.  Providers should resubmit all referral requests without adding the individual NPI.  Contact the MassHealth Customer Service Center at 1-800-841-2900 with any questions or concerns.

July 18, 2016

Submission of Replacement Claim for Acute Inpatient Discharges under the Adjudicated Payment Amount Per Discharge (APAD) Methodology

An acute inpatient hospital that submits interim claims (TOB 112, 113) and a claim for the final portion of the stay (TOB 114, or the replacement claim TOB 117) must follow up by replacing these claims with a full stay claim (TOB 111) and voiding the interim claims for that stay.  This is necessary to ensure full and proper payment and to avoid duplicate or excess payment under the APAD methodology.

If a hospital fails to void and replace the interim claims with the full stay claim, MassHealth will void the interim claims with a new EOB code 9981/ “Admit through Discharge Replacement Claim (TOB 111) Required for Correct Payment.”

This applies to claims for discharges from October 1, 2014 (when the APAD methodology was implemented) and going forward.

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

Messages from the Week of July 4, 2016

July 5, 2016

Inpatient Hospital Grouper Issue

As noted in an earlier message text (12/08/15), MassHealth identified an issue with the industry standard 3M APR-DRG grouper that affected inpatient hospital claims paid under the Adjudicated Payment Amount per Discharge (APAD) methodology.  Subsequently, MassHealth has determined that some claims that should have been assigned DRG 560 were instead assigned to DRG 951 or 952; other claims were assigned the correct DRG but an incorrect Severity of Illness (SOI.)  In most but not all cases, as noted below, these assignments resulted in an overpayment. 

MassHealth implemented 3M’s fix effective 4/18/16.  Mass Health is now reprocessing affected claims with dates of service between 10/1/15 (when ICD-10 replaced ICD-9) and 4/18/16 (the date MassHealth implemented the correction.)  For each claim, the result of the reprocessing is one of the following:

  • Change in the claim’s DRG and/or SOI, as well as a change in payment
  • Change in the claim’s DRG and/or SOI, but no change in payment (generally because of TPL repricing)

In addition, some of these claims were also selected for Utilization Management Program (UMP) review by MassHealth’s UMP vendor (Permedion).  MassHealth is therefore working with Permedion to avoid or minimize overlap between the reprocessing noted above and Permedion’s UMP process.

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

Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Tuesday, July 19, 2016
Time: 3:00-4:00 pm ET

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002.

This is the third of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2016), hosted by the Centers for Medicare & Medicaid Services (CMS). An additional webinar will be held on Wednesday, July 27, 2016 and information on how to join this webinar will be forthcoming.

Webinar participants will learn about:

-The PERM process and provider responsibilities during a PERM review
-Frequent mistakes and best practices
-Electronic Submission of Medical Documentation (esMD program)

To join the Webinar:
Audio: 1-877-267-1577, Meeting ID# 997 909 667
Webinar: https://meetings.cms.gov/orion/joinmeeting.do?MeetingKey=997909667

Presentation materials will be posted as downloads on the Providers tab of the PERM website at: http://tinyurl.com/j8ld66q

CMS encourages all participants to submit questions not addressed in the session to the dedicated PERM Provider email address at: PERMProviders@cms.hhs.gov or, you may also contact your State PERM Representatives with any questions and for information about education and training in your state.

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

Messages from the Week of June 27, 2016

June 27, 2016

Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Wednesday, June 29, 2016
Time: 3:00-4:00 pm ET

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002.

This is the second of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2016), hosted by the Centers for Medicare & Medicaid Services (CMS). The two additional webinars will be held on the dates below and information on how to join these webinars will be forthcoming:

-Tuesday, July 19, 2016
-Wednesday, July 27, 2016

Webinar participants will learn about:

-The PERM process and provider responsibilities during a PERM review
-Frequent mistakes and best practices
-Electronic Submission of Medical Documentation (esMD program)

To join the Webinar:

Audio: 1-877-267-1577, Meeting ID# 994 831 426

Webinar: https://meetings.cms.gov/orion/joinmeeting.do?MeetingKey=994831426

Presentation materials will be posted as downloads on the Providers tab of the PERM website at: http://tinyurl.com/j8ld66q

CMS encourages all participants to submit questions not addressed in the session to the dedicated PERM Provider email address at: PERMProviders@cms.hhs.gov or, you may also contact your State PERM Representatives with any questions and for information about education and training in your state.

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

Messages from the Week of June 20, 2016

June 20, 2016

Special Instructions for Mental Health Centers

In July 2013, CMS established a one unit limit on three behavioral health codes where MassHealth allowed up to four units (90847-family therapy, 90849-multiple family group therapy and 90853-group therapy). In October 2013, CMS established a one unit limit on one behavioral health code where MassHealth allowed up to four units (90882-Environmental intervention for medical management). As a result some claims denied for Edit 5930-MUE Units Exceeded, or paid at a reduced amount.

MassHealth initiated an increase to the rate for one unit for each code. Mental Health Center regulations were promulgated in March of 2014 to increase the rates with a 01/01/2014 effective date. On 09/01/2015 the revision was made retroactively to 07/1/2013 for codes 90847, 90849 and 90853 and to 10/01/2013 for code 90882.

These are the instructions for providers to receive the retro rate increase: 

Providers should submit their adjustments (reduced payments) and resubmittals (denied claims) directly to MMIS between June 15, 2016-July 15, 2016 for these procedure codes only.  Claims should be submitted on a separate file through EDI or DDE. Claims submitted for dates of service that exceed the MassHealth submission deadline may suspend for review for compliance with this process. If any claim denies or pays incorrectly during this process, providers should submit the claim for a Final Deadline Appeal.  

Situation A – If your claim was paid but cut back – meaning reduced payment:

                Replace / Submit the claim as an adjustment with all claim lines using the last paid ICN and billing with your usual and customary fee with only one unit for the procedure code that was reduced.

Situation B – If your claim was denied for edit 5930 – MUE UNITS Exceeded:

                Submit the claim as an original without the former ICN.  Correct the claim by billing for one unit and your usual and customary fee for that procedure code. It is very important that if your claim previously denied for edit 5930 AND a subsequent edit(s) that you correct the subsequent error(s) before submitting the claims.  Failure to correct subsequent errors with this resubmission could result in denial of your claim.

If you have any questions about this process please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

Messages from the Week of June 13, 2016

June 13, 2016

Retro Rate Adjustments for Hospice Providers

Please be advised that the most recent remittance advice (RA) may contain rate adjustments resulting from the certification of revised FFY15 rates (October 1, 2014 – September 30, 2015) by the Executive Office of Health and Human Services.  Please review this RA for accuracy.  Proposed corrections must be submitted to MassHealth Customer Service within 60 days from the date of this RA at Providersupport@mahealth.net or call 1-800-841-2900.For more information, refer to the POSC Job aid, view RA reports on the Get Trained web page (www.Mass.Gov/MassHealth/NewMMIS). 

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

Enhanced MassHealth Provider Directory Now Available

An enhanced MassHealth provider directory is now available from the MassHealth website at www.mass.gov/masshealth (select “Find a Doctor”). This new directory makes it easier for members to get connected with the care they need. Designed with the member in mind, it’s a simple and easy way to find providers, hospitals, and health centers.

With just a few clicks, users can search the large database of MassHealth-participating providers and health care facilities. They can also narrow their search by:

  • Specific provider type, like cardiologist or obstetrician
  • Location
  • A provider’s name

This new tool replaces Mass Health’s current online provider directory.

Important:  Members enrolled in a managed care plan, Senior Care Options (SCO) plan, or One Care plan, should contact their health plan or go to the plan’s website for provider information.

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

Messages from the Week of May 30, 2016

May 31, 2016

Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374

MassHealth is aware of an issue affecting Medicare crossover claims for dual eligible members (MassHealth and Medicare coverage) who were enrolled in a MassHealth CarePlus benefit plan. MassHealth has revised the benefit plan information for these members and has reprocessed affected crossovers claims on this and future remittance advices.  Any reprocessed claims that have denied again for Edit 4371 – Benefit plan claim type restriction on procedure and/or Edit 4374 - Benefit plan claim type restriction on revenue code are adjudicated correctly according to the revised member benefit plan.  

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

Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Tuesday, June 21, 2016
Time: 3:00-4:00 pm ET

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002.

This is the first of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2016), hosted by the Centers for Medicare & Medicaid Services (CMS). The three additional webinars will be held on the dates below and information on how to join these webinars will be forthcoming:

-Wednesday, June 29, 2016
-Tuesday, July 19, 2016
-Wednesday, July 27, 2016

Webinar participants will learn about:

-The PERM process and provider responsibilities during a PERM review
-Frequent mistakes and best practices
-Electronic Submission of Medical Documentation (esMD program)

To join the Webinar:

Audio: 1-877-267-1577, Meeting ID# 996 196 415
Webinar: https://meetings.cms.gov/orion/joinmeeting.do?MeetingKey=996196415

Presentation materials will be posted as downloads on the Providers tab of the PERM website at: http://tinyurl.com/j8ld66q

CMS encourages all participants to submit questions not addressed in the session to our dedicated PERM Provider email address at: PERMProviders@cms.hhs.gov or, you may also contact your State PERM Representatives with any questions and for information about education and training in your state.

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

Messages from the Week of May 23, 2016

May 23, 2016

To Home Health Agency Providers

In order to accommodate regional requests for open forums, we have added two additional sessions:

Lowell Pollard Memorial Library
401 Merrimack St., Lowell, MA. 01852
Monday, June 13th
11am - 12pm

Register for Lowell Outreach Forum here: https://form.jotform.com/DCStraining/hh-provider-outreach-forum-june-13

Springfield Library – Brightwood Branch
359 Plainfield Street, Springfield, MA 01107
Thursday, June 23rd
1:30 - 2:30pm

Register for Springfield Outreach Forum here: https://form.jotform.com/DCStraining/hh-provider-outreach-forum-june-23

During each 60 minute open forum, MassHealth will discuss topics including MassHealth Regulations, Provider On-line Service Center (POSC), Prior Authorization, and Required Documentation.

Space is limited.  Please register early!

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

PA Operating Standards Are Online

DME and Oxygen providers are advised: PA Operating Standards, including the process to request expedited PAs, are available via the MassHealth DME/OXY Payment and Coverage Guideline Tool. 

To confirm that you are using the most recent version of the applicable Tool go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/, click on MassHealth Payment and Coverage Guideline Tools, then on MassHealth DME and Oxygen Payment and Coverage Guidelines Tool.

To review the Operating Standards for the Prior Authorization process on the Payment and Coverage Guideline page: Click on the “Click Here” box on the middle, top of the page. This will bring you to the Quick Links page. Click on: “Prior Authorization Operating Standards”, located in the green box. The Operating Standard VI. Expedited Prior Authorization Requests states: “Prior Authorization Unit (PAU) will expedite the processing of a PA request for DME and Oxygen/Respiratory Equipment under the following circumstances: A.  The PA request is for a MassHealth Member who is being discharged from an inpatient facility and is in need of equipment at the time of discharge. B. Any other circumstances identified by the prescribing provider to prevent an acute hospitalization (i.e. acute illness, post-op).” Requests for expedited review for circumstances other than those identified in the operating standards will not be considered an expedited request and will be reviewed in the order in which it was received. Please review this operating standard for additional details to request an expedited PA review.

If you have any PA questions, please contact the PAU at PriorAuthorization@umassmed.edu or 1-800-862-8341.

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

Medicare Crossover Claims with Edit 6215 HCAC Claim Eligible for Cost Outlier Payment

As described in the All Provider Manual, Appendix V:  MassHealth Billing Instructions for Provider Preventable Conditions, MassHealth prohibits additional payment to hospitals for services associated with or resulting from Provider Preventable Conditions (PPCs.)  One of the PPC categories described is Health Care Acquired Conditions (HCACs) that can occur in the acute inpatient hospital setting.  For the most part, claims for services that include HCACs, when properly submitted by acute inpatient hospitals according to the instructions, can and are processed automatically and consistent with the prohibition noted above.

However, acute inpatient hospitals should be aware of one exception to the automated processing – for claims that (1) include an HCAC(s) and (2) qualify for outlier payment status in addition to the Adjudicated Payment Amount per Discharge (APAD), the outlier payment amount cannot be calculated until the hospital identifies which charges were the result of the HCAC.  Crossover claims will continue to suspend for Edit 6215 for manual pricing. 

Instructions for Medicare Crossover Claims Suspended or Denied for EDIT 6215

For Suspended Claims
No provider action is necessary.  MassHealth will manually price the claim including the outlier payments.  If the calculated MassHealth paid amount is zero after repricing the claim, the claim will be adjudicated.  If the calculated MassHealth paid amount is greater than zero after repricing the claim, the claim will be denied for edit 6215. Providers may resubmit denied claims per instructions below.   

For Denied Claims
If your hospital has a crossover claim denied for Edit 6215, you may resubmit the claim through the POSC with an attachment identifying the charges associated with the HCAC, as follows:

1. Within the attachment, list the hospital’s name and the denied claim’s 13-digit ICN.

2. Indicate which medical services have any charges that represent or resulted from an HCAC.

3. Revise the charges to show what they would have been had the HCAC(s) not occurred.

4. (a) Provide the name of the HCAC.

    (b) Briefly indicate the rationale for determining the revised charges.

MassHealth will review the attachment and if in agreement with the revised charges, will recalculate the payment and process the claim.  If the attachment does not support the revised charges, MassHealth will again deny the claim or will request additional information, along with a comment in a claim note. 

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

Messages from the Week of May 16, 2016

May 16, 2016

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 two weeks.  Please see the modified payment schedule outlined below.

RA DATE: 07/05/2016
PAYMENT DATE CHECKS: 07/08/2016
PAYMENT DATE EFT: 07/11/2016

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: 07/19/2016
PAYMENT DATE CHECKS: 07/22/2016
PAYMENT DATE EFT: 07/25/2016

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

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

Reprocess of Vision Care Services Provided to Dually Eligible Members

MassHealth has identified some vision care claims that providers erroneously billed to MassHealth prior to billing Medicare, the primary insurer for these claims. The MassHealth system has been updated to deny these claims in the future for Edit ‘2505 - MEMBER COVERED BY MEDICARE-DENY’. The affected claims will be systematically reprocessed on future remittance advices.

Providers are reminded that MassHealth is the payer of last resort and that they must make diligent efforts to obtain payment from all available third party resources including Medicare prior to billing MassHealth.  Please see All Provider Regulations 130 CMR 450.316.

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

Messages from the Week of May 9, 2016

May 9, 2016

Timely Filing Regulations for Claims with Other Health Insurance

Providers are reminded to adhere to the timely filing regulations when submitting claims for members with other health insurance.  (refer to 130CMR 450.313) All claims submitted with other health insurance (Medicare and Commercial insurance) adjudication information must be received within 90 days of the date of the insurer’s explanation of benefits.  Claims exceeding this requirement will be denied for edits 850 BILLING DEADLINE EXCEEDED DETAIL or 852 BILLING DEADLINE EXCEEDED HEADER.

If MassHealth denies the initial timely filed claim, providers may resubmit the corrected claim up to 18 months from the date of service of the claim. Claims exceeding this requirement will be denied for edit 853 FINAL DEADLINE EXCEEDED DETAIL or 855 FINAL DEADLINE EXCEEDED HEADER.   Claims denied for these edits may be appealed if ALL of the appeal criteria are met.  Please reference All Provider Regulations 130 CMR 450.323. 

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

Messages from the Week of May 2, 2016

May 2, 2016

Updated Personal Care Management Rates

Please be advised that the Executive Office of Health and Human Services (EOHHS) has updated the Personal Care Management (PCM) Rates for MassHealth Personal Care Management Providers, pursuant to regulation 101 CMR 309.00. The updated PCM rates are effective for dates of service January 1, 2016.

MassHealth is reprocessing these claims and the adjustments will begin to appear on remittance advices beginning in May. No further action is required by PCM Providers. If you have questions, contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

2016 Reprocessing for New Physician Codes

The Centers for Medicare & Medicaid Services (CMS) have revised the Healthcare Common Procedure Coding System (HCPCS) codes for 2016.

For dates of service on or after January 1, 2016, you must use the new codes in order to obtain reimbursement.

The new codes have been retroactively added with an effective date of January 1, 2016 and will be reprocessed for adjudication on a subsequence remittance advice.

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

Messages from the Week of April 18, 2016

April 19, 2016

Adult Foster Care (AFC) Enrollment Verification

As of 4/19/2016, Adult Foster Care Providers will have the ability to contact the MassHealth Customer Service Center (CSC) at 1-800-841-2900 to VERIFY if a MassHealth member who is seeking to enroll in the AFC program is already receiving MassHealth services that would be considered duplicative if the AFC provider were to enroll the member in the AFC program.

Example of duplicative services or Non-covered AFC days as defined in the AFC regulations section 408.437:

(A) the member is receiving any other personal care services, including, but not limited to, personal care services under 130 CMR 422.000 and home care services under the Executive Office of Elder Affairs regulation 651 CMR 3.03(5);

(B) the member is a resident or inpatient of a hospital, nursing facility (with the exception of MLOA or alternative placement days), rest home, group home, intermediate care facility for the mentally retarded, assisted living residence, or any other residential facility subject to state licensure or certification

Prior to rendering AFC services to a MassHealth member, please verify that the member is NOT already receiving services that may be considered duplicative and may result in denials of AFC claims:

  • Contact the MassHealth Customer Service Center (CSC) at 1-800-841-2900
  • Provide the following information to the CSC:
    • MassHealth Member Name
    • MassHealth Member ID
    • MassHealth Member Date of Birth
  • The CSC will check the MassHealth Member information and verify if the member is currently receiving a service that may be considered duplicative under MassHealth regulations.  

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

To Home Health Agency Providers

MassHealth Onsite Home Health Provider Outreach Forum

Please join us for a 90 minute open forum on Home Health Services, MassHealth Coverage and Prior Authorization requirements.

During this session, MassHealth will discuss topics including MassHealth Regulations, Provider On-line Service Center (POSC), Prior Authorization, and Required Documentation.

Space is limited.  Please register early!

Monday, May 9, 2016, 2:00 pm – 3:30 pm at UMass Medical School, Shrewsbury

  • Capacity 100

Register here for an Outreach Forum: https://form.jotform.com/DCStraining/hh-provider-outreach-forumMay9

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

Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374

MassHealth is aware of an issue affecting Medicare crossover claims for dual eligible members (MassHealth and Medicare coverage) that are enrolled in a MassHealth Care Plus benefit plan.

MassHealth has revised the benefit plan information for these members and has reprocessed affected crossovers claims on this and future remittance advices.  Any reprocessed claims that have denied again for Edit 4371 – Benefit plan claim type restriction on procedure and/or Edit 4374 – Benefit plan claim type restriction on revenue code are adjudicated correctly according to the revised member benefit plan.

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

Messages from the Week of April 11, 2016

April 11, 2016

Reminder: Virtual Gateway Messages

Due to many Agencies now using the Virtual Gateway providers should note that there will be messages from many areas. When logging into the Virtual Gateway Providers may see all messages including outage messages. MassHealth Providers should only focus on messages from MassHealth and the POSC as not all messages will not pertain to them.

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

Messages from the Week of April 4, 2016

April 4, 2016

Claims with HCAC Present and Inpatient Outlier Payments, Edit 6215

Background for Claims Suspended or Denied for EDIT 6215

As described in the All Provider Manual, Appendix V:  MassHealth Billing Instructions for Provider Preventable Conditions, MassHealth prohibits additional payment to hospitals for services associated with or resulting from Provider Preventable Conditions (PPCs.)  One of the PPC categories described is Health Care Acquired Conditions (HCACs) that can occur in the acute inpatient hospital setting.  For the most part, claims for services that include HCACs, when properly submitted by acute inpatient hospitals according to the instructions, can and are processed automatically and consistent with the prohibition noted above.

However, acute inpatient hospitals should be aware of one exception to the automated processing – for claims that (1) include an HCAC(s) and (2) qualify for outlier payment status in addition to the Adjudicated Payment Amount per Discharge (APAD), the outlier payment amount cannot be calculated until the hospital identifies which charges were the result of the HCAC.  Claims submitted by April 14, 2016 have suspended or will suspend for Edit 6215, HCAC Claim Eligible for Cost Outlier Payment; claims submitted after April 14, 2016 will deny for Edit 6215.

Instructions for Claims Suspended or Denied for EDIT 6215

For Suspended Claims

If your hospital has a claim suspended for EDIT 6215, you will need to identify the charges associated with the HCAC before the claim’s correct payment can be determined and the suspended status removed.   Specifically, please provide the following information in an e-mail to EHS.HCACOutlierClaimReview@state.ma.us:

1. In the e-mail subject line, indicate the hospital’s name and the suspended claim’s 13-digit ICN.

2. Indicate which medical services have any charges that represent or resulted from an HCAC.

3. Revise the charges to show what they would have been had the HCAC(s) not occurred.

4. (a) Provide the name of the HCAC.

    (b) Briefly indicate the rationale for determining the revised charges.

Time frame:  Submit the information by May 19, 2016.  Failure to submit the required attachment by this deadline will result in denial of the suspended claim.  MassHealth will review the information in the e-mail and if in agreement with the revised charges, will recalculate and pay the claim; if the e-mail does not support the revised charges, the claim may be denied.  Disposition will be indicated via an additional claim note.

For Denied Claims

If your hospital has a claim denied for Edit 6215, you will need to resubmit the claim through the POSC with an attachment identifying the charges associated with the HCAC, as follows:

1. Within the attachment, list the hospital’s name and the denied claim’s 13-digit ICN.

2. Indicate which medical services have any charges that represent or resulted from an HCAC.

3. Revise the charges to show what they would have been had the HCAC(s) not occurred.

4. (a) Provide the name of the HCAC.

    (b) Briefly indicate the rationale for determining the revised charges.

MassHealth will review the attachment and if in agreement with the revised charges, will recalculate the payment and process the claim.  If the attachment does not support the revised charges, MassHealth will again deny the claim or will request additional information, along with a comment in a claim note. 

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

Messages from the Week of March 28, 2016

March 28, 2016

Correction to All Provider Bulletin 259—Informational Messaging Regarding Ordering, Referring and Prescribing Provider Requirements on Claims from Independent Labs and Independent Diagnostic Testing Facilities

This is a correction to All Provider Bulletin 259, regarding claims from independent labs and independent diagnostic testing facilities.  The Bulletin indicated in error that informational messaging regarding ordering, referring and prescribing provider requirements on claims from labs and diagnostic testing facilities would begin on March 7, 2016 (Phase 1A).  Informational messaging on claims from these providers will not begin until Phase 1B, currently targeted for July, 2016.  We will notify providers in advance of the begin date for Phase 1B.

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

To Home Health Agency Providers

For those home health agency providers who were unable to participate in the March 16th Home Health webinar on the new MassHealth Regulations and Prior Authorization Process, please review the recorded webinar. 

https://www.youtube.com/watch?v=QgyEzPk5V6o

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

Messages from the Week of March 21, 2016

March 21, 2016

To Home Health Agency Providers

REPROCESSING OF HOME HEALTH CLAIMS DENIED FOR EDITS 8191 AND 8193

MassHealth is aware of an issue affecting Home Health Agency claims for home health aide and skilled nursing services.

The claims for these members may have erroneously denied for Edits 8191 (procedure code: G0299/G0300; skilled nursing visits) and 8193 (procedure code: G0156; home health aide units)
MassHealth is in the process of systematically reprocessing the affected claims.

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

2016 Ventilator Code Changes

Pharmacy, DME and Oxygen providers, please be advised that the two new procedure codes for home ventilators became effective January 1, 2016. The new codes are E0465 with modifiers U2 and RR (U2 modifier is used on rental months 1 through 6 for MassHealth members, RR modifier is used on rental months 7 and beyond). The codes have been added to the MassHealth DME/OXY Payment and Coverage Guideline Tool.  The modifier U2 can only be used on a new ventilator set up on or after January 1, 2016. If the provider was using U2 prior to January 1, 2016 and it still has a few units left it can be used up to the 6 month time frame only. Please note the description for the current procedure codes E0465 U2 RR and E0466 U2 RR have been changed with a new description.

If you have any questions regarding PA related issues, please contact the PAU at PriorAuthorization@umassmed.edu or 1-800-862-8341.

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

Messages from the Week of March 14, 2016

March 14, 2016

MassHealth Website Updates

MassHealth has updated its website. Some of the updates feature a new home page and easier navigation, which make it easier to find forms, resources and information about MassHealth.  It is important to note that while the address of the MassHealth home page is not changing (http://www.mass.gov/masshealth), some links to web pages within the MassHealth website   have changed. If you have bookmarked web pages that you use often, you may need to reset them.

Please also note that the new site also includes a list of providers, which is available in both the Members and Applicants tab and the Providers tab, and can be used for finding a MassHealth-participating provider or hospital in your area.

Please see our short video about these changes at https://www.youtube.com/watch?v=M19k8Z-ZYkc&feature=youtu.be.

If you have any questions about how to use the MassHealth website, please contact the MassHealth Customer Service Center at providersupport@mahealth.net or call 1-800-841-2900.

Messages from the Week of March 7, 2016

March 7, 2016

REVISED MESSAGE:

To Home Health Agency Providers

MassHealth will be hosting a Provider Training Webinar on Wednesday, March 16th from 12 pm – 1:30 pm.

Topic:  New Regulations including Implementing Prior Authorization for Home Health Services 

You will receive the webinar access information the day before the webinar via email.

Changes include:   

  1. Prior authorization requirements:
  2. For intermittent skilled nursing services and home health aide services provided pursuant to intermittent skilled nursing services, prior authorization is required whenever the services provided exceed one or more of the following:

    1. More than 30 skilled nursing visits in a 90 day period;
    2. More than 240 home health aide units in a 90 day period.
  3. Physicians signing the plan of care cannot be a physician on the staff of, or under contract with the home health agency
  4. A face-to-face encounter by the physician needs to be documented on the plan of care for new home health referrals, not more than 90 days before or 30 days after the start of home health services;
  5. Referrals to Aging Service Access Points (ASAPs) by home health agencies must be made upon assessment or reassessment for home health services or discharge from home health services for MassHealth members aged 60 and older.

For details on the revised regulations, please review:

Job Aids on prior authorization procedures for Home Health (check Prior Authorization section for Home Health):

http://tinyurl.com/zzkhak6

Bulletin:

http://www.mass.gov/eohhs/docs/masshealth/bull-2016/hha-51-a.pdf

Revised Regulations:

http://www.mass.gov/eohhs/docs/masshealth/transletters-2016/hha-51.pdf

Medical Necessity Guidelines for Home Health Services:

http://tinyurl.com/jf2xrmo

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

Messages from the Week of February 29, 2016

March 1, 2016

POSC Reminder

Following system updates on the weekend of February 20th some MassHealth providers have encountered errors, broken links or missing information on web-pages. Many of these issues are due to old cached (stored) links/information in your system which are no longer valid.  If you see these issues, please clear your browser cache and reload your page. If you need assistance, your network administrator can assist you with this.

Should the problems persist, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

February 29, 2016

POSC Download Issues

Due to system maintenance that was performed on February 21st, we have identified an issue where some users cannot successfully download complete outbound files and reports from the POSC. While this issue appears to be impacting only a small number of files, providers and users should still be aware of the issue and validate that your Provider Online Service Center (POSC) downloads are complete. We are actively working to resolve this issue and will provide an update an soon as it is available.

We apologize for any inconvenience this may cause.  Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.   EHS users with questions, please contact the EHS Customer Support Center at 617-994-5050 or email SystemsSupporthelpdesk@Massmail.state.ma.us

Informational Messaging Regarding Ordering, Referring and Prescribing Provider Requirements

Under Affordable Care Act requirements, when MassHealth requires that a service must be ordered, referred or prescribed:

  • the claim for the service must include the National Provider Identifier (NPI) of the provider who ordered, referred or prescribed the service
  • the provider who ordered, referred or prescribed the service must be enrolled with MassHealth either as a fully participating provider or as a nonbilling provider 

Certain claims with dates of service on or after March 7, 2016 that do not meet the above requirements will be processed with an informational message on the Remittance Advice. After an initial period to allow providers time to transition, we will notify providers that these edits will be set to deny if the requirements are not met. 

Please see All Provider Bulletin 259 for more information on the requirements and the list of informational messages.

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

Messages from the Week of February 15, 2016

February 16, 2016

POSC- Technical Upgrade Outage

Reminder: MassHealth will implement a technical upgrade of its Provider Online Service Center (POSC) application starting February 19th.   In order to facilitate the upgrade, the POSC will be unavailable from Friday, February 19th at 12:00 pm through Monday, February 22nd at 7:00 am.  MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable. MAP, CBHI and member and eligibility web services will also be impacted.

If your organization typically conducts business over the weekend, MassHealth strongly recommends that you process claims and other business transactions, including eligibility checks, before the shutdown. 

In addition, for this week only MassHealth will change the timing of its weekly processing cycle from Friday, February 19th to Wednesday, February 17th at 5pm. Claims submitted prior to Wednesday at 5pm will be processed in the February 17th cycle and claims submitted after that time will be processed in the following weekly cycle on Friday, February 26th. Payment timelines will not change so providers should not experience any delays in payments. PDF remittance advices will be available on February 18th.  The HIPAA 835s will be available on POSC on 2/24.

Please review and adhere to the POSC Technical Upgrade Informational Flyer at http://tinyurl.com/znvta5h and the accompanying job aid found at http://tinyurl.com/j4jywn3

We apologize for any inconvenience this may cause.  Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

Provider Types that Must Complete Revalidation or a Nonbilling (O&R) Provider Contract

Providers enrolled on or before March 25, 2011 and who have not yet completed revalidation will be subject to disenrollment from the MassHealth program.  It is important that providers contact the MassHealth Customer Service Center at revalidation@mahealth.net or 800-841-2900 to get more information about completing the revalidation process.

If the provider does not complete the revalidation process, they must complete a Nonbilling Provider Contract if they are in a provider type that is authorized to order, refer or prescribe services to MassHealth members. Failure to do so may prevent them at a future date from renewing their license. For additional information or to download a Nonbilling Provider Contract, please go to http://tinyurl.com/jjp7v6a.  Please contact revalidation@mahealth.net  or 800-841-2900 to get more information about completing the revalidation or the nonbilling process.

Implementation Update – MMIS/POSC Technical Upgrade

MassHealth will implement a technical upgrade of its MMIS and Provider Online Service Center (POSC) applications this weekend.   In order to facilitate the upgrade, the MMIS and POSC will now be unavailable from Friday, February 19th at 12:00 pm through Monday, February 22nd at 7:00 am.   Please note that this shut down time has been modified to accommodate important technical activities.

 If your organization typically conducts business over the weekend, MassHealth strongly recommends that you process claims and other business transactions, including eligibility checks, before the shutdown.  PDF remittance advices for claims transactions processed during the standard Wednesday, 2/17, payment cycle will appear on the POSC on Thursday, 2/18.  The835s will then appear on 2/24. Claims transactions received between 2/17 - 2/19, at 12pm will be processed in the following week’s cycle. 

Please remember the following:

  1. Where applicable, make sure that back end POSC IP address configured in your network is updated.
  2. Ensure that you have updated your browser to Internet Explorer 11, Google Chrome or Mozilla Firefox. 
  3. Update your bookmarks on 2/19 to:  https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal
  4. Providers do not have to wait until the cut-over to log in via the Virtual Gateway (VG).  You may access the VG now at: http://www.mass.gov/eohhs/gov/commissions-and-initiatives/vg/ 
  5. Please review and adhere to the POSC Technical Upgrade Informational Flyer at http://tinyurl.com/znvta5h and the accompanying job aid found at http://tinyurl.com/j4jywn3
  6. Please review and adhere to the MassHealth messages on mass.gov dated December 21, 2015, January 19, 2016, and February 1, 2016, at http://tinyurl.com/z474n76As noted, the shutdown time has been changed to 12:00 pm.

If you have any questions, need assistance with the IP address, or experience any issues with business transactions after the cut-over please contact the MassHealth Customer Service Center at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

Messages from the Week of February 8, 2016

February 9, 2016

PPC-HCAC with Inpatient Outlier Payments, Edit 6215

As described in the All Provider Manual, Appendix V: MassHealth Billing Instructions for Provider Preventable Conditions, MassHealth prohibits additional payment to hospitals for services associated with or resulting from Provider Preventable Conditions (PPCs.)  One of the PPC categories described is Health Care Acquired Conditions (HCACs) that can occur in the acute inpatient hospital setting.  For the most part, claims for services that include HCACs, when properly submitted by acute inpatient hospitals according to the instructions, can and are processed automatically and consistent with the prohibition noted above.

However, acute inpatient hospitals should be aware of one exception to the automated processing – for claims that (1) include an HCAC(s) and (2) qualify for outlier payment status in addition to the Adjudicated Payment Amount per Discharge (APAD), the outlier payment amount cannot be calculated until the hospital identifies which charges were the result of the HCAC.  Such claims have suspended for Edit 6215, HCAC Claim Eligible for Cost Outlier Payment.

Therefore, if your hospital has a claim suspended for Edit 6215, you will need to identify the charges associated with the HCAC before the claim’s correct payment can be determined and the suspended status removed.  Further instructions and time frames about how to identify these charges will be forthcoming.

MassHealth Seeks Testing Partners for its New Connectivity Method Option

MassHealth is currently seeking Beta Testing trading partners to test the MIME and SOAP options that are now included in MassHealth’s connectivity submission method between March 1st – May 31, 2016.

The alternative connectivity method provides a secure, system-to-system connection to MassHealth for sending and receiving the following HIPAA transactions: 270/271, 276/277, 835, 837I, 837P, 820, 834, 999/TA1. It is an automated process that is ideal for providers that transmit a large volume of HIPAA transactions.  It does not replace the existing HTS submission method and providers are not currently mandated to adopt the new submission methods.

MassHealth encourages any/all providers, billing intermediaries, clearinghouses and vendors that would like to participate in Beta Testing during this timeframe to contact the MassHealth Customer Service Center EDI Testing Team immediately. The EDI Testing Team will assist you throughout the testing process. For more information about the new connectivity method and how you can participate in Beta Testing, please contact the MassHealth Customer Service Center at 1-800-841-2900 or edi@mahealth.net.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization.

Messages from the Week of February 1, 2016

February 1, 2016

Group Practitioner Application Redesign

As part of our continuing efforts to improve service to our provider community, MassHealth is redesigning its provider enrollment forms. A new provider enrollment application for groups will be introduced on 2/01/2016.

The Provider Application for Group Practitioner Organizations (PE-GPO) will replace the Medical Assistance Program for billing intermediary Provider Application for provider type: 97 Group.

With the implementation of the new Provider Application for group practices, the National Provider Identifier (NPI) Supplement Form is no longer required.  PLEASE DESTROY ANY COPIES OF THE OLD APPLICATIONS AFTER 4/01/2016.  If any outdated applications are received after 4/1/2016 they will be rejected and applicants will be required to reapply using form PE-GPO. You can request the application from the MassHealth Customer Service Center by e-mail at providersupport@mahealth.net or by phone at 1-800-841-2900.

Update – Get Ready for the MMIS/Provider Online Service Center (POSC) Technical Upgrade

MassHealth will implement a technical upgrade of its MMIS and POSC applications on February 22, 2016.

In order to facilitate the upgrade, the MMIS and POSC will be unavailable from Friday, February 19th at 5:00 pm through Monday, February 22nd at 8:00 am. If your organization typically conducts business over the weekend, please ensure that you process claims and other business transactions before the shutdown. 

If your organization has configured the backend IP address as an allowable site for your network users, please contact the MassHealth Customer Service Center immediately to acquire the information necessary to ensure that your users will be able to access the new URL on February 22, 2016.  Also, please ensure that you have updated your browser to Internet Explorer 11, Google Chrome or Mozilla Firefox.  Please view the MassHealth banner message dated December 22, 2014, found at http://tinyurl.com/z474n76 for additional information regarding browser connections.

Providers do not have to wait until the cut-over to log in via the Virtual Gateway (VG).  You may access the VG now at: http://tinyurl.com/grsuxtj.  Please follow the system prompts to register.  Prior to the shutdown please log into the POSC to ensure that your permissions are correct and you are able to access all the services that you have been granted access to.  It will be important to ensure that you have the same access after the cut-over.

Please review the POSC Technical Upgrade Informational Flyer at http://tinyurl.com/znvta5h and the accompanying job aid found at http://tinyurl.com/j4jywn3 for important information regarding the changes that will be made, what providers should do to prepare for the upgrade, and what Users can expect to experience on or after the implementation date.

Reminder:   The technical upgrade will not alter any of the services currently available on the POSC or affect the subordinate ID access assigned by the primary user within provider organizations.  For uninterrupted access to the POSC be sure to update your bookmarks to:  https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal.

MMIS/POSC Technical Upgrade Webinars have been scheduled for the following dates:

2/10/16@1pm
2/17/16@1pm

To register for these training sessions, visit www.masshealthtraining.com and click the Webinar tab and then select the date

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

Pharmacy, DME and Oxygen – Updated Payment and Coverage Guidelines Tool Now Online

REVISED

Pharmacy, DME and Oxygen providers please be advised that the MassHealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web. 

To confirm that you are using the most recent version of the applicable Tool (V.25), go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/, then on MassHealth Payment and Coverage Guideline 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.

Messages from the Week of January 25, 2016

January 25, 2016

To Home Health Agency Providers

G0154 (Services of a skilled nurse in home health setting) will be retired as of 12/31/2015

As of January 1, 2016 providers are asked to bill by visit and not by units of time.

G0154 will be replaced with:

  • G0299: Services of an RN in home health setting, each 15 minutes (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members, use when billing for a member in home health services 1- 60 calendar days)

and

  • G0300:  Services of an LPN in home health setting, each 15 minutes (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members, use when billing for a member in home health services 1- 60 calendar days)

G0154 TT will be replaced with:

  • G0299 TT:  Services of an RN in home health setting, each 15 minutes. Use when billing for each subsequent member – not for the first member- when two or more members in the same household are receiving a nursing visit during the same time period). (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members

and

  • G0300 TT:  Services of an LPN in home health setting, each 15 minutes. Use when billing for each subsequent member – not for the first member- when two or more members in the same household are receiving a nursing visit during the same time period). (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members

G0154 UD will be replaced with:

  • G0299 UD:  Services of an RN in a home setting, each 15 minutes (per visit; use when billing for a member in home health services for 61 calendar days or longer)

and

  • G0300 UD:  Services of an LPN in a home setting, each 15 minutes (per visit; use when billing for a member in home health services for 61 calendar days or longer)

G0154 TT, UD will be replaced with:

  • G0299 TT, UD:  Services of an RN in home health setting, each 15 minutes. Use when billing for each subsequent member – not for the first member- when two or more members in the same household are receiving a nursing visit during the same time period , for members in home health services for 61 calendar days or longer. (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members

and

  • G0300 TT, UD:  Services of an LPN in home health setting, each 15 minutes. Use when billing for each subsequent member – not for the first member- when two or more members in the same household are receiving a nursing visit during the same time period, for members in home health services for 61 calendar days or longer. (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members

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

Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374

MassHealth is aware of an issue affecting Medicare crossover claims for dual eligible members (MassHealth and Medicare coverage) who were enrolled in a MassHealth CarePlus benefit plan. The crossover claims for these members may have erroneously denied for Edit 4371 – Benefit plan claim type restriction on procedure and/or Edit 4374 - Benefit plan claim type restriction on revenue code.  MassHealth is in the process of revising the benefit plan information for these members, and will systematically reprocess affected crossovers claims on future remittance advices.

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

Messages from the Week of January 18, 2016

January 19, 2016

Update – MMIS/Provider Online Service Center (POSC) Technical Upgrade – Effective February 22, 2016

MassHealth will implement a technical upgrade of its MMIS and POSC applications on February 22, 2016.

In order to facilitate the upgrade, the MMIS and POSC will be unavailable from Friday, February 19th at 5:00 pm through Monday, February 22nd at 8:00 am. If your organization typically conducts business over the weekend, please ensure that you process claims and other business transactions before the shutdown. 

Please note that effective February 22, 2016, all Users logging into the POSC will sign in via the integrated Virtual Gateway log-in process.  Users will access the POSC through the VG Portal utilizing their existing password, which enables the User to access all MassHealth applications. All Users logging into the POSC will sign in via the integrated Virtual Gateway log-in process.  Please review the POSC Technical Upgrade Informational Flyer at http://tinyurl.com/znvta5h and the accompanying job aid found at http://tinyurl.com/j4jywn3 for important information regarding the changes that will be made, what providers should do to prepare for the upgrade, and what Users can expect to experience on or after the implementation date.

Reminder:   The technical upgrade will not alter any of the services currently available on the POSC or affect the subordinate ID access assigned by the primary user within provider organizations.  However, Users will need to update their bookmarks to the POSC to:  https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal. In addition, the backend IP address is changing. If your organization has configured the IP address as an allowable site for your network users, please contact the MassHealth Customer Service Center to acquire the information necessary to ensure that your users will be able to access the new URL on February 22, 2016. 

MMIS/POSC Technical Upgrade Webinars have been scheduled for the following dates:

1/27/16 @1pm
2/10/16@1pm
2/17/16@1pm

To register for these training sessions, visit www.masshealthtraining.com and click the Webinar tab and then select the date.

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

Revalidation Process Changes

MassHealth is continuing its Provider Revalidation effort, as required by the federal Affordable Care Act, which must be completed by March 24, 2016.  The process requires you revalidate your enrollment information for MassHealth. You are receiving this remittance advice message because you/your entity may have received a Revalidation Request letter in FY 2014 or 2015.

The Centers for Medicare & Medicaid Services (CMS) have approved changes to the MassHealth Provider Revalidation Process that will simplify the revalidation process for many.

Enrollment in Medicare may satisfy the Medicaid revalidation process for providers who are enrolled in both Medicaid and Medicare and meet the following criteria.

  • The MassHealth provider has an active Medicare ID.
  • The MassHealth provider’s “doing business as” (DBA) name & address listed matches the name & practice location listed with Medicare
  • Any owners listed with MassHealth match the owners listed with Medicare.

If you have not completed your required revalidation, are active with Medicare and not sure what is needed to finish your revalidation please send an email to revalidation@mahealth.net.  Please note your revalidation is incomplete, include your name, NPI, and provider number.  MassHealth Provider Enrollment and Credentialing will review your Medicare and MassHealth profile to verify the criteria listed above.  If any discrepancies are found, MassHealth Provider Enrollment and Credentialing will contact you via email with instructions for the appropriate next steps.  If no discrepancies are found, MassHealth will notify you that no further action will be required for revalidation.  Once the documentation is processed, a confirmation notice will be sent via US Mail to the DBA address on file.

MassHealth Seeks Testing Partners for Its New Connectivity Method Option

REVISED

MassHealth is currently seeking Beta Testing trading partners to test the MIME and SOAP options that are now included in MassHealth’s connectivity submission method between February 1st – March 31, 2016.

The alternative connectivity method provides a secure, system-to-system connection to MassHealth for sending and receiving the following HIPAA transactions: 270/271, 276/277, 835, 837I, 837P, 820, 834, 999/TA1. It is an automated process that is ideal for providers that transmit a large volume of HIPAA transactions.  It does not replace the existing HTS submission method and providers are not currently mandated to adopt the new submission methods.

MassHealth encourages any/all providers, billing intermediaries, clearinghouses and vendors that would like to participate in Beta Testing during this timeframe to contact the MassHealth Customer Service Center EDI Testing Team immediately. The EDI Testing Team will assist you throughout the testing process. For more information about the new connectivity method and how you can participate in Beta Testing, please contact the MassHealth Customer Service Center at 1-800-841-2900 or edi@mahealth.net.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization.

To Hospice Providers

CMS requires changes to be made for Routine Home Care Hospice services as of January 1, 2016. 

The following are the updates to the billing code and services:

1)  Routine Home Care (days from 1 to 60)             T2042* (no change)

2)  Routine Home Care (days greater than 60)         T2042 UD*

An audit process will be in place to check for provider compliance on billing at the 60+ day rate

*Use modifier TN for T2042 and T2042 UD when billing for members outside the county in which the provider is located.

3)  New service: Service Intensity Add-on (SIA)

The SIA rate is an addition to the Routine Home Care (RHC) rate when all of the following criteria are met:  1) The day is a RHC level of care day 2) The RHC day occurs during the last 7 days of the member’s life, and the patient is discharged expired 3) Direct patient care is furnished by a registered nurse (RN) or social worker that RHC day.  Additionally, the SIA rate will equal the continuous home care hourly payment rate, for a minimum of 15 minutes and up to 4 hours per day. The time of a social worker’s phone calls is not eligible for an SIA rate payment.

Services of a registered nurse:              G0299
Services of social worker:                     G0155

Providers are required to attach documentation of medical necessity for this service (SIA) and claims on this service will be reviewed manually.  A prior authorization process is currently being considered for this service and providers will be updated when this is in place.

4)  Any hospice provider that does not comply with the CMS quality data submission requirements will be paid at the non-compliant rate

Link to the new rates for October 1, 2015 – September 30, 2016: http://tinyurl.com/hvpnpeu    

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

Messages from the Week of January 11, 2016

January 11, 2016

MassHealth Updates the CARC’S & RARC’S List Effective January 1, 2016

MassHealth has completed its review of the October 1, 2015 CORE Code Combination Claim Adjustment Reason Codes and Remittance Advice Remark Codes (CARCs & RARCs) updates.

MassHealth has modified MMIS to adopt these changes. Please review the updated CARCs & RARCs list found at http://tinyurl.com/zxdj6cy on mass.gov. Providers should review the online list for the most up-to-date EOB code combinations.

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

Timely Filing Regulations for Claims with Other Health Insurance

Providers are reminded to adhere to the timely filing regulations when submitting claims for members with other health insurance.  (refer to 130CMR 450.313) All claims submitted with other health insurance (Medicare and Commercial insurance) adjudication information must be received within 90 days of the date of the insurer’s explanation of benefits.  Claims exceeding this requirement will be denied for edits 850 Billing Deadline Exceeded detail or 852 Billing Deadline Exceeded header.

If MassHealth denies the initial timely filed claim, providers may resubmit the corrected claim up to 18 months from the date of service of the claim. Claims exceeding this requirement will be denied for edit 853 Final Deadline Exceeded detail or 855 Final Deadline Exceeded header.   Claims denied for these edits may be appealed if ALL of the appeal criteria are met.  Please reference All Provider Regulations 130 CMR 450.323.  

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

Messages from the Week of December 28, 2015

December 31, 2015

835 and Payment Delay

Due to the Christmas and New Year’s Day holidays, payments and 835s will be delayed by one business day.  For questions, please contact the MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

December 28, 2015

Personal Care Attendant (PCA) Overtime and Intra-Day Travel Time Pay

Effective January 1, 2016 dates of service, Fiscal Intermediaries will be able to submit claims to MassHealth for PCAs who have earned PCA Overtime and Intra-Day Travel Pay.

The service code for billing the PCA Overtime is:

  • 99509 TU - Home visit for assistance with activities of daily living and personal care. (Use this code and modifier to bill for Overtime. Per 1 minute, special payment rate). (Current P.A. for PCA services required for each member.)

The service code for billing the PCA Intra-Day Travel Time is:

  • A0170 - Transportation ancillary (Use this code to bill for Intra-Day Travel Time for PCA services, per 1 minute). (Current P.A. for PCA services required for each member.)

Fiscal Intermediaries should use the Overtime and Intra-Day claiming number when billing this code to MassHealth. Updates to subchapter 6 of the Provider Manual are forthcoming.

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

New POS 19 Implementation

Revised

Effective 01/4/2016, All Providers and Facilities will have available to them POS 19 “Off Campus-Outpatient Hospital”.  POS 19 is valid for any claim, regardless of date of service, when processed on or after 1/1/16.  If a Provider or Facility is using POS 99 for purposes of the NPI crosswalk please contact the MassHealth Customer Service Center at providersupport@mahealth.net or call 1-800-841-2900.

Messages from the Week of December 21, 2015

December 21, 2015

Provider Online Service Center (POSC) Technical Upgrade

MassHealth will perform a technical upgrade of its MMIS and POSC applications in early 2016.  As a result, the POSC right navigation will be consolidated with the left navigation, and the log in and password reset functionality will be modified to align with the Virtual Gateway (VG) log in process.  When the technical upgrade is implemented Users that have never logged in directly through the VG, will be redirected from the POSC home page to the VG to register as a first time user (e.g. set up security questions, accept terms and conditions). If you currently log in via the VG then you are already registered and do not need to take any additional action to register. 

Please note that the technical upgrade will not alter any of the services currently available on the POSC or affect the subordinate ID access assigned by the primary user within provider organization.  However, Users will need to update their bookmarks to the POSC.

More information regarding the technical upgrade will be made available over the next several weeks.  If you have any questions, please contact the MassHealth Customer Service Center at providersupport@mahealth.net or call 1-800-841-2900.

To Home Health Agency Providers

REVISED

G0154 (Services of a skilled nurse in home health setting) will be retired as of December 31, 2015

G0154 will be replaced with:

  • G0299: Services of an RN in home health setting, each 15 minutes (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members, use when billing for a member in home health services 1- 60 calendar days)
    and
  • G0300:  Services of an LPN in home health setting, each 15 minutes (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members, use when billing for a member in home health services 1- 60 calendar days)

G0154 TT will be replaced with:

  • G0299 TT:  Services of an RN in home health setting, each 15 minutes. Use when billing for each subsequent member – not for the first member- when two or more members in the same household are receiving a nursing visit during the same time period). (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members
    and
  • G0300 TT:  Services of an LPN in home health setting, each 15 minutes. Use when billing for each subsequent member – not for the first member- when two or more members in the same household are receiving a nursing visit during the same time period). (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members

G0154 UD will be replaced with:

  • G0299 UD:  Services of an RN in a home setting, each 15 minutes (per visit; use when billing for a member in home health services for 61 calendar days or longer)
    and
  • G0300 UD:  Services of an LPN in a home setting, each 15 minutes (per visit; use when billing for a member in home health services for 61 calendar days or longer)

G0154 TT, UD will be replaced with:

  • G0299 TT, UD:  Services of an RN in home health setting, each 15 minutes. Use when billing for each subsequent member – not for the first member- when two or more members in the same household are receiving a nursing visit during the same time period , for members in home health services for 61 calendar days or longer. (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members
    and
  • G0300 TT, UD:  Services of an LPN in home health setting, each 15 minutes. Use when billing for each subsequent member – not for the first member- when two or more members in the same household are receiving a nursing visit during the same time period, for members in home health services for 61 calendar days or longer. (per visit; PA for MassHealth CarePlus members not enrolled with a managed care organization and for complex care members

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

Messages from the Week of December 14, 2015

December 14, 2015

Rate Adjustments for Mental Health Codes

Please note the phone number correction

Starting on Monday 11/09/2015, MassHealth will perform mass adjustments on Mental Health codes that required a rate increase effective January 1, 2015. Providers should expect to see these adjustments in their upcoming Remittance Advice.

If you have any questions 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/OXY Payment and Coverage Guideline 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 www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/, and then click on MassHealth Payment and Coverage Guideline 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.

To Home Health Agency Providers

MassHealth is aware that G0154 will be retired as of January 1, 2016.  G0154 will be replaced with G0299 (direct skilled nursing visit of a registered nurse in the home health or hospice setting) and G0300 (direct skilled nursing visit of a licensed practical nurse in the home health or hospice setting).  MassHealth is currently working on making systems changes, and will be communicating updates to providers.

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

Correct Coding 2016 Ventilators

To all Oxygen and Respiratory Therapy providers, Durable Medical Equipment providers, and Pharmacy providers that provide Ventilators in the Home Setting MassHealth is aware of coding changes that are effective for date of service January 1, 2016. The following HCPCS have been deleted by CMS with the effective date of December 31, 2015:

E0450 is deleted and crosswalked to E0465 (Home Ventilator, any type, used with invasive interface (trach tube)

E0460 is deleted and crosswalked to E0466 (Home Ventilator, any type, used with non-invasive interface (mask, chest shell)

E0461 is deleted and crosswalked to E0466 (Home Ventilator, any type, used with non-invasive interface (mask, chest shell)

E0463 is deleted and crosswalked to E0465 (Home Ventilator, any type, used with non-invasive interface (mask, chest shell)

E0464 is deleted and crosswalked to E0466 (Home Ventilator, any type, used with non-invasive interface (mask, chest shell)

Providers that have prior authorizations please note the deleted HCPCS will no longer be valid. MassHealth is currently working on making systems changes, and will be communicating updates and a process to providers as soon as possible.

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

Messages from the Week of December 7, 2015

December 7, 2015

Inpatient Hospital Grouper Issue

MassHealth has identified an issue with the industry standard 3M APR/DRG grouper that is affecting in-patient hospital claims.  Specifically, for services involving a normal delivery that include a repair of a laceration, the grouper cross--walks to DRG #952 when it should cross-walk to DRG #560.  This has resulted in a number of potential overpayments to acute hospitals since October 1, 2015.  MassHealth is currently evaluating the issue and will notify providers within the next several weeks about its approach to address the issue with 3M and recoup overpayments as applicable.   If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900.

Messages from the Week of November 30, 2015

November 30, 2015

Medical Practitioner Application Redesign - Update

A revised provider enrollment application for individual medical practitioner was introduced on 10/01/2015. The Provider Application for Medical Practitioners and Checklist (PE-MP 8-15, PE-MP-CL 8-15) replaced the Medical Assistance Program Provider Applications.

MassHealth is reevaluating the disclosure questions that were embedded in this revised medical practitioner application and, as a result, is requiring applicants to complete the existing stand-alone Federally Required Disclosures form (FRDF) until further notice.  Anyone who has already received form PE-MP 8-15 will need to complete and submit a FDRF along with the application, and anyone who has already submitted a completed form PE-MP 8-15 will need to complete and separately submit a FRDF. The FRDF (form PE-FRD) can be found on the mass.gov website in the MassHealth Provider Forms section at the following link:  http://tinyurl.com/oe8xzur.

An updated version of the Provider Application for Medical Practitioners and Checklist (PE-MP 11-15, PE-MP-CL 11-15) is now available. Interested practitioners can request the updated application from the MassHealth Customer Service Center by e-mail at providersupport@masshealth.net or by phone at 1-800-841-2900. Please destroy all earlier versions of this form.

To Hospice Providers

MassHealth is aware that CMS requires coding changes to be made for Hospice services as of January 1, 2016.  MassHealth is currently working on making systems changes, and will be communicating updates to providers.

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

To Home Health Agency Providers

MassHealth is aware that G0154 will be retired as of January 1, 2016.   MassHealth is currently working on making systems changes, and will be communicating updates to providers.

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

Messages from the Week of November 16, 2015

November 16, 2015

Important Reminder – Diagnosis Indicator Field

MassHealth reminds providers that claims which include diagnosis and procedure codes that are not compatible will deny.  When submitting professional claims to MassHealth via the Provider Online Service Center (POSC) please ensure that the diagnosis Indicator field located in the Procedure tab is accurately cross referenced to the diagnosis code identified on the Billing and Service tab.  This will ensure that the intended diagnosis and procedure code combination is referenced during claims adjudication.  

For more information please review the “Submitting Professional Claims” job aid on Mass.gov or contact the MassHealth Customer Service Center at 1-800-841-2900.

Rate Adjustments for Mental Health Codes

Starting on Monday 11/09/2015, MassHealth will perform mass adjustments on Mental Health codes that required a rate increase effective January 1, 2015. Providers should expect to see these adjustments in their upcoming Remittance Advice.

If you have any questions please contact MassHealth Customer Service Center at 1-800-842-2900 or providersupport@MAHealth.net.

Messages from the Week of November 9, 2015

November 9, 2015

Important Reminder – V5010 Requirements

REMINDER: As previously communicated in March, 2015, providers and other trading partners that submit claims transactions to MassHealth must adhere to the HIPAA V5010 requirements as mandated on January 1, 2012 (i.e. diagnosis code, etc.).  Transactions that do not comply with V5010 requirements will be rejected.

Please ensure that you have fully complied with this 2012 requirement. Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA. For questions, please contact MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

Messages from the Week of November 2, 2015

November 2, 2015

Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374

MassHealth is aware of an issue affecting Medicare crossover claims for dual eligible members (MassHealth and Medicare coverage) who were enrolled in a MassHealth CarePlus benefit plan. The crossover claims for these members may have erroneously denied for Edit 4371 - Benefit plan claim type restriction on procedure and/or Edit 4374 - Benefit plan claim type restriction on revenue code.   MassHealth is in the process of revising the benefit plan information for these members, and will systematically reprocess affected crossovers claims on future remittance advices.

Messages from the Week of October 26, 2015

October 26, 2015

ICD Error Code Resolution

Please note the phone number correction

Providers must ensure that claims rejected for diagnosis or ICD procedure code not on file are fully evaluated to determine what modifications must be made to the claim before it is resubmitted to MassHealth.  Specifically, providers must check to ensure that the code submitted on the claim is a valid ICD code, confirm that the dates of service billed are consistent with the code set submitted on the claim, and ensure that the correct ICD qualifier is selected on the POSC or submitted on a batch file transaction (9 = ICD-9 or 0 = ICD-10).  Once the cause of the error is identified the claim should be modified and resubmitted.

 Please reference the MassHealth ICD-10 transition bulletin at www.mass.gov/masshealth/ICD-10 to view important transition & billing information.   If you have any questions please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@MAHealth.net.

Messages from the Week of October 12, 2015

October 13, 2015

Important Reminder-Submit Valid ICD-10 Codes on Claims

MassHealth reminds providers that you must submit valid ICD-10 codes on all transactions submitted to MassHealth with dates of service or dates of discharge on or after 10/1/15. 

Please note that three digit ICD-10 CM codes can only be used if they are not further subdivided within the code set.  Please review the July 6th CMS/AMA clarification notification regarding ICD-10 at https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf. 

Please ensure that any/all codes submitted on transactions to MassHealth are valid ICD-10 codes.  Also, please review MassHealth’s ICD-10 transition bulletin at www.mass.gov/masshealth/icd-10 for additional information regarding MassHealth’s transition to ICD-10.   If you have any questions, please contact 1-800-841-2900.

Reminder – ICD-10 Claim Submission

When submitting claims transactions to MassHealth on or after 10/1/15 please ensure that the diagnosis and procedure codes submitted on all transactions are compatible. You must:

  • Include the ICD qualifier on all claims to differentiate between ICD-9 and ICD-10 claim submissions
  • Use ICD-9 codes on claims with dates of service or date of  discharge prior to 10/1/15
  • Use ICD-10 codes on  claims with dates of service or date of discharge on or after 10/1/15
  • Ensure that you are using diagnosis and procedure codes that are compatible to the ICD version submitted

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

Messages from the Week of October 5, 2015

October 5, 2015

MassHealth Implements ICD-10

MassHealth implemented ICD-10 on October 1, 2015.  

Transactions that contain ICD codes submitted to MassHealth with dates of service or dates of discharge on or after October 1, 2015 must include ICD-10 codes.  

Please visit the MassHealth ICD-10 web page at www.mass.gov/masshealth/ICD-10 to view the ICD-10 All Provider Bulletin #253, dated September 2015, which outlines key transition guidance that all providers must adhere to.

If you experience any issues with transitioning to ICD-10 please contact MassHealth Customer Service at 1-800-841-2900 or by email at providersupport@mahealth.net.

Acute Inpatient Hospitals Preadmission Screening Requests Must Be Processed Through the POSC

MassHealth will no longer accept fax and paper Preadmission Screening (PAS) requests for Acute Inpatient Hospitals as of October 1, 2015.  This change has been made to correspond with the upcoming implementation of ICD-10 (10th revision of the International Statistical Classification of Diseases) on October 1, 2015. Providers must use the Provider Online Service Center (POSC) to process all PAS requests. Providers should enter the ICD10 diagnosis code in the appropriate field and the CPT code in the notes field.  Please leave the procedure code field blank. If available, providers may enter the ICD10 PCS code in the ICD procedure field in lieu of the CPT code. 

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

Clarification Regarding Pre-Admission Screening (PAS) Submissions

MassHealth will continue to accept CPT codes on PAS requests for prospective admissions with dates of service on or after 10/01/2015. Providers should enter the ICD-10 diagnosis code in the appropriate field and enter the CPT code in the “notes” field. If you submit a CPT code in the notes field you must leave the ICD procedure field blank. If available, providers may choose to enter the ICD-10 PCS code in the appropriate ICD procedure field in lieu of the CPT code(s).

ICD-10 Implementation Monitoring

As the industry transitions to ICD-10, MassHealth will monitor the accuracy of code compatibility on transactions submitted with dates of service or dates of discharge on or after 10/1/15. 

In order to monitor code compatibility, MassHealth will suspend and review transactions that receive one of the code compatibility edits (4037 & 4066) for the first few weeks after implementation. Claims that suspend for review will be released to a paid or denied status no later than 45 days from receipt.

When submitting claims transactions to MassHealth, please be sure the diagnosis and procedure codes submitted on all transactions are compatible.

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

Messages from the Week of September 28, 2015

September 28, 2015

MMQ Terminates October 1st – You Must Transition Now!

A final reminder for all nursing facility providers: As of October 1, 2015, MassHealth will no longer support its proprietary MMQ (Management Minutes Questionnaire) software. By September 30, 2015, you must transition to another submission method. If you attempt to use the software after that date your submissions will be rejected.

One of the following MMQ submission methods must be used:

  • Using the POSC (Provider Online Service Center) DDE (Direct Data Entry) MMQ functionality
  • Submitting MMQ batch files in accordance with MassHealth MMQ file specifications
  • Hiring a vendor to generate your MMQ batch files

If you need help in transitioning, please visit the MassHealth Job Aid online at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf.

Batch submitters may view the MassHealth MMQ file specifications available at www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf.   Both of these documents were modified for ICD-10.

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

October 1st ICD-10 Implementation is Just Days Away – Please Be Ready!

MassHealth will transition to ICD-10 in four (4) days.  Please ensure that your organization is ready! 

When you submit claims transactions on or after October 1, 2015, you must:

  • Include the ICD qualifier on all claims to differentiate between ICD-9 and ICD-10 claim submissions
  • Use the appropriate code set on transactions.  This must be based upon the date of service or date of discharge
  • Ensure that you are using diagnosis and procedure codes that are compatible to the ICD version submitted
  • Include ICD-10 codes on all paper PA (Prior Authorization) requests that are sent via standard postal delivery on or after September 25th, 2015 as these requests may not be received until October 1st or later

Please view the ICD-10 implementation checklist at http://tinyurl.com/nawcdtq to ensure that you are prepared for ICD-10.

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

September ICD-10 Webinar Training Sessions Still Available - Please Sign Up Now!

With ICD-10 implementation just days away, MassHealth still has a limited number of September Webinar training sessions available for providers and vendors. 

Monday September 28th         10:00-Noon
Tuesday, September 29th        10:00-Noon

After the 10/1/15 Implementation, MassHealth is offering providers and Vendors one-hour Q&A sessions every Thursday in October:

October 8th    11:00 am – Noon
October 15th 11:00 am – Noon
October 22nd 11:00 am – Noon
October 29th   11:00 am - Noon

To register for these training sessions, visit www.masshealthtraining.com and click the Webinar tab and then select the date.

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

New Medical Practitioner Application Webinar

MassHealth is implementing a new medical practitioner application for provider enrollment.  To assist providers with the new application process we are hosting two webinars to walk thru the application and answer providers questions. To register for one of these webinars please visit www.masshealthtraining.com.

Thursday, October 15th       10:00 AM-11:00 AM
Thursday, October 15th        2:00 PM – 3:00 PM

Medical Practitioner Application Redesign

As part of our continuing efforts to improve service to our provider community, MassHealth is redesigning its provider enrollment forms. A new provider enrollment application for individuals will be introduced on 10/01/2015.

 The Provider Application for Medical Practitioners (PE-MP) will replace the Medical Assistance Program Provider Applications for the following provider types:

01: Physician
02: Optometrist
03: Optician
04: Ocularist
05: Psychologist
06: Podiatrist
07: Therapist
08: Nurse Midwife
16: Chiropractor
17: Nurse Practitioner
44: Hearing Instrument Specialist
50: Audiologist
61: Independent Nurse

With the implementation of the new Provider Application for Medical Practitioners, the National Provider Identifier (NPI) Supplement Form and the Federally Required Disclosures Form (FRDF) are no longer required for individual providers.

PLEASE DESTROY ANY COPIES OF THE OLD APPLICATIONS AFTER 10/01/2015. If any outdated applications are received after 11/01/2015 they will be rejected and applicants will be required to reapply using form PE-MP. You can request the revised application from the MassHealth Customer Service Center by e-mail at providersupport@masshealth.net or by phone at 1-800-841-2900.

Deadline for Hospitals to Submit Adjustments for Section 1202 Payments Extended to October 15, 2015

MassHealth has extended the submission deadline for Section 1202 claims adjustments for Acute Inpatient hospitals and Acute Outpatient hospitals to October 15, 2015.  Acute Inpatient hospitals and Acute Outpatient hospitals are eligible to receive Section 1202 payments for Section 1202-eligible services rendered by Section 1202-eligible physicians for dates of service in calendar years 2013 and 2014. All adjusted claims must be submitted according to the instructions in Acute Inpatient Hospital Bulletin 151 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aih-151.pdf, and Acute Outpatient Hospital Bulletin 31 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aoh-31.pdf and received by MassHealth no later than October 15, 2015. For questions, contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

Messages from the Week of September 21, 2015

September 25, 2015

RITE Way Transportation

RITE Way Transportation is no longer providing transportation services.  If you have questions or need assistance, please call MassHealth Customer Service at the dedicated telephone number that has been set up to address this matter: 1-844-748-3928.

September ICD-10 Training Sessions Still Available – Please Sign Up Now!

With ICD-10 implementation just days away, MassHealth still has a limited number of training sessions available for providers and vendors.  For in-person training, one session remains:

Boston Public Library-Hyde Park Branch, 35 Harvard Ave., Hyde Park, Thursday, September 24th, 1:30-3:00      

To register for this training session, visit www.masshealthtraining.com and click the Events tab. 

In addition to the live training, we offer you the following Webinars:

Tuesday September 22nd        10:00-Noon
Monday September 28th         10:00-Noon
Tuesday, September 29th        10:00-Noon

To register for a Webinar session, visit www.masshealthtraining.com, select the Webinar tab and then select the date.

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

October 1st ICD-10 Implementation is Just Days Away – Please be Ready!

MassHealth will transition to ICD-10 in ten (10) days.  Please ensure that your organization is ready! 

When you submit claims transactions on or after October 1, 2015, you must:

  • Include the ICD qualifier on all claims to differentiate between ICD-9 and ICD-10 claim submissions
  • Use the appropriate code set on transactions.  This must be based upon the date of service or date of discharge
  • Ensure that you are using diagnosis and procedure codes that are compatible to the ICD version submitted

Include ICD-10 codes on all paper PA (Prior Authorization) requests that are sent via standard postal delivery on or after September 25th, 2015 as these requests may not be received until October 1st or later

Please view the ICD-10 implementation checklist at http://tinyurl.com/nawcdtq to ensure that you are prepared for ICD-10.

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

Messages from the Week of September 14, 2015

September 14, 2015

October 1st ICD-10 Implementation is Just Days Away  – Are You Ready?

MassHealth will transition to ICD-10 in 17 days.  Please ensure that your organization is ready! 

When you submit claims transactions on or after October 1, 2015, please make sure to:

  • Include the ICD qualifier on all claims to differentiate between ICD-9 and ICD-10 claim submissions
  • Use the appropriate code set on transactions.  This must be based upon the date of service or date of discharge
  • Ensure that you are using diagnosis and procedure codes that are compatible 

Please view the ICD-10 implementation check-list at http://tinyurl.com/nawcdtq to ensure that you are prepared for ICD-10.

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

Messages from the Week of September 7, 2015

September 8, 2015

ICD-10 Implementation Q&A Web Conferences – Your Questions Answered

The ICD-10 implementation date of October 1st, 2015 is fast approaching. The last day to submit your first file is September 18th!

To ensure that all MassHealth trading partners are tested, we invite you to join us for a series of Q & A web conferences. This is the perfect opportunity to discuss any questions that you may have regarding testing or any obstacles that could prevent or delay your testing activities. Please view the schedule, conference line and web conference information below:

Conference Line Information:

Dial In: 1-866-740-1260, Pass Code: 1474004

Web Conference Schedule:

We look forward to you joining our ICD-10 Testing Q&A Meetings! For questions, please call the EDI Department directly at 1-855-295-4047 or by email at edi@mahealth.net.

Corrections for Edit 4037 Claims Denials 

Please note that claims adjudicated between 8/25/15 and 9/2/15 that denied for EDIT 4037- Procedure Code vs. Diagnosis Restriction will be systematically reprocessed and will appear on subsequent Remittance Advices over the next few weeks.

If a claim that denied for EDIT 4037 subsequently denies following the reprocessing, providers are advised to make the necessary correction and resubmit the claim.  

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

Missed ACA Section 1202 Payments for Providers

To those physicians who responded by the required deadlines and submitted the Physician Certification and Attestation Form to MassHealth confirming their Section 1202 eligibility:

MassHealth is now reprocessing certain claims in order to pay those physicians the difference between the Section 1202 rate and the regular physician rate that the claims originally paid.  In the coming weeks, your remittance advices will reflect these adjustments. These impacted claims, with dates of service between 1/1/13- 12/31/14, will contain the unique EOB Code 9985.

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

Professional Part B Crossover Claims: Edit 560 - M-CARE Coinsurance AMT Greater than the Amount Paid

All providers are reminded that claims containing Coordination of Benefits (COB) information must be submitted to MassHealth with valid HIPAA Claim Adjustment Reason Codes (CARCs) as reported on the other insurers’ explanation of benefits (EOB). MassHealth has identified Professional Part B crossover claims that were erroneously billed by providers with a Medicare Coinsurance Amount that is greater than the Medicare Paid Amount.

Beginning September 02, 2015, Professional Part B crossover claims submitted with a Medicare Coinsurance Amount that is greater than the Medicare Paid Amount will deny for ‘Edit 560 - M-CARE COINSURANCE AMT GREATER THAN THE AMOUNT PAID.’

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

Messages from the Week of August 31, 2015

August 31, 2015

Transition to ICD-10 October 1st – Are You Ready? Testing Deadline Extended to September 18th

ICD-10 implementation is now just days away!  As of October 1st, all providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after that date.

It is imperative that your organization is ready to transition on October 1st. Please visit the ICD-10 web page at www.mass.gov/masshealth/icd-10 to review important information about how to prepare for MassHealth’s transition to ICD-10.  If you have not yet attended one of the ICD-10 information, education and training sessions, please sign up for a session at www.masshealthtraining.com. 

The deadline to submit ICD-10 test transactions to MassHealth was August 31st. However, MassHealth is committed to working with any trading partner that is ready and willing to test. To that end, we have extended the testing deadline to Friday, September 18th.   If you have not yet tested your ICD-10 transactions and will have a test file ready before September 18th, please upload your test file at http://tinyurl.com/q55gst4 or contact the EDI Department directly at 1-855-295-4047 or by email at edi@mahealth.net.

EVSpc and EVScall Have Terminated – Effective September 1st

EVSpc and EVScall functionality have terminated as of September 1, 2015. If you attempt to use the software, you will receive a rejection message indicating that the file has not been accepted. MassHealth will NOT return a 999 HIPAA acknowledgment. This impacts both eligibility (270) and claim status inquiry (276) submissions.

You must use another eligibility verification method as outlined at http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/. Click on “Information and Software for Electronic Transactions.”

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

Important Reminder: MassHealth’s Proprietary MMQ Software Terminates October 1st – You Must Transition Now!

A final reminder for all nursing facility providers: As of October 1, 2015, MassHealth will no longer support its proprietary MMQ (Management Minutes Questionnaire) software. By September 30, 2015, you must transition to another submission method. If you attempt to use the software after that date your submissions will be rejected.

One of the following MMQ submission methods must be used:

  • Using the POSC (Provider Online Service Center) DDE (Direct Data Entry) MMQ functionality
  • Submitting MMQ batch files in accordance with MassHealth MMQ file specifications
  • Hiring a vendor to generate your MMQ batch files

If you need help in transitioning, please visit the MassHealth Job Aid online at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf.

Batch submitters may view the MassHealth MMQ file specifications available at  www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf. Both of these documents were modified for ICD-10.

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

ICD-10 Update For Early Intervention Specialty Services

To prepare for the ICD-10 implementation on October 1, 2015, MassHealth has updated  the ICD-9 diagnosis codes for Early Intervention Specialty (EIS) Services outlined in Transmittal Letter EIP-20 (Revised Service Codes and Descriptions – New Early Intervention Specialty Service) to ICD-10.

The following diagnoses ICD-10 codes are required for dates of service on or after October 1, 2015:

  • Autistic disorder (diagnosis code F84.0)
  • Other childhood disintegrative disorder (diagnosis code F84.3)
  • Asperger’s syndrome (diagnosis code F84.5)
  • Other pervasive developmental disorders (diagnosis code F84.8)
  • Pervasive developmental disorder, unspecified (diagnosis code F84.9)
  • Rett’s Syndrome (diagnosis code F84.2)

Prior to filing claims, please refer to Transmittal Letter EIP-20 for information and eligibility requirements for EIS Services.  Go to www.mass.gov/eohhs/docs/masshealth/transletters-2012/eip-20.pdf.

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

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – August 2015:

  • All Provider Bulletin 252: Improving Access for MassHealth Members with Disabilities
  • All Provider Bulletin 251: Enhancements to the Claiming Process and New Certification Process for MassHealth Limited Program
  • All Provider Bulletin 250: Enhancements to the Provider Revalidation Process

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library at http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/.

September ICD-10 Training Session Dates – Please Sign Up Now!

ICD-10 implementation is just days away! You must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. Please sign up for one of our information sessions to get an important overview of ICD-10 and the operational impacts to the POSC:

Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 10:30-Noon
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 1:30-3:00
Burlington Public Library, 22 Sears St., Burlington, Monday, September 14th, 11:00-12:30
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 10:30-Noon
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 1:30-3:00
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 10:30-Noon
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 1:30-3:00
Boston Public Library-Hyde Park Branch, 35 Harvard Ave., Hyde Park, Thursday, September 24th, 1:30-3:00      

To register for a training session, visit www.masshealthtraining.com and, under the Events tab, select the session for the date you wish to attend.

In addition to the live trainings, we offer you the following Webinars:

Tuesday September 8th 10:00-Noon
Tuesday September 22nd 10:00-Noon

To register for a Webinar session, visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the month of October will be forthcoming.

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

Messages from the Week of August 24, 2015

August 25, 2015

Masshealth Claims Denied For Edit 2548 – Non-Covered Amount is Not Equal to Billed Amount

MassHealth has identified claims adjudicated from 6/23/15 through 8/14/15 which paid erroneously.  

The affected claims contained an amount in the non-covered amount field which was not equal to the claim billed amount.  These claims have been reprocessed and will deny for Edit 2548 NON-COVERED AMT IS NOT EQUAL TO THE BILLED AMT on future remittance advices. Providers should refer to Appendix “Supplemental Instructions for Claims with Other Insurance” in the Provider Manual for instructions on billing claims using the non-covered amount field for TPL exception billing.

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

Messages from the Week of August 17, 2015

August 17, 2015

Reminder: September 1st Deadline for Hospitals to Submit Adjustments for Section 1202 Payment

This is a reminder to Acute Inpatient hospitals and Acute Outpatient hospitals that, in order to receive Section 1202 payments for Section 1202-eligible services rendered by Section 1202-eligible physicians for dates of service in calendar years 2013 and 2014, all adjusted claims must be submitted to and received by MassHealth by September 1, 2015.

Please refer to Acute Inpatient Hospital Bulletin 151 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aih-151.pdf pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                 , and Acute Outpatient Hospital Bulletin 31 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aoh-31.pdf pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                for additional guidance.

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

Important Reminder - V5010 Requirements

REMINDER: As previously communicated in March, 2015, providers and other trading partners that submit claims transactions to MassHealth must adhere to the HIPAA V5010 requirements as mandated on January 1, 2012 (i.e. diagnosis code, etc.). Transactions that do not comply with V5010 requirements will be rejected.

Please ensure that you have fully complied with this 2012 requirement. Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

Augmentative and Alternative Communication (AAC) Device Coverage

Coverage for electronic tablets already in effect for children under EPSDT:

Under its DME program, MassHealth covers medically necessary dedicated AAC tablets and AAC software and applications for children under age 21. A dedicated tablet is one that is configured to limit the primary use to a medical purpose, such as for use as an AAC (for example, as a speech generating device).

An evaluation by a healthcare practitioner (physician, physician assistant or nurse practitioner) and a speech therapist are required to confirm the medical need for an AAC and then the medical appropriateness of a particular device, such as a tablet. The speech therapist will then recommend a DME provider that could provide the AAC device or tablet. The DME provider should follow the existing prior authorization process to request authorization to provide the tablet to the child. New and existing DME providers should contact MassHealth customer service (1-800-841-2900) for enrollment and prior authorization information.

MassHealth is in the process of updating its regulations to (1) explicitly add, to the definition of DME, electronic devices used as for medical purposes as AAC, such as tablets dedicated to the functional speaking needs of the member and locked or configured to prevent use not related to communication and (2) include coverage of AAC software and applications.

Once the regulations have been updated, MassHealth will cover medically necessary dedicated tablets as AAC through a prior authorization process available for members of all ages.

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

Messages from the Week of August 10, 2015

August 13, 2015

MassHealth Member Eligibility Verification Processing Issue (HIPAA 270)

MassHealth has identified an issue when processing HIPAA 270 eligibility transactions. The issue occurred when a provider submits a HIPAA 270 request spanning multiple dates: for example the request was for member eligibility from 7/1/2015 to 7/10/2015 but MassHealth was only returning a response for 7/1/15. This issue starting occurring after 10PM on Sunday August 9th (after a code promotion) and impacted all HIPAA 270 requests submitted with spanning dates up to 5PM on Wednesday, August 12th. Requests with single dates of eligibility were not impacted. The issue is now corrected. We ask that any providers with HIPAA 270 inquiries that were impacted to please resubmit the requests to us if applicable.

We apologize for any inconvenience caused by this error and thank you for your continued commitment to the MassHealth Program.

Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

August 10, 2015

ICD-10 Trading Partner Testing Q&A Web Conferences in August – Please Sign Up!

The October 1st ICD-10 implementation date is fast approaching. The last day to submit your first file is August 31st!  

To ensure that all MassHealth trading partners that submit transactions to MassHealth and/or develop software for MassHealth providers are tested prior to implementation, we invite you to join us for a series of web conferences to discuss any questions that you may have regarding testing or any obstacles that could prevent or delay your testing activities. This is the perfect opportunity to have your concerns addressed and questions answered. Listed below is the schedule, conference line and web conference information:  

Conference Line Information:
Dial In: 1-866-740-1260, Pass Code: 1474004

10:00 AM Thursday August 13th:
Web Conference Information: https://cc.readytalk.com/r/7eu0m3ju7zeg&eom

10:00 AM Thursday August 20th:
Web Conference Information: https://cc.readytalk.com/r/hw2kv0r0f3ur&eom

10:00 AM Thursday August 27th:
Web Conference Information: https://cc.readytalk.com/r/iiv5xdduuxww&eom

We look forward to you joining our ICD-10 Testing Q&A Meetings! For questions, please call the EDI Department directly at 1-855-295-4047 or by email at edi@mahealth.net.

ICD-10 Training Session Dates in August and September – Please Sign Up Now!

All MassHealth providers are again reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. MassHealth is offering information sessions that provide you an overview of ICD-10 and the operational impacts to the POSC system. Please sign up for one of the August or September training dates below:

Milford Public Library 80 Spruce St, Milford, Thursday August 20th 10:30-12:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 1:30-3:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 10:30-12:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 1:30-3:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 10:30-12:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 1:30-3:00
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 10:30-Noon
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 1:30-3:00
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 10:30-Noon
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 1:30-3:00
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 10:30-Noon

Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 1:30-3:00
Burlington Public Library, 22 Sears St., Burlington, Wednesday, September 23rd, 10:30-Noon
Burlington Public Library, 22 Sears St., Burlington, Wednesday, September 23rd, 1:30-3:00
Boston Public Library-Hyde Park Branch, 35 Harvard Ave., Hyde Park, Thursday, September 24th, 1:30-3:00

To register for a training session, visit www.masshealthtraining.com and, under the Events tab, select the information session for the date you wish to attend.

In addition to the live trainings, we offer the following Webinars:

Tuesday August 11th 10:00-Noon
Tuesday September 8th 10:00-Noon
Tuesday September 22nd 10:00-Noon

To register for the Webinar session, visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of September and October will be forthcoming.

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

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – July 2015

  • Acute Inpatient Hospital Bulletin 152: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
  • All Provider Bulletin 249: ICD-10 Implementation Readiness
  • Community Health Center Bulletin 83: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
  • School-Based Medicaid Bulletin 28: School-Based Medicaid Program Guidance on Indirect Cost Rates

TRANSMITTAL LETTERS – July 2015:

  • LAB-44: Subchapter 6 Revisions
  • AOH-35: Revised Service Codes 

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library at http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/.

Messages from the Week of August 3, 2015

August 3, 2015

Thank You for Completing the ICD-10 Readiness Survey

MassHealth wants to thank the many providers who took the time to complete our brief online survey on ICD-10 readiness.

With the October 1, 2015 implementation date fast approaching, your survey answers will help MassHealth better understand the current status of provider preparation, e.g., deploying new software and testing transactions.  MassHealth can provide assistance, guidance and materials to all providers, vendors, billing intermediaries and clearinghouses.

All providers are urged to stay current with MassHealth’s latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids. Go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

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

Messages from the Week of July 27, 2015

July 27, 2015

EVSpc and EVScall Terminate September 1st – You Must Transition Now!

All MassHealth providers are again reminded: EVSpc and EVScall will terminate on September 1, 2015. All functionality will cease as MassHealth cannot provide software support after that date.

You must stop using the software immediately and transition to other eligibility verification methods outlined at http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/ and click on “Information and Software for Electronic Transactions.”

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits even if EOHHS has been advised of the possibility of such damages.

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

Important Reminder to All Providers: Please Complete the ICD-10 Readiness Survey by this Friday, July 31st

ICD-10 implementation is only two months away – October 1st, 2015.  As a MassHealth provider or vendor, you must be ready for this implementation.

Please take MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 31st by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?id=416.  How are you preparing for ICD-10? Have you deployed new software?  Do you need any assistance, guidance or materials?

Your survey answers will help MassHealth to a.) better understand the status of your implementation effort and b.) provide assistance and/or guidance to providers, vendors, billing intermediaries and clearinghouses as October 1st approaches.

Please stay current with MassHealth’s latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

Messages from the Week of July 20, 2015

July 20, 2015

Revamped Revalidation Webinar Now Available For Providers

All MassHealth providers are invited to join the revamped Revalidation Tutorial Webinar for guidance on how to complete the Revalidation process. 

The webinar will provide you step-by-step instructions on how to access your information on the POSC, change/update your profile information and download and complete any original signature documents that may be required.

Webinars are held every 2nd Thursday and 4th Tuesday of the month.  The next Webinar will be held: 

Tuesday, July 28, 2015
1:00 – 2:00 PM

To join the Webinar, go to:

Audio Login -
Toll-Free (US & Canada): 866.740.1260
Toll: 303.248.0285
Access Code: 4725660

Web Login -
Meeting URL: http://www.readytalk.com/?ac=4725660
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800.843.9166 or help@readytalk.com
Access Code: 4725660

We also offer more information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid.  Please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment and click on Provider Revalidation. For questions, please contact MassHealth Customer Service at revalidation@mahealth.net or call 1-800-841-2900.

Deadline Extended to July 31st! Please Complete the ICD-10 Readiness Survey

Are you ready FOR ICD-10 implementation on October 1, 2015? How is your organization preparing for ICD-10? Do you need any materials, guidance or assistance from MassHealth?  Have you deployed new software? Are you ready to test transactions?

Please complete MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 31st by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?id=416

Your answers will help MassHealth better understand the status of your implementation effort and provide assistance and/or guidance to providers, vendors, billing intermediaries and clearinghouses as the implementation date approaches.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

ICD-10 Training Session Dates Available in August – Please Sign Up Now!

All MassHealth providers are reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. To help you prepare for ICD-10 implementation, MassHealth is offering information sessions that provide an overview of ICD-10 and the operational impacts to the POSC system. Please view the list of August training dates below:

South Yarmouth Public Library 312 Old Main St, S. Yarmouth, Tuesday August 4th 1:30-3:00
Medford School of Nursing 107 Governors Ave, Medford, Thursday August 6th, 10:30-12:00
Medford School of Nursing 107 Governors Ave, Medford, Thursday August 6th, 1:30-3:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 10:30-12:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 1:30-3:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 10:30-12:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 1:30-3:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 10:30-12:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 1:30-3:00                    

To register for a training session, please visit www.masshealthtraining.com and, under the Events tab, select the information session for the date you wish to attend.

In addition to the live trainings, we offer the following Webinar:
Tuesday August 11th 10:00-12:00

To register for the Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of September and October will be forthcoming.

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

Messages from the Week of July 13, 2015

July 13, 2015

Claims to Deny or Suspend for Duplicative Services

Effective dates of service July 1, 2015, MassHealth has implemented changes to prevent payment of duplicative services for the following providers/programs: Personal Care Attendant (PCA) program, Adult Foster Care (AFC) and Group Adult Foster Care (GAFC), Home Health Agencies (HHA) and Independent Nurses.  Audits will deny or suspend claims if there is a conflict. Examples:

  • Provider submits PCA program claim; claim will deny if member is already in AFC/GAFC
  • Provider submits AFC/GAFC claim; claim will deny if member is already in the PCA program
  • Member is in an inpatient/institutional setting (chronic, acute, SNF); claim should suspend if member is already in PCA, AFC/GAFC or HHA/Continuous Skilled Nursing

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

Claims Edits to Identify Potential Duplicative Services for Assessments/Evaluations/Re-Evaluations

Effective dates of service July 1, 2015, MassHealth has implemented changes to identify potential duplicative services for the following providers: Personal Care Management (PCM) Agencies and Adult Foster Care (AFC).  Audits will be posted on the Remittance Advice (RA) if there is a conflict. Examples:

  • Provider submits PCA program evaluation or reevaluation; claim will pay with the edit that indicates that the member is already in AFC/GAFC
  • Provider submits an AFC assessment; claim will pay with the edit that indicates that the member is already in the PCA program

PCM and AFC providers receiving this edit will need to work with the member to resolve any conflicts in service before proceeding to enroll the member into the PCA or AFC program to prevent fraud and denials.

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

Claims Submitted for Therapy Services Provided by Assistants Will Not be Paid

Therapy providers are reminded that MassHealth does not currently pay for therapy services provided by physical, occupational or speech therapy assistants as per MassHealth regulation 432.412 in the Therapy Provider Manual:

432.412: Nonpayable Services
The MassHealth agency does not pay a therapist for any of the following services:

(A) Services provided by any person under the therapist's supervision;

For questions, please contact the Customer Services Center at 1-800-841-2900 or providersupport@masshealth.net.

Messages from the Week of July 6, 2015

July 7, 2015

Important Reminder on V5010 Requirement to Include Attending Provider NPI on Claims

REMINDER: As previously communicated in March, 2015, providers and other trading partners that submit claims transactions to MassHealth must adhere to the HIPAA V5010 requirements as mandated on January 1, 2012. This includes ensuring that the attending provider’s NPI is submitted on any/all institutional claims except for claims that only include non-scheduled transportation. 

Please note that effective August 9, 2015 MassHealth will begin to reject institutional claims that do not contain the Attending Provider’s NPI. The only exception will be for claims containing non-scheduled transportation services.

Please ensure that you have fully complied with this 2012 requirement.   Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

Important Reminder: MMQ Software Terminates in Three Months – Have You Transitioned Yet?

All nursing facility providers are again reminded: As of October 1, 2015, MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software. By September 30, 2015, you must transition to another method of submitting MMQs, such as:

  • Using the POSC (Provider Online Service Center) DDE (Direct Data Entry) MMQ functionality
  • Submitting MMQ batch files in accordance with MassHealth MMQ file specifications
  • Hiring a vendor to generate your MMQ batch files

Do you need help in transitioning? MassHealth has posted a Job Aid online at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf.

Batch submitters may view the MassHealth MMQ file specifications available at www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf. Both of these documents were modified for ICD-10.

For questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

EVSpc AND EVScall Terminate in Two Months – You Must Transition Now

All MassHealth providers are again reminded: EVSpc and EVScall will terminate on September 1, 2015. All functionality will cease as MassHealth cannot provide software support after that date. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)
    • You must coordinate with MassHealth Customer Service to test batch and HTS files before you will be allowed to submit and receive HIPAA transactions in an electronic batch file format through the POSC or HTS methods.
    • If you already use a vendor that submits “270” requests for you from a system that does NOT use the EVSpc/EVScall software, you should not be impacted by the EVS termination. Confer with your software vendor if you have any questions regarding its submission methods.

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits even if EOHHS has been advised of the possibility of such damages.

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

ICD-10 is Just 90 Days Away – You Must Test Transactions Now!

All MassHealth providers are reminded: ICD-10 will be implemented on October 1, 2015. Both providers and vendors that submit transactions on behalf of providers must test ICD-10 transactions with MassHealth prior to implementation. If you or your vendor do not test with MassHealth, there is a risk that your claims may deny in “production,” which may negatively impact financials.

  • Please contact the MassHealth EDI team immediately at 1-855-295-4047 or at edi@mahealth.net to schedule a test date.
  • If you do not plan to test, please contact the EDI team to confirm why you are not testing.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at  www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

Changes to the Personal Care Attendant (PCA) Orientation Service Code

Effective July 1, 2015 dates of service, the service code that Fiscal Intermediaries use to bill for PCA Orientation will be changing.

The new service code is:

  • 99509 U3 - Home Visit Day Life Activity (Personal Care Services) (Use to bill for PCA New Hire Orientation, per diem, per eligible PCA)

Fiscal Intermediaries should use the payroll claiming number when billing this code to MassHealth. Updates to subchapter 6 of the Provider Manual are forthcoming.

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

Personal Care Attendant (PCA) Earned Sick Leave Pay

Effective July 1, 2015 dates of service, Fiscal Intermediaries will be able to submit claims to MassHealth for PCAs who have earned PCA Sick Leave pay.

The service code for billing the PCA Sick Leave is:

  • 99509 U1 - Home Visit Day Life Activity (Personal Care Services per 15 minutes) (Use to bill for PCA Earned Sick Leave pay) (Current PA for PCA Services required for each member)

Fiscal Intermediaries should use the payroll number when billing this code to MassHealth. Updates to subchapter 6 of the Provider Manual are forthcoming.

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

Messages from the Week of June 29, 2015

June 29, 2015

ICD-10 Training Session Dates Available in July – Please Sign Up Now!

REMINDER: All MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. To help you prepare for ICD-10 implementation, MassHealth is providing information sessions to guide you on how to implement ICD-10 with MassHealth. Please view the list of July training dates below:

-Tuesday July 14: 10:00 AM-Noon, Baystate Medical Center, 101 Wassen Ave., Springfield MA
-Tuesday July 14: 1:00-3:00 PM, Baystate Medical Center, 101 Wassen Ave., Springfield MA
-Wednesday July 15: 10:00 AM-Noon, Worcester Library, 3 Salem Street, Worcester MA
-Wednesday July 15: 1:00 PM - 3:00 PM, Worcester Library, 3 Salem Street, Worcester MA

To register for a training session, please visit www.masshealthtraining.com and under the Webinar tab select the LIVE ICD-10 Training for the date you wish to attend.

In addition to the live trainings, we offer the following Webinar:

Monday July 13, 2015 10:00 AM – 12:00 PM

To register for the Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of August through October will be forthcoming.

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

Messages from the Week of June 22, 2015

June 22, 2015

Please Complete the ICD-10 Readiness Survey

ICD-10 must be implemented on October 1st, 2015. As a MassHealth provider or vendor, are you ready? How is your organization preparing for ICD-10? Do you need any materials, guidance or assistance from MassHealth?  Have you deployed new software? Are you ready to test transactions?

Please take MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 17th by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?preview=show&id=416.

Your answers will help MassHealth to better understand the status of your implementation effort and provide assistance and/or guidance to providers and vendors, billing intermediaries and clearinghouses as the implementation date approaches.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

ICD-10 Training Session Dates Now Available June and July – Please sign Up!

REMINDER: MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015.  To help you prepare for ICD-10 implementation, MassHealth is providing training sessions to guide you on how to implement ICD-10 with MassHealth. Please view the list of June and July training dates below:

-Wednesday, June 24, 10:30 am–12:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Wednesday, June 24, 1:30 pm–3:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Thursday, June 25, 10:30 am–12:00 pm, Brightwood Library, 359 Plainfield St. Springfield MA
-Thursday, June 25 1:30 pm–3:00 pm, Brightwood Library, 359 Plainfield St. Springfield, MA
-Tuesday, June 30, 10:30 am–12:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday, June 30, 1:30 pm–3:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday July 14: 10:00 am-Noon, Baystate Medical Center, 101 Watson Ave., Springfield MA
-Tuesday July 14: 1:00-3:00 pm, Baystate Medical Center, 101 Watson Ave., Springfield MA
-Wednesday July 15: 10:00 am-Noon, Worcester Library, 3 Salem Street, Worcester MA
-Wednesday July 15: 1:00 PM - 3:00 pm, Worcester Library, 3 Salem Street, Worcester MA

To register for a training session, please visit www.masshealthtraining.com and under the Webinar tab select LIVE ICD-10 Training for the date you wish to attend.

In addition to the live trainings, we offer the following Webinars:

Monday June 29, 2015 10:00 AM – 12:00 PM
Monday July 13, 2015 10:00 AM – 12:00 PM

To register for a Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then the date you wish to attend. Additional training session dates, times and locations for the months of August through October will be forthcoming.

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

Attention All Providers: Important New Changes to Revalidation Process

All MassHealth providers are advised that there are two new changes that affect how you complete revalidation and enrollment, as explained below.

  1. An original “wet” signature is no longer required on the FRDF (Federally Required Disclosures Form). You may now submit a FRDF to MassHealth by uploading it onto the POSC, by e-mail or by fax (1-617-988-8974). Please provide a fax cover sheet requesting that the document be scanned to your PID/SL or ATN.
  2. There are now revalidation-specific document type labels in the drop-down menu on the POSC (Provider Online Service Center). Please select document types that begin with “REV” when you submit documents in response to a Revalidation Notification and follow these steps:
    1. Go to the Steps panel and click Attachments.
    2. Under List of Attachments, click New Item.
    3. Under Attach and Send Files:
      1. From the Document Type drop-down menu, click the applicable document type.
      2. Click Browse and then select your document to upload.
      3. Click Add/Upload to add the document to the provider file.

If you need assistance, MassHealth offers revalidation tutorial webinars on the 2nd Thursday and 4th Tuesday of every month. To register for the webinar, please go to: http://www.masshealthtraining.com/lms/_portal/account/?2.

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

Messages from the Week of June 8, 2015

June 9, 2015

ICD-10 Training Sessions Now Available – Have You signed Up Yet?

REMINDER: MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015.

To help you prepare for ICD-10 implementation, MassHealth is providing training sessions to guide providers on how to implement ICD-10 with MassHealth.  The sessions will be conducted from June 24, 2015 to October 8, 2015.  Please view the list of June training dates below:

-Wednesday, June 24, 10:30 am–12:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Wednesday, June 24, 1:30 pm–3:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Thursday, June 25, 10:30 am–12:00 pm, Brightwood Library, 359 Plainfield St. Springfield MA
-Thursday, June 25 1:30 pm–3:00 pm, Brightwood Library, 359 Plainfield St. Springfield, MA
-Tuesday, June 30, 10:30 am–12:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday, June 30, 1:30 pm–3:00 pm, Old Colony Library, 2 Main St. Randolph, MA

To register for one of these training sessions, please visit www.masshealthtraining.com.  Additional training session dates, times and locations for the months of July through October will be forthcoming.

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

ICD-10 Starts October 1st – Time is Running Out For Transaction Testing

REMINDER:  The ICD-10 implementation is just four months away. If you are a vendor that submits transactions to MassHealth on behalf of providers, you must test transactions with MassHealth before implementation. Please contact the MassHealth EDI team immediately at 1-855-295-4047 or at edi@mahealth.net to schedule a test date.  If you do not plan to test, please contact the EDI team to confirm why you are not testing.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at

www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

Messages from the Week of June 1, 2015

June 1, 2015

MassHealth Prior Authorization Requirements

Reminder: MassHealth requires providers to obtain prior authorization (PA) for certain services.

Please review your MassHealth program regulations for a proposed service to determine when PA is required.

Please note that PA requests for certain services require additional forms that must accompany your request. In addition to program regulations that apply to your provider type, and the all provider regulations at130 CMR 450.303, PA requirements may appear in Subchapter 6 of certain provider manuals, in provider bulletins or in other written issuances from MassHealth. You can access the MassHealth provider manuals and provider bulletins from the MassHealth online Provider Library at http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. 

Durable Medical Equipment, Oxygen, Orthotics and Prosthetics should also refer to coverage guideline tools for PA requirements. These providers can access the coverage guideline tools by clicking on Provider Library and then on MassHealth Payment and Coverage Guideline Tool.

Providers must follow these PA guidelines to avoid such claim denials as Edit Code 3003 (Procedure code requires PA).  For any PA questions, please contact the Prior Authorization Unit (PAU) at PriorAuthorization@umassmed.edu or 1-800-862-8341.

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – May 2015:

  • DEN-93: Revised Service Codes
  • FPA-52: 2015 HCPCS
  • PHY-144: 2015 HCPCS
  • ROC-3: 2015 HCPCS

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/).

Messages from the Week of May 25, 2015

May 26, 2015

To DME Providers and Hospice Providers

This is a reminder that the hospice provider is responsible for all durable medical equipment (DME) and medical supplies for the management of terminal illness for the member receiving hospice services.

Claims from DME providers for DME and medical supplies for members receiving hospice services will be automatically denied. DME providers are required to re-submit their claims with documentation showing that the services provided are not related to the terminal illness. Providers should resubmit these claims with the supporting documentation on the POSC according to All Provider Bulletin 225, using Delay Reason Code 11. Program managers will review these claims. In certain cases where the member has been receiving supplies before initiation of hospice services, and/or if supplies are not related to the terminal illness, claims will be paid.

Hospice Provider Manual: 437.423: Covered Services
(G) Drugs and Durable Medical Equipment and Medical Supplies. The hospice must provide and be responsible for all drugs and durable medical equipment and medical supplies needed for the palliation and management of the terminal illness and related conditions, according to the member's plan of care.

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

Messages from the Week of May 18, 2015

May 18, 2015

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 3 weeks.  Please see the modified payment schedule outlined below.

RA DATE: 07/07/2015
PAYMENT DATE CHECKS: 07/10/2015
PAYMENT DATE EFT: 07/13/2015

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: 07/21/2015
PAYMENT DATE CHECKS: 07/24/2015
PAYMENT DATE EFT: 07/27/2015

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

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

Attention Dental Providers: Important Information Regarding Adult Dentures

Effective May 15, 2015 MassHealth will cover dentures for adult members.

The affected service codes covered are:

D5110, D5120, D5211, D5212, D5510, D5520, D5610, D5620, D5630, D5640, D5650, D5660, D5710, D5711, D5730, D5731, D5750, D5751

Prior Authorization is not required; however, other limitations may apply. Please check the Office Reference Manual at www.masshealth-dental.net for complete coverage information.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

Messages from the Week of May 11, 2015

May 14, 2015

Provider Online Service Center (POSC)

The MassHealth Provider Online Service Center (POSC) is currently experiencing intermittent issues with processing of Direct Data Entry (DDE) Claims.  If you get a message when submitting a DDE claim that “Your transaction has not been processed please try again later”  we ask that you wait for 30 minutes and check if the claim was received before resubmitting the claim.  In some cases, this message is posting despite the claim being processed in the MassHealth system. Other portal functions are not impacted. We are working to resolve this issue and we apologize for any inconvenience that this may cause.

Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.

Member Eligibility Submission Limit in Effect as of May 8th

Effective Friday, May 08, 2015, MassHealth began placing a limit on member eligibility batch transactions. Any single transaction including more than 3,000 members will be rejected. This limit allows for more efficient and timely processing of all eligibility transactions.

OF IMPORTANCE: Due to technical issues, this submission limit went into effect two days prior to the original effective date communicated (May 10, 2015). If you were not able to support this change until the original implementation date of May 10th and you experienced validation issues due to the 3,000 limit on either May 8th or May 9th, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

To ensure the efficient processing of your eligibility request, please adhere to these submission guidelines:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. ALWAYS INCLUDE the member’s Medicaid ID number on the eligibility request if known.
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received.

ICD-10 Implementation – Urgent Reminder – Vendor-PHASE II Testing Ends on May 29, 2015

An urgent reminder from MassHealth: Vendor Phase II testing will end on May 29, 2015.

To date there has been limited vendor participation in the MassHealth ICD-10 testing phase.

If you are a vendor that submits transactions to MassHealth on behalf of providers you must test that transaction with MassHealth before implementation.

MassHealth strongly urges vendors that are ready for testing to arrange a test date immediately. Contact the EDI team directly at 1-855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

Messages from the Week of May 4, 2015

May 4, 2015

New XML Gateway Hardware and IP Address

Effective Tuesday April 28th,  MassIT has put new XML Gateway hardware into operation and the IP address of the XML gateway DNS name has changed.  If you are using the fully qualified domain name (wsgw.mass.gov) for the XML gateway, then this change will be transparent to you.  For those partners who are connecting via an IP address or have hard coded the IP address of the XML Gateway, you will want to change to use the Fully Qualified Domain name and/or new IP.  As we transition to the new gateway, we will monitor traffic and attempt to notify any customers that are required to make changes, but a proactive check is recommended to prevent any unplanned service disruptions.  Partners who may have hardcoded old IP addresses are advised to replace them as soon as possible with the new IP addresses and  update firewall rules as needed to assure connectivity. Please also check to ensure the retired gateway IPs are not cached anywhere (interchange agent) as well. The old hardware will be retired in the coming weeks.

Retiring Hardware Enterprise XML Gateway IPs:

Host NameVIP (target)Physical (source)
wsgw.mass.gov (Prod)170.63.98.114170.63.98.115 and 170.63.98.116

New Enterprise XML Gateway IPs:
Host NameVIP (target)Physical (source)
wsgw.mass.gov (Prod)170.63.70.72170.63.70.73 and 170.63.70.74


If you are experiencing any issues related to this change, please contact the MassIT CommonHelp at commonhelpservicedesk@massmail.state.ma.us or call (866) 888-2808.

Important Information for Chronic Disease and Rehabilitation Hospitals: Billing for Administrative Days (ADs)

For inpatient admissions on or after April 17, 2015, MassHealth will limit payment for Administrative Day (AD) coverage.  MassHealth will no longer pay for the first approved 45 administrative days of a member’s inpatient hospital stay. For any approved administrative day stay beyond 45 days, MassHealth will pay the hospital at its current AD rate.

For this matter, hospitals will be required to split their claims when billing for a continued inpatient stay that includes both hospital level of care and administrative day level of care in addition to entering an Occurrence Span Code on their claims.  The following are revised billing instructions that hospitals must follow when billing for administrative days:

  1. For hospital level of care days, hospitals should continue to bill as they currently do.
  2. For administrative day level of care stay, up to the first 45 days, hospitals should bill with an Occurrence Span Code of 22 along with the Occurrence Span Dates for the member’s stay.
  3. For administrative days that exceed 45 days (i.e., day 46 and beyond), hospitals should bill with an Occurrence Span Code of 21 with the Occurrence Span Dates for the member’s stay.

MassHealth policy regarding pre-admission screening, conversion and continued stay reviews has not changed.  Claims will continue to require a Preadmission Screening (PAS) number when billing any inpatient hospital stay.

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

EVSpc and  EVScall Terminate September 1st – Do you need Assistance in Transitioning?

MassHealth continues to remind all providers that EVSpc and EVScall will terminate on September 1, 2015. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)

To help you choose another verification method, MassHealth has posted a detailed Job Aid online. Go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

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

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – April 2015:

  • AFC-14: Alternative Placement Days
  • CDR-30: Elimination of Payment for Administrative Days

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/).

Messages from the Week of April 27, 2015

April 27, 2015

Important Information to Dental Providers: DentaQuest Provider Web Portal Availability

Due to a DentaQuest system update, there was an interruption in the loading of updated MassHealth member eligibility information to the provider web portal over the weekend of April 24th 2015. Please note:

  • The member eligibility data that will be available will be current as of 2:00 PM, Thursday April 23rd, and will likely not be updated until Tuesday April 28. DentaQuest will update the message on the provider portal if the files are not updated by this date.
  • During this time, while you can print copies of the member’s eligibility screen for appeals purposes, please be aware that MassHealth will NOT pay claims for members who have lost eligibility during this time.
  • Claims entered via the portal during the migration will experience a delay in processing.
  • Remittance Advices will not be posted until Tuesday April 28th.

The DentaQuest system update is essential to the improvement of their systems. Thank you for your patience while DentaQuest completes these enhancements.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

Messages from the Week of April 20, 2015

April 21, 2015

MMQ Software Terminates on October 1, 2015 – Please Transition Now

All nursing facility providers are again reminded that MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software as of October 1, 2015. By September 30, 2015, you must transition to an alternative method of submitting MMQs, such as:

•   Using the POSC (Provider Online Service Center) DDE (Direct Data Entry) MMQ functionality
•   Submitting MMQ batch files in accordance with MassHealth MMQ file specifications
•   Hiring a vendor to generate your MMQ batch files

To assist you in transitioning, MassHealth has posted a Job Aid online at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf.

Batch submitters may view the MassHealth MMQ file specifications available at www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf. Both of these documents were modified for ICD-10.

For questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

Messages from the Week of April 13, 2015

April 13, 2015

MassHealth Hospice Provider Training Webinar on May 6th 

To all Hospice Providers - Admitting Nurses, Billing Staff and Quality Managers: MassHealth invites you to attend a Provider Training Webinar on May 6th from 1:30 – 3:00 pm.

Information will include updates to regulations, review of current regulations that impact payment, information on the hospice election form, nursing facility guidelines, program eligibility, and claims and payment information. To join the webinar:

Conference Call Login:

Toll-Free (US & Canada): 866-740-1260
Access Code: 4725653

Web Login:

Meeting URL: http://www.readytalk.com/?ac=4725653
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800.843.9166 or help@readytalk.com
Access Code: 4725653

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

Update – Customer Service Center Experiencing Unusual High Call Volume

As the MassHealth Customer Service Center continues to experience unusually high call volume, providers are advised to avoid long wait times on the telephone by using the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please include your full name, MassHealth provider name, PIDSL (Provider Identification Service Location Number) and/or NPI, phone number and the details of the inquiry. The MassHealth Customer Service Center will direct your question(s) to the appropriate customer service specialist to assist you as quickly as possible.

OF IMPORTANCE: Please do not send member PHI (protected health information) in your email.  Instead, please notify MassHealth by email that you have a question that requires transmission of PHI and we will respond by initiating a secure email discussion with you.

ICD-10 Trading Partner Testing – Have You Signed Up Yet?

MassHealth reminds all providers: you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2015, as required by federal law. To help you prepare for ICD-10 implementation, MassHealth is currently testing with trading partners. Full Trading Partner Testing began April 1, 2015 and will continue through September 30, 2015.

If you submit batch claims transactions to MassHealth, it is imperative that you schedule a test date immediately.  The MassHealth EDI testing team has been outreaching to providers to schedule test dates.  Please ensure that your organization responds to all outreach attempts made by MassHealth.

If you are not certain that your organization has scheduled a test date, please contact the MassHealth EDI testing team directly at 855-295-4047 (toll free) or at edi@mahealth.net.

To stay current with the latest ICD-10 updates, including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, Provider Bulletins and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

Messages from the Week of April 6, 2015

April 6, 2015

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

BULLETINS – March 2015:

  • Long-Term Care Facility Bulletin 109: Annual Review of Personal Needs Allowance Account

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/).

Important Message for Acute Inpatient Hospitals – Information on Claims Adjustments and Billing Instructions for Admissions Spanning 10/1/14 are now Available Online

In-state and out-of-state acute inpatient hospitals are advised that information on claim adjustments and additional billing instructions for hospital stays that span October 1, 2014, and that exceed 20 days are now available online.

Inpatient acute hospitals are now being paid using the new FFY15 (Federal Fiscal Year 2015) APAD (Adjudicated Payment Amount per Discharge) methodology and, for qualifying discharges as applicable, the FFY15 Outlier Payment methodology. These replace the prior FFY14 SPAD (Standard Payment Amount per Discharge) and outlier per diem methodologies. The web page clarifies payment and details claims adjustments and billing instructions for admissions that occurred before and extended beyond October 1, 2014, with a length of stay of greater than 20 acute days.

MassHealth will be voiding and correctly paying certain claims for these admissions.

Hospitals must now follow the new billing instructions outlined on the web.

Please go to: www.mass.gov/eohhs/provider/insurance/masshealth/claims/customer-services/billing/ and then click on Billing Tips.

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

Messages from the Week of March 30, 2015

March 30, 2015

Important Reminder: EVSpc and EVScall Terminate September 1st

All providers who are still using EVSpc and EVScall to verify member eligibility are again reminded: EVSpc and EVScall will terminate on September 1, 2015. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)

To help you with these suggested transition methods, MassHealth has posted a detailed Job Aid online. Go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

Please do not delay! EVSpc/EVScall has already stopped displaying current key eligibility messages regarding MassHealth member coverage.

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

Important Reminder to Dental Providers: All TPL Claims Must Be Sent Electronically Effective May 1, 2015

Dental providers are reminded: all TPL claims must be sent electronically, effective May 1, 2015.

Paper TPL claims sent on or after this date will be denied.  Please see the Dental Provider web portal for more information: www.masshealth-dental.net.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

Attention All Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

All MassHealth Dental Providers billing CDT service codes are again reminded: please disregard any past RA message texts that advised of MassHealth mail forwarding ending on 12/31/14.

This message does not affect MassHealth Dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Please send all Dental Claims to the following address only:

DentaQuest – MassHealth Dental Claims
12121 North Corporate Parkway
Mequon, WI 53092

Dental providers should continue to refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, prior authorizations, claims, electronic claims, provider complaints and fraud, and provider enrollment.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

Messages from the Week of March 23, 2015

March 25, 2015

MassHealth Remittance Advices (RA) and HIPAA 835 Payment Files

MassHealth Remittance Advices (RA) and HIPAA 835 Payment files are now available for download. We apologize for the delay.  If you have questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.

March 23, 2015

Clarification Regarding Submission of Hospital-Based Nonbilling Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

The Hospital-Based Nonbilling Provider Enrollment Form must be submitted to MassHealth on or before April 1, 2015 for services of hospital-based physicians working in hospital-licensed health centers, acute inpatient hospitals or acute outpatient hospitals to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.             

Physicians can obtain Hospital-Based Nonbilling Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) can be found  in MassHealth Provider Bulletins issued in February 2015 at: www.mass.gov/eohhs/provider/insurance/masshealth/section-1202-rates-for-physicians-who-provide-pcs.html

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

V5010 – Reminder to Providers

REMINDER: Providers and other trading partners that submit claims transactions to MassHealth must adhere to the HIPAA V5010 requirements as mandated on January 1, 2012. This includes ensuring that the attending provider’s NPI is submitted on any/all institutional claims except for claims that only include non-scheduled transportation.

Please ensure that you fully comply with this 2012 requirement as MassHealth will fully enforce it to ensure HIPAA compliance. Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

Remittance Advices (RA) and HIPAA 835 Payment Files

Due to extended MMIS weekend processing, MassHealth anticipates a one day delay in the generation of provider Remittance Advices (RA) and HIPAA 835 Payment files. As soon as the RA and 835 Payment files are available for download, we will post a message here.

If you have questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.

Messages from the Week of March 16, 2015

March 18, 2015

POSC

Providers and Trading Partners who receive a weekly 835 Payment file on the POSC are advised that a duplicate file was created in error this week. You may notice that the same file is appearing twice. Please just ignore the second file. We apologize for any confusion or inconvenience that this may cause.

If you have any questions, please contact the EHS Customer Support Center at SystemsSupporthelpdesk@state.ma.us.  For provider questions regarding this issue, please contact the Virtual Gateway customer service line at 1-800-421-0938.

March 16, 2015

Customer Service Center Experiencing Unusual High Call Volume

MassHealth Customer Service Center is currently experiencing unusually high call volume. We apologize for this inconvenience.

To avoid long wait times on the telephone, please be aware that providers can make use of the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please make sure to include the caller's full name, MassHealth provider name, Provider Identification Service Location (PIDSL) Number and/or National Provider Identifier (NPI), telephone number and the details of the inquiry or question(s). The MassHealth Customer Service Center will direct your inquiry to the appropriate customer service specialist to assist you as quickly as possible.

ICD-10 Trading Partner Testing Update

REMINDER: All MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2015, as required by federal law.

MassHealth is continuing to prepare for ICD-10 implementation and is currently testing with trading partners. Vendor Phase II testing continues through March 31, 2015. Full Trading Partner Testing begins April 1, 2015, continuing through August 31, 2015. The MassHealth EDI testing team will be outreaching over the next several months to help you prepare for testing.

If you have questions or you are ready to schedule a test date, please contact the MassHealth EDI testing team directly at 855-295-4047 (toll free) or at edi@mahealth.net.

To stay current with the latest ICD-10 updates, including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, Provider Bulletins and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

Important Notification:  MMQ Software Will Terminate on October 1, 2015

Effective October 1, 2015, MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software currently used by nursing facility providers. By September 30, 2015, all providers using this software must transition to an alternative method of submitting MMQs. Other methods include:

  • Using the POSC (Provider Online Service Center) DDE (Direct Data Entry) MMQ functionality
  • Submitting MMQ batch files in accordance with MassHealth MMQ file specifications
  • Hiring a vendor to generate MMQ batch files

MassHealth will provide support for the proprietary MMQ software only until September 30, 2015, when all nursing facility providers must have transitioned to alternate methods.

To facilitate the transition, MassHealth has already removed the MMQ software from the web site and has made available updated MMQ file specifications. POSC users may refer to the MMQ Job Aid available at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf. Batch submitters may view the MassHealth MMQ file specifications available at www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf. Both of these documents were modified for ICD-10.

If you have questions or need assistance in transitioning off the MassHealth MMQ software tool, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.

Messages from the Week of March 9, 2015

March 9, 2015

Customer Service Center Experiencing Unusual High Call Volume

MassHealth Customer Service Center is currently experiencing unusually high call volume. We apologize for this inconvenience.

To avoid long wait times on the telephone, please be aware that providers can make use of the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please make sure to include the caller’s full name, MassHealth provider name, Provider Identification Service Location (PIDSL) Number and/or National Provider Identifier (NPI), telephone number and the details of the inquiry or question(s). The MassHealth Customer Service Center will direct your inquiry to the appropriate customer service specialist to assist you as quickly as possible.

Section 1202 Notice of Overpayment Letters Mailed

During the week of March 9, 2015 MassHealth will begin to mail Notice of Overpayment letters to group practices that did not respond to the Final Notice of Lack of Section 1202 Eligibility dated December 9, 2014.

The Notice of Overpayment contains the amount of Section 1202 overpayments made to the group practice for identified claims for certain dates of service submitted in connection with Section 1202 of the Affordable Care Act, which should not have been paid Section 1202 rates. As a result, MassHealth is taking steps to recover any Section 1202 payments that have been made to the group practice since January 1, 2013. Details can be seen on remittance advices at the end of March and throughout April.  Remittance Advice Code 9985 will appear on affected claims.

If the group practice seeks to dispute the amount of the identified overpayments indicated in the Notice of Overpayment letter, it must respond timely to the Notice of Overpayment as noted in the letter; otherwise, it will forfeit any rights to an adjudicatory hearing or to appeal the agency decision.

All communications to MassHealth concerning this matter, including any reply, should be sent to the MassHealth Customer Service Center (CSC) by e-mail at providersupport@mahealth.net, by fax at 617-988-8974 or by mail to the following address:

MassHealth Customer Service Center
Attn: Provider Enrollment, Section 1202 Reply to Notice of Overpayment
P.O. Box 9162
Canton MA 02021

Messages from the Week of March 2, 2015

March 6, 2015

EDI Transactions

MassHealth is currently experiencing delays in processing EDI transactions (this includes claims submission, claims status transactions as well as eligibility transactions).  As a result providers may be experiencing a delay in receiving 999 acknowledgements or seeing the transactions processed.  Direct Data Entry (DDE) claims are not impacted. Providers do not need to resubmit these EDI files as they will be processed. We are working to resolve the issue and we plan to complete processing this weekend. We apologize for any inconvenience.

We apologize for any inconvenience this may cause. If you have any questions, please contact the EHS Customer Support Center at SystemsSupporthelpdesk@state.ma.us  

For provider questions regarding this outage, please contact the Virtual Gateway customer service line at 1-800-421-0938.

March 2, 2015

Reminder: Member Eligibility Inquiry Submission Guideline Now Expanded from 1,000 to 3,000 Per Transaction

Providers and vendors are reminded: MassHealth has adjusted its member eligibility submission guideline to accommodate up to 3,000 members in an eligibility transaction.

MassHealth strongly encourages providers to modify their eligibility submission practices immediately as, effective May 10, 2015, the agency will begin to reject transactions that exceed 3,000 members. The 270/271 HIPAA Implementation Guide requires that the 270 transaction contain no more than ninety-nine patient requests when using the transaction in batch mode but allows for other patient request limits to be set. MassHealth agrees to the reasonable limit of up to 3,000 member request per transaction and reserves the right to modify this limit as required in accordance with the HIPAA standard.

To ensure the timely and efficient processing of your eligibility files, please adhere to these submission guidelines:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. YOU MUST INCLUDE the member’s Medicaid ID number on the eligibility request if known.
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received.

Please begin immediately to adhere to these batch file submission guidelines as non-conformance will impact the timely response to your file submission. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

Update: Crossover Claims Denied Erroneously for Edits 853 AND 855

Providers are advised: crossover claims that were denied erroneously for Edit 853 and Edit 855 on claims processed from 10/26/2014 through 12/18/2014 have been reprocessed and will appear on a future remittance advice.  

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

Crossover Claims Denied Erroneously for Modifier Edits

As indicated by a message text published in December 2014, MassHealth has resolved an issue that resulted in erroneous denials of crossover claims that processed from 10/26/2014 through 12/18/2014 for the following edits:

EDIT 4010 - MODIFIER REQUIRES MEDICAL REVIEW
EDIT 4033 - INVALID PROC MOD COMBINATION
EDIT 4203 - MODIFIER IS NOT COVERED

The crossover claims adjudicated after 12/18/2014 will no longer deny for these edits. Providers may resubmit denied crossover claims as MassHealth will NOT be reprocessing these claims.  No changes are necessary to the modifiers on the crossover claim when resubmitting these claims.

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

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

BULLETINS – February 2015:

  • Acute Inpatient Hospital Bulletin 151: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services
  • Acute Inpatient Hospital Bulletin 150: New Fax Number for MassHealth Applications and Documents
  • Acute Outpatient Hospital Bulletin 31: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services
  • Community Health Center Bulletin 82: New Fax Number for MassHealth Applications and Documents
  • Physician Bulletin 98: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services

TRANSMITTAL LETTERS – February 2015:

  • DME-33: 2014 HCPCS
  • ORT-24: 2014 HCPCS
  • OXY-31: 2014 HCPCS
  • PRT-25: 2014 HCPCS

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/).

Messages from the Week of February 23, 2015

February 23, 2015

Pharmacy, DME and Oxygen – Updated Payment and Coverage Guidelines, PA Operating Standards Now Online

Pharmacy, DME and Oxygen providers are advised: The MassHealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web.

To confirm that you are using the most recent version of the applicable Tool (v.23), go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/, then on MassHealth Payment and Coverage Guideline Tool.

You will also find the newly-updated Operating Standards for the Prior Authorization process on the Payment and Coverage Guideline page.  Click on the “Click Here” box on the upper right corner of the page.  This will bring you to the Quick Links page. Please note: this must be open in POSC to view deferral reasons. If you have any PA questions, please contact the PAU at PriorAuthorization@umassmed.edu or 1-800-862-8341.

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

ICD-10 Implementation – Vendor-Phase II Testing Underway – Have You Signed Up Yet?

A reminder from MassHealth: With the implementation of ICD-10 scheduled for October 1, 2015, MassHealth is continuing to test with trading partners. Vendor Phase II testing is underway from February 2 – March 31, 2015. MassHealth strongly urges vendors that are ready for testing to arrange a test date immediately.

Testing involves submitting test claims, receiving test results, submitting corrected test claims and getting approved for production. Please schedule your testing immediately if you have not done so already. Contact the EDI team directly at 855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

Deadline Extended to April 1, 2015 to Submit Hospital-Based Non-Billing Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

The Hospital-Based Non-Billing Provider Enrollment Form must be submitted to MassHealth on or before April 1, 2015 for services of a hospital-based physician to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.

Physicians can obtain Hospital-Based Non-billing Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) will be forthcoming in a MassHealth Provider Bulletin.

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

Messages from the Week of February 2, 2015

February 3, 2015

ICD-10 Implementation – Vendor-Phase II Testing is Underway

A reminder from MassHealth: With the implementation of ICD-10 scheduled for October 1, 2015, MassHealth is continuing to test with trading partners. Vendor Phase II testing is underway from February 2 – March 31, 2015. Full Trading Partner Testing – Phase II is scheduled for April 1 – August 31, 2015. However, any trading partner that is currently ready to test should contact MassHealth immediately to arrange a test date.  

Testing involves submitting test claims, receiving test results, submitting corrected test claims and getting approved for production. MassHealth strongly urges you to schedule testing immediately if you have not done so already. Please contact the EDI team directly at 855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – January 2015:

-ABR-16: Revisions to Abortion Services Regulations
-AIH-52: Gender Dysphoria, Sterilization, and Hysterectomy Policies
-ALL-212: Revised Payment Methodology for Out-of-state Chronic Disease and Rehabilitation Hospitals
-AOH-34: Revisions to Abortion Services Regulations
-AOH-33: Updated Gender Dysphoria and Sterilization Policies; Out-of-State Chronic Disease and Rehabilitation Hospitals
-AUD-17: Addition of Cochlear Implant External Components and Subchapter 6 Updates
-CHC-102: Gender Dysphoria, Sterilization, Hysterectomy, and Laboratory Services Policy
-COH-9: Updated Gender Dysphoria and Sterilization Policies; Out-of-State Chronic Disease and Rehabilitation Hospitals
-FAS-28: Updated Gender Dysphoria and Sterilization Policies, and Provider Eligibility Requirements
-FPA-51: Updated Sterilization Provisions and Subchapter 6
-HIS-25: Regulation and Subchapter 6 Updates
-PHM-61: Updated Gender Dysphoria Policy
-PHY-142: Updated Gender Dysphoria and Sterilization Policies
-POD-71: Updated Gender Dysphoria Policy
-STR-18: Updated Sterilization Clinic Regulations

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/).

Messages from the Week of January 19, 2015

January 20, 2015

Member Eligibility Inquiry Submission Guideline Now Expanded from 1,000 TO 3,000 Per Batch File

Providers and vendors are advised: MassHealth has adjusted its member eligibility submission guideline to accommodate up to 3,000 members in a single eligibility batch file request.

MassHealth strongly encourages providers to modify their eligibility submission practices immediately as the agency will begin this spring (mid-late March) to reject submissions that exceed 3,000 members.

REMINDER: To ensure the timely and efficient processing of your transactions, please adhere to these submission guidelines which conform to Phase I CORE 155: Eligibility and Benefits Batch Response Time Rules, HIPAA ASC X12 and MassHealth policy:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. YOU MUST INCLUDE the member’s Medicaid ID number on the eligibility request if known.
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received from MassHealth on the prior eligibility response (where applicable).

It is important that you adhere to these batch file submission guidelines as non-conformance will impact the timely response to your file submission. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

Job Aid Now Posted Online For Help in Transitioning From EVSpc and EVScall

MassHealth has now posted a Job Aid online for all providers who are still using EVSpc and EVScall and need to transition to another method of member eligibility verification and claim status inquiry.

Please go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf for a list of EVS transition options, access methods, set-up processes, resources and helpful links.

MassHealth has extended the termination date for EVSpc and EVScall software to September 1st, 2015. Please note that MassHealth will reject any/all transactions that are generated from this tool on or after the termination date.  However, providers should not delay! Please make this transition as soon as possible, as the software tool no longer displays key eligibility messages regarding MassHealth member coverage.

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

Important MassHealth Disclaimer Regarding EVSpc and EVScall Software Termination

All MassHealth Providers were notified on August 18, 2014, to stop using EVSpc to verify member eligibility as the software tool does not provide eligibility notifications, warnings, and other important messages about MassHealth Members that are provided by other MassHealth eligibility access methods noted below. Pursuant to that August notification, you must transition to one of the eligibility verification methods available on the POSC or via MassHealth Automated Voice Response (AVR).

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits, even if EOHHS has been advised of the possibility of such damages. To the maximum extent permitted by applicable law, EOHHS disclaims all warranties, conditions, representations or guaranties of any kind, either express, implied, statutory or otherwise including, but not limited to, any implied warranties or conditions of satisfactory quality or fitness for a particular purpose.

MassHealth has extended the termination date for EVSpc and EVScall software to September 1st, 2015. MassHealth will reject any/all transactions generated from the tool after this date. To choose a new eligibility verification method, please refer immediately to the EVSpc/EVScall Job Aid page now online: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

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

Response Deadline Approaching: Letter Regarding 1202 Rate Eligibility

This is a reminder to all providers who received a letter from MassHealth, dated December 9, 2014 regarding ACA Section 1202 Physician Eligibility:

If you believe that a physician is eligible for Section 1202, you must submit the Physician Certification and Attestation Form by February 1, 2015 in order to reinstate a physician’s 1202 eligibility and receive any missed 1202 payments.

If you do not respond to the notice dated December 9, 2014, MassHealth will calculate and recover any Section 1202 payments that have been made to group practices since January 1, 2013 for services provided by physicians who did not attest to 1202 eligibility and did not return a completed Certification and Attestation form by the deadline

The Form is available at: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf and should be returned to MassHealth PEC, P.O. Box 9162, Canton MA 02021 or by FAX to 1-617-988-8974.

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

Messages from the Week of January 12, 2015

January 12, 2015

Deadline to Submit Hospital-Based Non-Billing Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

This is a reminder that the Hospital-Based Non-Billing Provider Enrollment Form must be submitted to MassHealth on or before March 1, 2015 for services of a hospital-based physician to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.

Physicians can obtain Hospital-Based Non-billing Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) will be forthcoming in a MassHealth Provider Bulletin.

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

Messages from the Week of January 5, 2015

January 5, 2015

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – December 2014:

-Acute Inpatient Hospital Bulletin 149: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
-All Provider Bulletin 248: Information about ICD-10
-Community Health Center Bulletin 81: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
-Nursing Facility Bulletin 138: Increase in Medical Leave-of-Absence (MLOA) Days

TRANSMITTAL LETTERS - December 2014:

-CHC-101: 2014 HCPCS and Vaccine Codes

 You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/).

Important Date Change:  EVSpc and EVScall Software Termination Extended to September 1, 2015

IMPORTANT INFORMATION – All MassHealth Providers were notified on August 18, 2014, to stop using EVSpc to verify member eligibility as the software tool does not provide eligibility notifications, warnings, and other important messages about MassHealth Members that are provided by other MassHealth eligibility access methods noted below. Pursuant to that August notification, you must transition to one of the eligibility verification methods available on the POSC or via Automated Voice Response (AVR). If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits, even if EOHHS has been advised of the possibility of such damages. To the maximum extent permitted by applicable law, EOHHS disclaims all warranties, conditions, representations or guaranties of any kind, either express, implied, statutory or otherwise including, but not limited to, any implied warranties or conditions of satisfactory quality or fitness for a particular purpose.

MassHealth has extended the termination date for EVSpc and EVScall software from February 28th to September 1st, 2015. All functionality will end and there will be no support for the software after that date. Please refer to: www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/evspc.html.

EVSpc/EVScall has already stopped displaying current key eligibility messages regarding MassHealth member coverage. Therefore, you must immediately stop using EVSpc and EVScall and transition to one of the following POSC or other access methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042 or
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions in accordance with MassHealth specifications:
    • Upload 270 batches through the POSC or
    • Submit and receive batched transactions directly (system-to-system) via HTS (Healthcare Transaction Services)

OF IMPORTANCE: To submit and receive HIPAA transactions in an electronic batch file through the POSC or through the HTS method, you must first coordinate with MassHealth Customer Service. For questions or assistance, contact the MassHealth Customer Service Center immediately at 1-800-841-2900 or providersupport@mahealth.net.

Important Reminder: 1202 Enhanced Payments Have Ended Effective 12/31/2014

Physicians and group practices that have been receiving enhanced rates under ACA Section 1202 are advised: the enhanced rates have expired effective 12/31/14.

For dates of service January 1, 2015 and forward, your remittance advices will reflect standard, unenhanced MassHealth physician rates.

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

Medicare Crossover Claims Denied for Edit 519 – Admit Date is After Statement Period “From” Date

MassHealth has resolved an issue that resulted in erroneous denials of Inpatient Part A crossover claims for Edit 519 with process dates from 9/11/2014 through 12/23/2014. 

Crossover claims adjudicated after 12/23/2014 will no longer deny for Edit 519. MassHealth has reprocessed the previously denied crossover claims which will appear on a future remittance advice.

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

MassHealth Mail Forwarding Has Ended Effective 12/31/14

All providers are reminded that mail forwarding - from the old MassHealth Hingham address to the current Canton address – has ended as of December 31, 2014. Please make sure you use the correct address or your mail will be returned to you as undeliverable.

PROVIDER ENROLLMENT AND CREDENTIALING – Use this mailing address to submit new enrollment applications, provider file updates or correspondence:

MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton MA 02021

PAPER CLAIMS - If you are authorized to submit paper claims, the P.O. Box is:

MassHealth
Attn: Original Paper Claims Submissions
P.O. Box 9152
Canton MA 02021

PAPER PRIOR AUTHORIZATIONS - Send PA-1 request forms to:

MassHealth
Attn: Prior Authorization
100 Hancock Street, 6th Floor
Quincy MA 02171

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

Dental Providers: Please Use Correct DentaQuest Address For Claims

All MassHealth Dental Providers billing CDT service codes should disregard the message text “MassHealth Mail Forwarding Has Ended Effective 12/31/14.” This message does not affect dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Please send all Dental Claims to:

DentaQuest – MassHealth Dental Claims
12121 North Corporate Parkway
Mequon, WI 53092

Please refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, provider enrollment, prior authorizations, claims, electronic claims, provider complaints and fraud.

For questions, contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.