Messages from Week of April 14, 2014

April 14, 2014

Coverage of Restorative Adult Dental Services

MassHealth is covering additional restorative services (fillings) for adults, effective for dates of service beginning March 1, 2014.

MassHealth will pay for the following restorative services for all members, including those age 21 and older:

D2140 - Amalgam restorations
D2150 - Amalgam restorations
D2160 - Amalgam restorations
D2161 - Amalgam restorations
D2332 - Resin-based composite restorations
D2335 - Resin-based composite restorations
D2391 - Resin-based composite restorations
D2392 - Resin-based composite restorations
D2393 - Resin-based composite restorations
D2394 - Resin-based composite restorations

Please refer to MassHealth Dental Bulletin 43 at www.mass.gov/eohhs/docs/masshealth/bull-2014/den-43.pdf.  For questions, please contact the MassHealth Customer Services 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 from March 2014:

-All Provider Bulletin 243: New Coverage Type: MassHealth CarePlus
-All Provider Bulletin 242: Provider Revalidation
-Community Health Center Bulletin 79: MassCor Online Eyeglass Order System
-Dental Bulletin 43: Coverage of Restorative Adult Dental Services
-Physician Bulletin 97: MassCor Online Eyeglass Order System
-Vision Care Bulletin 17: MassCor Online Eyeglass Order System

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

Messages from Week of April 7, 2014

April 7, 2014

Important Message Regarding ICD-10

On April 1, 2014 the bill H.R. 4302, Protecting Access to Medicare Act of 2014 was signed into law. A component of the law states that HHS (Department of Health and Human Services) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015.  Based upon this change, MassHealth is evaluating the impact of the delay on MassHealth and will provide more information as soon as it becomes available. In the interim MassHealth will continue to test ICD-10 transactions with its trading partners.

Diagnosis Edits

Providers are advised that their claims will deny with the following edits if the claims are submitted with a diagnosis code that is not covered on the date of service:

4188- DIAG CODE NOT COVERED FOR DOS
4189- SECOND DIAG CODE NOT COVERED FOR DOS
4190- THIRD DIAG CODE NOT COVERED FOR DOS
4191- FOURTH DIAG CODE NOT COVERED FOR DOS
4192- FIFTH DIAG CODE NOT COVERED FOR DOS
4193- SIXTH DIAG CODE NOT COVERED FOR DOS
4194- 7 - 24 DIAG CODE NOT COVERED FOR DOS

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

Early Intervention Service Code T1024 (40 Units Counting Method)

Effective with DOS (Dates of Service) January 1, 2014, MassHealth will no longer use the previous rolling calendar year methodology to count the 40 maximum units allowed per member per 12-month period for service code T1024-EARLY INTERVENTION ASSESSMENT.

MassHealth will now count the 40 units maximum for T1024 using the standard calendar year (January 1 through December 31) method. For example, if a claim for service T1024 is submitted with the first DOS of February 1, 2014, then MassHealth will begin counting up to 40 units in the calendar year period beginning February 1, 2014 and ending December 31, 2014. January 1, 2015 will start a new calendar year where MassHealth will begin counting another 40 units toward the next 12-month period.

MassHealth will systematically reprocess previously adjudicated claims for T1024 due to Edit 8155 (limit 40 units in 12 months per member) for DOS January 1, 2014 and following, on future remittance advices. No action is required on the part of the provider.

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

Messages from the Week of March 31, 2014

March 31, 2014

Letters Regarding Physician Eligibility for Section 1202 Rates

This is a reminder to all physicians who received a letter from MassHealth, dated February 28, 2014 regarding ACA Section 1202 Physician Eligibility:

Please complete and return the Physician Certification and Attestation Form available at www.mass.gov/eohhs/docs/masshealth/providerservices/forms/aca-1202.pdf. You must confirm your eligibility for Section 1202 rates. Otherwise, MassHealth will begin the process to terminate this eligibility and recover any Section 1202 payments that have been made to your group practice.

Please return the completed form 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.net.

Orthotics and Prosthetics Claims Adjustments

Orthotics and Prosthetics providers are reminded: Following EOHHS’s adoption of revised rates on June 21, 2013, MassHealth has started reprocessing claims where the fees were increased and providers received an incorrect amount. The claims will adjust according to the rate change and will pay the difference. This only affects paid claims, not denied claims.

Providers do NOT need to resubmit claims to receive the fee increase. Claims are being reprocessed systematically.

We apologize for any inconvenience. For questions regarding this change, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

Temporary MassHealth Member Coverage

MassHealth and the Health Connector are pleased to confirm that, effective February 1, 2014, temporary coverage is being provided to individuals who submitted MassHealth applications in January for subsidized coverage. This temporary coverage will continue until at least June 30, 2014, unless the individual’s application is processed sooner. Individuals with temporary coverage can seek services from any provider that accepts MassHealth.

No ID card will be issued. Individuals will receive a letter containing a Member ID that confirms MassHealth Standard Fee-for-Service temporary coverage; they must present this letter to providers as confirmation of coverage.  In addition, Providers should always verify eligibility via EVS on the POSC (Provider Online Service Center).

For more details and answers to frequently asked questions about temporary coverage, please go to: www.mass.gov/masshealth.  Under “News and Updates,” click on “Temporary Coverage Expansion Update.” Or contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

Messages from the Week of March 24, 2014

March 24, 2014

Letters Regarding Physician Eligibility for Section 1202 Rates– Response Due March 30, 2014

This is a reminder to all physicians who received a letter from MassHealth, dated February 28, 2014 regarding ACA Section 1202 Physician Eligibility:

Please respond to the letter by March 30, 2014 by completing and returning the Physician Certification and Attestation Form available at www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf. You must confirm your eligibility for Section 1202 rates. Otherwise, MassHealth will begin the process to terminate this eligibility and recover any Section 1202 payments that have been made to your group practice.

Please return the completed form by March 30, 2014 to MassHealth PEC, P.O. Box 9162, Canton MA 02021.

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

Minor Changes to MMIS DDE (Direct Data Entry) Screens

MassHealth is now phasing in MMIS modifications to support the ICD-10 implementation this coming October.

Effective April 1, 2014, providers that use the POSC (Provider Online Service Center) will begin to see minor changes in the DDE (Direct Data Entry) screens, including changes in drop-down menus, the addition of ICD radio buttons and changes in field length among these minor modifications.

Please do not attempt to use these fields until implementation. Although they are viewable, these functionalities will be disabled until implementation in October.

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

Reprocessed Long Term Care Claims

MassHealth will be reprocessing Long Term Care claims from the recent retro run for dates of service 07/01/2012 through 07/31/2012. These claims denied for EDIT 2528 – LTC-POTENTIAL MEDICARE 1ST 100 DAYS, EDIT 2556 – LTC-POTENTIAL MEDICARE C 1ST 100 DAYS and EDIT 2557 – LTC-POTENTIAL PRIVATE INSURANCE. These reprocessed claims will appear on a future remittance advice.

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

1202 Rate Updates for 2014

MassHealth is in the process of updating the calendar year 2014 Section 1202 rates. Further information, including the time frame for adjusting claims, will be forthcoming.

Important Notice: EVSpc Windows Operating System Support to Change April 8th

MassHealth’s proprietary EVSpc software is currently supported only on Windows XP and Windows Vista. Effective April 8, 2014, Microsoft will no longer support Windows XP.

MassHealth recommends that providers NOT USE Windows XP after April 8, 2014 because the EVSpc software may not function correctly and MassHealth WILL NOT be able to provide support. MassHealth will not upgrade the software to any other Operating Systems.

Providers currently using Windows Vista may continue to use the tool.  Providers using Windows XP should begin to leverage the DDE (Direct Data Entry) and batch inquiry options on the POSC. You may also acquire an external trading partner to submit eligibility transactions on your behalf.

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

Important Message: Incorrect Fax Number in Member Booklets

This is an important message for all organizations and staff who assist individuals with submitting verifications or subsidized applications for MassHealth or Health Connector coverage. Your immediate action is required.

An incorrect fax number is listed on the inside front cover of the Member Booklet for Health Coverage and Help Paying Costs (ACA-1 Packet (Rev. 01/14)).

THE CORRECT NUMBER IS:  617-887-8770.

If you have the Member Booklets referenced above, please call MassHealth Customer Service at 1-800-841-2900 to receive a replacement shipment, and/or correction labels you can place over the incorrect number on all copies of the Member Booklets in your inventory.

MassHealth is the Payer of Last Resort

All providers are reminded: MassHealth is the payer of last resort. Providers must make diligent efforts to obtain payment from other resources prior to billing MassHealth. Providers may submit coordination of benefits (COB) claims with a remaining patient responsibility to MassHealth according to MassHealth billing instructions.

MassHealth liability is the lesser of (1) the member’s liability including co-insurance, deductibles and co-payments, or (2) the provider’s charges or maximum allowable amount payable under the MassHealth payment methodology, whichever is less, minus the insurance payment. Please see All Provider Regulations 130 CMR 450.316, 450.317, and 450.318.

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

Messages from the Week of March 17, 2014

March 19, 2014

Important Message: Incorrect Fax Number in Member Booklets

This is an important message for all organizations and staff who assist individuals with submitting verifications or subsidized applications for MassHealth or Health Connector coverage. Your immediate action is required.

An incorrect fax number is listed on the inside front cover of the Member Booklet for Health Coverage and Help Paying Costs (ACA-1 Packet (Rev. 01/14)).

THE CORRECT NUMBER IS:  617-887-8770.

If you have the Member Booklets referenced above, please call MassHealth Customer Service at 1-800-841-2900 to receive a replacement shipment, and/or correction labels you can place over the incorrect number on all copies of the Member Booklets in your inventory.

MassHealth Provider Revalidation Has Begun

All providers are advised that MassHealth, as required by the Affordable Care Act, has begun its provider revalidation effort. The process requires that you revalidate your enrollment information for MassHealth under new enrollment screening criteria.  You may also be required to submit original signature documentation to support your revalidation, including a Federally Required Disclosures Form.

This revalidation initiative will be conducted by provider type and will initially focus on providers enrolled on or before March 25, 2011, and will be completed by March 24, 2016.

Then, providers enrolled after March 25, 2011 will be revalidated on or before five years from the date that they were initially enrolled.

The following provider types have been mailed revalidation letters and must complete the revalidation process on the POSC (Provider Online Service Center) within 45 days of the date on the revalidation letter:

-02 Optometrist
-03 Optician
-04 Ocularist
-16 Chiropractor
-43 Prosthetics
-47 Orthotics
-50 Audiologist

Failure to complete the revalidation will affect your enrollment status and may result in sanctions. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

Admission Dates Required for Inpatient Claims – Advisory

MassHealth reminded providers back in November that an admission date is required on claim submissions when the place of service is an Inpatient hospital, Inpatient Psychiatric facility, Skilled Nursing facility or a Comprehensive Inpatient Rehabilitation facility.

However, last fall, the Medicare intermediary requested a modification to the industry-standard HIPAA compliance software used by MassHealth that requires the admission date for inpatient services. This change inadvertently impacted the processing of some professional claims. MassHealth is working with its software vendor to modify the MMIS to ensure that MassHealth only applies the admit date compliance editing to the appropriate claims. The change will be implemented on or before March 31, 2014.

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

Messages from the Week of March 10, 2014

March 10, 2014

Hospice Claims that Previously Denied Due to Conflict with NCCI Edits

On October 1, 2013, CMS (Centers for Medicare and Medicaid Services) reversed the decision to deny hospice claims for members in nursing facilities when Procedure Code T2042-ROUTINE CARE was billed in conjunction with Procedure Code T2046-ROOM AND BOARD on the same DOS (Date of Service), under the NCCI (National Correct Coding Initiative).

Claims were denied using the following edits:
5927 – NCCI-ANOTHER SERVICE PREV PAID-SAME CLAIM
5928 – NCCI-ANOTHER SERVICE PREV PAID-OTHER CLAIM
5929 – NCCI-CONFLICT WITH OTHER SERVICE PREV PAID

Providers are advised to re-submit to MassHealth any affected claims for dates of service April 1, 2013 to October 1, 2013 that were denied with edits 5927, 2928 and 5929.  For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

Updated EFT Enrollment/Modification Request Form Now Available

All MassHealth providers are advised that the EFT (Electronic Funds Transfer) Enrollment/Modification Form has been updated and is available on the MassHealth web site at: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/eft-1.pdf.  Please begin using this new form immediately if you are enrolling or you need to modify current EFT information.

Please discard any previous version of the EFT Request form.  Only the newest version, marked “EFT-1 (Rev. 02/14)” in the lower left corner, will be accepted from April 1, 2014 on.  All other forms will be rejected.

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

Messages from the Week of March 3, 2014

March 3, 2014

Personal Care Attendant (PCA) New Hire Orientation

Effective March 1, 2014, Fiscal Intermediaries will be able to submit claims to MassHealth for PCAs (Personal Care Attendants) who have completed the PCA New Hire Orientation Program.

The service code for billing the PCA New Hire Orientation is: T1020 U3 - Personal Care Services, per diem, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment.  (Code may not be used to identify services provided by home health aide or certified nurse assistant.) (Use only to bill for PCA New Hire Orientation Program.) (Current P.A. for PCA services required for each member.)

Updates to Subchapter 6 of the PCA Provider Manual are forthcoming. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Home Health Claims Submitted with TOB (Type of Bill) 033X         

Home Health Care providers are reminded that MassHealth, in accordance with CMS guidelines, no longer accepts Home Health claims submitted with TOB (Type of Bill) 033X with dates of service from October 1, 2013 forward.  All claims submitted with TOB 033X will be denied.

The National Uniform Billing Committee (NUBC) has redefined 032X Type of Bill to mean “Home Health Services under a Plan of Treatment.” This revision allows for “one Type of Bill code for all home health services provided under a home health plan of care.” Providers are advised to update their billing to reflect this change. Please reference your NUBC manual for additional information. This change does not apply to Crossover claims.

Updates to the MassHealth UB-04 Billing Guide are forthcoming. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Messages from the Week of February 24, 2014

February 25, 2014

Attention Electronic Claim Submission Waivered Providers: New 1500 Claim Form Required as of March 22, 2014

On June 17, 2013, the National Uniform Claim Committee (NUCC) announced the approval of the 02/12 version of the 1500 Health Insurance Claim Form (1500 Claim Form). The new form accommodates reporting needs for ICD-10 and aligns with requirements in the Professional (837P) Version 5010 Technical Report Type 3. On April 1, 2014, payers will be required to process paper claims submitted only on the revised 1500 Claim Form.

To accommodate this April 1, 2014 deadline, providers who have been approved to submit paper claims are advised that MassHealth will only accept the previous 08/05 version of the 1500 form until March 21, 2014. Any 08/05 version of the form received after that date will be returned to the provider. Providers must begin submitting paper claims on the revised 1500 Claim Form as of March 22, 2014.

For more information on the changes made to the form, please visit the NUCC website at www.nucc.org. MassHealth will also provide additional information as it becomes available. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

Messages from the Week of February 17, 2014

February 20, 2014

Provider Rate Change for Procedure Code 88112

On November 18, 2013, MassHealth updated the rate for procedure code 88112 for provider types 80 (Acute Outpatient Hospital) and 81(Hospital Licensed Health Centers) retroactive to 07-01-12.

Any claims which were adjudicated with dates of service 07/01/2012 and after will be systematically adjusted to pay correctly. The adjustments may appear on this or a future Remittance Advice.

We apologize for any inconvenience this may have caused. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Provider Billing Reminder: CARCs and RARCs Have Changed

Providers are again reminded that CARCs (Claims Adjust Reason Codes) and RARCs (Remittance Advice Remark Codes) have changed, as required by ACA (Affordable Care Act) Operating Rules. To view the new CARCs/RARCs list, go to www.mass.gov/masshealth/aca, and then click on ACA Operating Rules.

Providers are also reminded to update business processes. Please contact your financial institution to ensure it supports the new CCD+ Addenda file format used to transmit payment information.

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

Messages from the Week of February 3, 2014

February 3, 2014

CMS ICD-10 Readiness Survey for Specialty Providers

CMS (the Centers for Medicare and Medicaid) is requesting that providers across the country complete its ICD-10 Readiness Survey. This will help CMS gauge provider readiness for the ICD-10 transition.

Please take this online survey at https://www.surveymonkey.com/s/ICD-10_Provider_Readiness_CMS. It takes less than ten minutes to complete and your responses will remain anonymous. Please submit your entry by February 10, 2014.

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

MassHealth ICD-10 Readiness Survey – Deadline Extended

MassHealth has extended the deadline for providers to take the online ICD-10 Readiness Survey to Monday, February 10, 2014.

The Readiness Survey will gather key information that will allow MassHealth to better anticipate the needs of our providers, billing intermediaries, clearinghouses and software vendors as we all prepare for ICD-10 implementation.

Please complete the ICD-10 Readiness Survey at http://webapps.ehs.state.ma.us/reviewsurvey/ReviewSurvey.aspx?id=381. Please make every effort to review and submit your entry by February 10, 2014.

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

MMQ Software Changes Coming in October 2014

Effective 10/1/14, MassHealth will no longer support the proprietary MMQ software currently available on Mass.gov/masshealth. All providers currently utilizing this software must transition to the MMQ direct data entry functionality on the POSC or generate an MMQ file in accordance with the MMQ file submission specifications prior to 9/30/14.

MassHealth is currently updating the specifications to include the ICD-10 modification and will notify you once they are available. MassHealth will continue to keep you informed of this important transition.

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from January 2014:

-All Provider Bulletin 241: Information about ICD-10-CM/PCS

Provider Transmittal Letters from January 2014:

-COH-8: New Subchapter 6

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

Messages from the Week of January 27, 2014

January 30, 2014

The MMIS POSC will be down tonight, January 30, 2014, from 9 PM to 10 PM for an emergency upgrade.

We apologize for any inconvenience this may cause.  If you have any questions please contact the EHS Customer Support Center at 617-994-5050 or email SystemsSupporthelpdesk@state.ma.us.

For provider questions regarding this outage, please contact the Virtual Gateway customer service line at 1-800-421-0938.

January 27, 2014

MassHealth Reprocessing Pharmacy Claims in Payment Cycles

MassHealth has identified TPL (third party liability) pharmacy claims in a recent audit that were affected by an incorrect pricing methodology. The time span for the TPL pricing issue includes dates of service from February 1, 2006 through December 15, 2012. These claims are now being systematically adjusted.

The POPS (Pharmacy On-line Processing System) reimbursement logic was not comparing MassHealth’s “Allowed Charge” to the provider’s “Submitted Charge” before subtracting “Other Payer Amount” and comparing it to “Patient Responsibility.” The overpayment should be the difference between “Allowed Charge” and “Provider Charge.”

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

Important Information: Provider Revalidation Starts March 2014

All providers are advised that MassHealth will begin its Revalidation effort in March 2014. Section 6401(a) of the Affordable Care Act requires Medicare and Medicaid to revalidate your provider enrollment information at least every five years with new screening criteria.

This revalidation initiative will initially focus on providers enrolled on or prior to March 25, 2011, and will be completed by March 24, 2016. Providers enrolled afterMarch 25, 2011, will be revalidated on or before five years from the date that they were initially enrolled.

The process will require that you revalidate your enrollment information for MassHealth and complete and return a Federally Required Disclosures form. See 42 CFR 455.414, Section 6401 of the Affordable Care Act (ACA) and 42 CFR 455.104 (c)(1)(iii).

Failure to complete the revalidation will affect your enrollment status and ability to receive MassHealth claim payments.

Additional information about the Revalidation initiative is forthcoming. Please continue to check www.mass.gov/masshealth.

Messages from the Week of January 20, 2014

January 21, 2014

ICD-10 Trading Partner Testing

All MassHealth providers are reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2014, as required by federal law.

MassHealth is continuing to prepare for ICD-10 implementation and, to that end, invites you to participate in planned trading partner testing in the second quarter of 2014. Details on the testing timeline, requirements and instructions will be announced shortly. As we prepare for the testing, MassHealth EDI Analysts will be outreaching our trading partners over the next several months to gather preliminary information and assess provider readiness for ICD-10.

For more details, please read MassHealth All Provider Bulletin 241. Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. Click on Provider Bulletins, then 2014 Provider Bulletins.

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

ICD-10 Readiness Survey

ICD-10 is coming! And MassHealth is very interested in how you are preparing for this October 1, 2014 implementation.

A readiness survey has been developed to gather key information and enable MassHealth to better anticipate the needs of our providers and to coordinate effectively with billing intermediaries, clearinghouses and software vendors.

Please complete the ICD-10 Readiness Survey at http://webapps.ehs.state.ma.us/reviewsurvey/ReviewSurvey.aspx?id=381 no later than January 31, 2014. Please make every effort to review and submit your entry within the timeframe requested.

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

Attention All Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

All MassHealth Dental Providers billing CDT service codes should disregard the Message Text “Update to Important Announcement: Provider Operations Changes.” These changes do 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.

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 January 13, 2014

January 13, 2014

Update to Important Announcement: Provider Operations Changes

MassHealth advised all providers last month that, during the period from December 16-31, 2013, all Provider Services functions would transition from Hewlett Packard Enterprise Services (HPES) to the MAXIMUS MassHealth Customer Service Center (CSC). The transition is now complete effective January 2, 2014, and we want to remind you of four changes that impact you as a provider:

PROVIDER ENROLLMENT AND CREDENTIALING – Please use this new 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 new P.O. Box is:

MassHealth
Attn: Original Paper Claims Submissions
P.O. Box 9152
Canton MA 02021

PAPER PRIOR AUTHORIZATIONS - Effective immediately, please send PA-1 request forms to:

MassHealth
Attn: Prior Authorization
100 Hancock Street, 6th Floor
Quincy MA 02171

Some MassHealth Customer Service Center staff/positions and their direct contact information have changed. However, regular contact information remains the same: MassHealth CSC’s main phone number at 1-800-841-2900, the Provider Support mailbox at providersupport@mahealth.net and the EDI Support mailbox at edi@mahealth.net.

EFT/ERA Operating Rule in Effect January 1, 2014

On January 1, 2014, MassHealth implemented the EFT/ERA Operating Rule in accordance with Section 1104 of the Administrative Simplification provisions of the ACA (Affordable Care Act).

Providers who enroll or modify an existing EFT arrangement on or after January 1, 2014 must complete the new EFT Enrollment/Modification Form, available at the MassHealth EFT web page. Go to www.mass.gov/masshealth, click on the Information for MassHealth Providers link, then Insurance (Including MassHealth), then MassHealth, then ACA, and then ACA Operating Rules.

Contact your financial institution to ensure it supports the new CCD+ Addenda file format used to transmit payment information.

Also effective January 1, 2014, providers who sign up to receive the 835 ERA (Electronic Remittance Advice) or modify the receiver of the 835 must complete the new ERA Enrollment Modification form, available on the MassHealth ACA Operating Rules Web page. Go to www.mass.gov/masshealth, click on the Information for MassHealth Providers link, then Insurance (Including MassHealth), then MassHealth, then ACA, and then ACA Operating Rules.

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

For questions, please contact MassHealth Customer Service 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 from December 2013:

-Managed Care Organization Bulletin 3: Current Procedural Terminology (CPT) Codes and Payment to Providers for Behavioral Health Services
-All Provider Bulletin 240: Temporary Coverage for Applicants for Subsidized Health Insurance
-Nursing Facility Bulletin 137: Nursing Facility Pay for Performance Program for Fiscal Year 2014

Transmittal Letters from December 2013:

-AIH-49: Revisions to MassHealth Regulations-Affordable Care Act
-ALL-205: Revisions to Regulations for the Affordable Care Act
-AOH-31: Revisions to MassHealth Regulations-Affordable Care Act
-CHC-99: Revisions to MassHealth Regulations-Affordable Care Act
-CHC-98: 2013 HCPCS and Vaccine Codes
-FAS-27: Revisions to MassHealth Regulations-Affordable Care Act
-FPA-50: Revisions to MassHealth Regulations-Affordable Care Act
-HHA-49: Revisions to MassHealth Regulations-Affordable Care Act
-IDTF-13: Revisions to MassHealth Regulations-Affordable Care Act
-LAB-42: Revisions to MassHealth Regulations-Affordable Care Act
-PHM-60: Revisions to MassHealth Regulations-Affordable Care Act
-PHY-140: Revisions to MassHealth Regulations-Affordable Care Act
-PHY-139: 2013 HCPCS
-POD-70: Revisions to MassHealth Regulations-Affordable Care Act
-POD-69: 2013 HCPCS

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

Messages from the Week of January 6, 2014

January 7, 2014

System Maintenance

MAPIR (Medical Assistance Provider Incentive Repository) will be unavailable Sunday 1/12/2014 from 6:00 PM until 10:00 PM due to system maintenance.   The MMIS POSC, including the internal MMIS application,  AVR, IVR, EVS, and all eligibility services will be unavailable. MAP and CBHI will also be unavailable.

We apologize for any inconvenience this may cause.  If you have any questions please contact the EHS Customer Support Center at 617-994-5050 or email SystemsSupporthelpdesk@state.ma.us.

For provider questions regarding this outage, please contact the Virtual Gateway customer service line at 1-800-421-0938.

Messages from the Week of December 9, 2013

December 9, 2013

Updated Community Health Center Rates

Please be advised that EOHHS (Executive Office of Health and Human Services) has updated the MassHealth Community Health Center Rates, pursuant to regulation 101 CMR 304.00.

These updated rates are effective for dates of service as of October 1, 2013. MassHealth will process mass retro rate adjustments in future Remittance Advices.  No further action is required by Community Health Center Providers.

To view the updated rates, go to www.mass.gov/eohhs/gov/laws-regs/hhs/. Click on EOHHS Regulations; then click Provider Payment Rates (by Provider Type) and then CHC Providers (Ambulatory Care).

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

Verification Testing/Sober Home Laboratory Requests

Providers are reminded that, in accordance with 130 CMR 450.307 (Unacceptable Billing Practices), MassHealth does not permit duplicative billing, including the submission of multiple claims for the same service by the same provider or multiple providers. This includes verification laboratory testing using the same specimen or another body fluid, which is duplicative and therefore not a covered procedure.

Also, in accordance with 130 CMR 401.411 (Non-Covered Services and Payment Limitations), MassHealth does not pay for drug screen tests performed for residential monitoring purposes since that purpose does not satisfy the requirement that laboratory tests must be medically necessary. This includes requests signed by a MassHealth authorized prescriber, if the purpose of the test is to comply with a sober home’s residential monitoring policy. Please review Clinical Laboratory Program Bulletin 9 (February 2013) for more information on drug screen-related quantitative test edits, sober home requests and laboratory requests: http://www.mass.gov/eohhs/docs/masshealth/bull-2013/lab-9.pdf.

For questions, please contact MassHealth Customer Service 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 from November 2013:

  • HHA-48: Revised Regulations  
  • IN-27: Revised Regulations  

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

Important Announcement - Provider Operations Changes

On January 1, 2014, MAXIMUS’s Customer Service Center (CSC) will assume direct responsibility for MassHealth Provider Enrollment & Credentialing (PEC), Electronic Data Interchange (EDI) and Provider Relations (including Provider Outreach & Training).  With this transition, Hewlett Packard Enterprise Services (HPES) will no longer provide subcontract services to support these functions.

From December 16-31, 2013, CSC will finalize the transition of these functions from HPES.  During this two-week period, there may be some delay in the processing of provider enrollment applications, provider profile updates, paper claims data entry, voids and 90-day waivers in order to complete this transition.

For details on how this transition may affect you, including key dates, “what is changing” and “what will remain the same”, go to www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ or www.mass.gov/eohhs/gov/departments/masshealth/.

Messages from the Week of December 2, 2013

December 2, 2013

Processing Delay

Due to a processing delay this weekend, 835 payment files are delayed slightly and will be available for download on POSC on Tuesday Dec. 3, 2013. We apologize for any inconvenience.

Messages from the Week of November 18, 2013

November 18, 2013

Home Health Advanced Beneficiary Notice Changes on December 9, 2013

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

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

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

EFT/ERA Operating Rule Goes into Effect January 1, 2014

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

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

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

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

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

Messages from the Week of November 11, 2013

November 13, 2013

Reminder: Bundling of Procedure Codes Not Allowed

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

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

Reminder: MassHealth is the Payer of Last Resort

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

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

Messages from the Week of November 4, 2013

November 4, 2013

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from October 2013:

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

Transmittal Letters from October 2013:

  • ALL-204: Revised Appendix Y

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

Messages from the Week of October 21, 2013

October 21, 2013

Attestation of Compliance Letter Mailing

MassHealth recently mailed out its ANNUAL ATTESTATION OF COMPLIANCE form along with a cover letter. This form is intended for MassHealth provider entities that make or receive at least $5 million in Medicaid payments annually. If you received this mailing in error, MassHealth asks that you please disregard it and apologizes for any inconvenience.

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

Reminder to Keep Provider Profile Information Up-to-Date

All providers are reminded: in accordance with MassHealth regulation 130 CMR 450.223(B), you must notify MassHealth in writing within 14 days of any change of information submitted in your original enrollment application including, but not limited to, changes in ownership or control, changes in address, criminal convictions or license status. Failure to notify MassHealth constitutes a breach of the provider contract and may result in termination of the provider contract or other sanctions. The absence of notification constitutes confirmation of no changes.

Any changes must be submitted to MassHealth and such changes do not become effective until the request has been processed.

To submit changes through the POSC (Provider Online Service Center), go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile. You may also submit changes, in writing, to Provider Enrollment and Credentialing, PO Box 9118, Hingham MA 02043.

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

Admission Dates are Required for Inpatient Claims

Providers are reminded: You are required to input the admission date on both 1500 and UB-04 claim types when the place of service is an Acute Inpatient hospital, Inpatient Psychiatric facility, Chronic Inpatient hospital or a Skilled Nursing facility. MassHealth will begin to enforce this standard compliance requirement in December.

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

Messages from the Week of October 7, 2013

October 7, 2013

All Providers – Billing for Services to Members Enrolled in Hospice

All providers are reminded to check the MassHealth Eligibility Verification System (EVS) to determine if a member is enrolled in hospice prior to rendering services.

In accordance with 130 CMR 437.412 (B) Waiver of Other Benefits, except for members described in 130 CMR 437.412 (A) (2), upon electing to receive hospice services, a member waives all rights to MassHealth benefits for the following services for the duration of the election of hospice services: (2) any MassHealth services that are related to the treatment of the terminal illness for which hospice services were elected, and (3) any MassHealth services that are equivalent or duplicative of hospice services with certain exceptions cited in 130 CMR 437.412 (B).

Claims for members enrolled in hospice submitted by non-hospice providers may be suspended with Edit 2018 – MEMBER ENROLLED IN HOSPICE, in order to determine if the services are related to the treatment of the terminal illness or equivalent or duplicative of hospice services. Claims from non-hospice providers where non-compliance with130 CMR 437.412 (B) (2) & (3) is found will be denied with Edit 2018 – MEMBER ENROLLED IN HOSPICE. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

Third Party Claims – Other Insurer Remittance Dates Required

Providers are reminded that MassHealth requires the other insurer remittance date when billing third party claims.  This remittance date is found on the other insurer’s EOB (Explanation of Benefits). For 837I transactions, this information is entered in Loop 2330B, DTP03 segment. For 837P transactions, this information is entered in Loop 2430, DTP03 segment. For claims submitted through the POSC (Provider Online Service Center), this information is entered in the Remittance Date field.

The remittance date should not match either the EOB date of any other insurer or the service date(s) on the claim. Submitting claims with duplicate EOB dates may result in denials for the following two new edits:

2507 DUPLICATE EOB DATES AT THE HEADER
2560 DUPLICATE EOB DATES AT THE DETAIL

Claims denying with these edits may be rebilled using the correct EOB/adjudication dates for all payers.

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

Out-of-State Hospital Providers – Notice of Rate Update

Out-of-State Acute Inpatient and Acute Outpatient Hospital providers please note: in accordance with MassHealth regulations 130 CMR 450.233 (D), new rates have taken effect for claims with dates of service 10/01/13 and thereafter.

To view the rates, go to http://www.mass.gov/eohhs/gov/laws-regs/. Click on the link to “MassHealth Regulations and Publications”, then click on “Special Notices for Hospitals”, and then click “Rates of Out-of-State Acute Hospital Services Effective October 01, 2013.” For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

New MassHealth  Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from September 2013:

-All Provider Bulletin 237: Primary Care Clinician (PCC) Plan Referral Process and Requirements

Transmittal Letters from September 2013:

-ALL-203: Integrated Care Organizations
-DEN-91: Revised Regulations about Dental Sealants
-NF-60: Integrated Care Organizations 
-PCA-19: Integrated Care Organizations

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

Messages from the Week of September 30, 2013

September 30, 2013

MMIS is Currently Experiencing Intermittent Issues Processing EDI Transactions

MMIS is currently experiencing intermittent issues processing EDI transactions. This issue may result in a delay of file processing and generation of functional acknowledgements (999s).  We are working to resolve this issue and restore processing to normal and we apologize for any inconvenience this may cause.   If you have any questions please contact the EHS Customer Support Center at 617-367-5500 or email SystemsSupporthelpdesk@Massmail.state.ma.us

Available October, 2013: Viewing Voids and Adjustments on the 835

Effective Monday, September 30, 2013, MassHealth will begin generating voids and adjustments on the 835 at both the detail line level and the header level. Providers will begin to see this change reflected on the 835 during October 2013.

Reversal transactions, identified by the CLP02 field equal to 22, have always been reported at the header level, even if the original payment was reported at the detail level. As of 09/30/13, reversal 835 transactions will mirror original payments. If original payment was reported at the claim detail, the reversal will be reported at the detail. Likewise, reversals will be reported at the header if original payments were reported at the header.

For further details, please see the ASC X12N Health Care Payment/Advice (835) Implementation Guide, section 1.10.2.8, Reversals and Corrections.

Messages from the Week of September 16, 2013

September 16, 2013

Chronic Disease and Rehabilitation Outpatient Crossover Denials

MassHealth has reprocessed Chronic Disease and Rehabilitation Outpatient Crossover claims with adjudication dates from 5/26/2009 through 5/21/2013 that denied in error for Edit 4801- PROCEDURE NOT COVERED BY PROVIDER CONTRACT. These reprocessed claims will appear on a future remittance advice. For questions, please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.

Messages from the Week of September 9, 2013

September 9, 2013

GAFC Claims Suspended for Edit 4014

MassHealth has identified an error in MMIS that caused several GAFC claims billed with service code H0043 to suspend for Edit 4014-NO PRICING SEGMENT ON FILE. This issue is being corrected and those claims currently in suspense should be released on the following week’s pay cycle. MassHealth apologizes for any inconvenience. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

DME, Oxygen & Respiratory Operating Standards for Prior Authorization

DME, Oxygen and Respiratory providers are reminded that clarified Operating Standards for the prior authorization process are now in effect as of September 01, 2013. These Operating Standards apply to providers of enteral and absorbent products (B and T service codes) and have been documented in collaboration with MassHealth, the PAU (Prior Authorization Unit) and the DME provider association, HOMES.

All DME, Oxygen and Respiratory providers who submit claims to MassHealth for B and T codes were emailed a copy of the Operating Standards on 8/26/13.

If you have any questions, please contact the 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:

Provider Bulletins from August 2013:

-All Provider Bulletin 236: Payment for Vaccine Administration and Office Visit
-All Provider Bulletin 235: Section 1202 Rates for Physicians Who Provide Primary Care Services
-Hospice Bulletin 10: Changes to MassHealth Coverage Types
-School-Based Medicaid Bulletin 25: Parental Authorization to Share Information with MassHealth

Transmittal Letters from August 2013:

-HCBS-2: Adoption of New HCBS Service Codes, Descriptions and Modifiers

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

Messages from the Week of September 2, 2013

September 4, 2013

Health Safety Net (HSN) NCCI Claim Denials Have Been Reprocessed

HSN providers are advised that claims that previously denied with the following NCCI (National Correct Coding Initiative) edits have been reprocessed:

5927-NCCI ANOTHER SERVICE PREVIOUSLY PAID SAME CLAIM
5928-NCCI ANOTHER SERVICE PREVIOUSLY PAID DIFFERENT CLAIM
5929-NCCI CONFLICT WITH ANOTHER SERVICE PREVIOUSLY PAID
5930-MUE UNITS EXCEEDED

These claims may appear on this remittance advice or a future remittance advice. For questions, please contact MassHealth Customer Service 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 from July 2013:

-Acute Outpatient Hospital Bulletin 30: Improving the Management of Postpartum Visits
-Community Health Center Bulletin 77: Improving the Management of Postpartum Visits
-Family Planning Agency Bulletin 12: Improving the Management of Postpartum Visits
-Home Health Agency Bulletin 49: Improving the Management of Postpartum Visits
-Physician Bulletin 95: Improving the Management of Postpartum Visits

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

Messages from the Week of August 19, 2013

August 20, 2013

Independent Nurses-Plan of Care Requirements

Independent Nurses are reminded: When you co-vend with other providers (home health agencies or nurses) to deliver CSN (continuous skilled nursing services), you and the other provider(s) are each responsible for obtaining orders from the member’s physician for CSN and the plan of care.  Independent Nurses should not provide nursing care to members, using physician orders and a plan of care issued to another home health agency or nurse provider.

Please refer to 130 CMR 414.412 (A-E) for Plan of Care requirements. For questions, contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

Nursing Facility Hospice Day of Discharge Billing Clarification

Nursing Facilities are reminded that, in accordance with 130 CMR 437.424 (B)(3), Hospice Providers must bill for hospice room and board on the day of hospice discharge when the member is to remain in the nursing facility.

Also, Hospice providers are reminded to enter Status Code 30 on the claim, indicating that the member will remain in the nursing facility after discharge from hospice.

EXAMPLE: If a member is discharged from hospice on 11/06, the member remains in the hospice sequence through 11/06. If the nursing facility bills for NF services on 11/06, the claim will deny. The nursing facility is paid hospice room and board on the day of hospice discharge. The nursing facility can begin billing for NF services the day after Hospice discharge, as in this example, 11/07.

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

Messages from the Week of August 12, 2013

August 14, 2013

Monthly MMQ Submission Reminder

Nursing Facility providers are reminded: you must submit your monthly MMQs (Management Minute Questionnaires) no later than the 15th of every month. If you have questions about your MMQ submission, please contact MassHealth Customer Service for assistance at providersupport@mahealth.net or call 800-841-2900. Your issues and inquiries will be properly triaged for review and resolution.

Messages from the Week of August 5, 2013

August 6, 2013

Available this Fall: Viewing Voids and Adjustments on the 835

MassHealth providers will soon be able to view voids and adjustments on the 835 at both the detail line level and the header level. The level of detail of the voids and adjustments will be based upon the level of detail of the original payment. Please ensure that your systems and your business operations are able to support this change. Providers interested in testing the new recoupment modifications can do so by contacting the EDI team at 1-800-841-2900 or edi@mahealth.net.

Nursing Home MMQ Issues

Nursing Home providers are reminded: if you have questions or issues with MMQs (Management Minute Questionnaires), please contact MassHealth Customer Service for assistance at providersupport@mahealth.net or call 800-841-2900. Your issues/inquiries will be properly triaged for review and resolution.

Nurse Practitioner and Nurse Midwife Claims Adjustments

Due to a systems issue, some claims for Nurse Practitioners and Nurse Midwives were paid incorrectly. The original claims were either underpaid or overpaid and are being adjusted to reflect the correct payment. The adjustments may appear on this remittance advice or a future remittance advice. For questions, please contact Customer Service at providersupport@masshealth.net or 800-841-2900.

Medicare Part B Denied Services That Require Manual Pricing

MassHealth has identified certain Medicare Part B crossover claims that were paid the full billed amount in error. The affected claim lines were denied by Medicare and were not manually priced as required by MassHealth. These claims have been adjusted with Edit 410 – MEDICARE DENIAL ON CROSSOVER CLAIM. The adjustments will appear on this or future remittance advices.

Providers Can Re-Bill these Affected Crossover Claims by Going on the Provider Online Service Center (POSC) and attaching the required documentation to support manual pricing via Direct Data Entry (DDE).

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

Messages from the Week of July 22, 2013

July 22, 2013

Crossover Claims Missing Medicare Carrier

MassHealth has identified crossover claims with dates of service 10/15/2010 through 12/12/2012 that were paid in error. These claims were missing the Medicare adjudication information on each detail line, as required in the MassHealth companion guide and billing guide.  Claims have been reprocessed with Edit 2552-CROSSOVER CLAIM MISSING MEDICARE CARRIER on this remittance advice.

These claims may be resubmitted with the appropriate Medicare adjudication information on each detail line as required. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900. 

Nursing Facility Claims Denied for Edit 2557-Potential Private Insurance in First 100 Days

MassHealth has identified a small volume of claims processed from December 2012 through July 21, 2013 that denied in error with Edit 2557-POTENTIAL PRIVATE INSURANCE IN FIRST 100 DAYS. Nursing Facility claims that included the private insurance adjudication details on the claim were denied in error for Edit 2557 due to pharmacy or dental coverage on the member’s file. The MMIS processing system was corrected on July 21, 2013 and will no longer edit nursing facility claims for pharmacy or dental coverage. Providers may resubmit claims denied in error or wait for the claims to be reprocessed on a future remittance advice.

Please note: many of the claims denied for Edit 2557 were denied correctly. These claims were either missing the required insurance adjudication information or contained the wrong carrier code. Please refer to Nursing Facilities Bulletin 133 and Appendix G of the Nursing Facility manual for information on TPL billing. The 7-digit carrier code for the member’s other insurance coverage can be obtained through Appendix C of the provider manual or the eligibility response in the Provider Online Service Center (POSC).

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

Messages from the Week of July 15, 2013

July 16, 2013

Hospice Claims Denying for Edit 5930 – MUE Units Exceeded

A number of Hospice claims are denying for Edit 5930 - MUE (Medically Unlikely Edits) UNITS EXCEEDED. Procedure codes T2042-ROUTINE CARE and T2046-ROOM AND BOARD are allowed one (1) unit per day with from-and-through dates of service.

When billing these codes, the service date line must match the Header Statement Covered Period from-and-through field.

When billing EDI claims or DDE (Direct Data Entry) claims, providers should bill from-and- through dates of service on one detail line. Example: 01/01/2013 – 01/31/2013 = 31 units to match the Header Dates of Service.

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

Certain Hospice Claims Deny Due to Conflict with NCCI

Due to recent updates to the federal National Correct Coding Initiative (NCCI), when hospice providers submit claims for members in nursing facilities for T2042-ROUTINE CARE in conjunction with T2046-ROOM AND BOARD on the same date of service (DOS), claims are denying with the following edits due to conflicts with NCCI codes:

5927 – NCCI-ANOTHER SERVICE PREV PAID-SAME CLAIM
5928 – NCCI-ANOTHER SERVICE PREV PAID-OTHER CLAIM
5929 – NCCI-CONFLICT WITH OTHER SERVICE PREV PAID

Providers are advised to continue to submit hospice claims for members in nursing facilities until a resolution is reached.

The affected claims are for dates of service April 01, 2013 and forward. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

Messages from the Week of July 1, 2013

July 1, 2013

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from June 2013:

-School-Based Medicaid Bulletin 24: School-Based Medicaid Program Interim Rates (Amended)
 

Transmittal Letters from June 2013: 

-ALL-201: Changes to MassHealth Payment Methods for Out-of-State Acute Hospitals   
-FPA-49: 2013 HCPCS

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

To sign up for e-mail alerts when Bulletins and Transmittal Letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of June 24, 2013

June 24, 2013

Adjustments for ACA Section 1202 Rates for Physicians who Provide Primary Care Services

MassHealth has identified overpayments, and in some cases underpayments, of ACA section 1202 rates on certain Evaluation and Management and Vaccine Administration claims submitted from January 1, 2013 to May 4, 2013, due to an error in preliminary section 1202 rates released by CMS. The enclosed remittance advice may contain claims processed from April to May 2013 that have been systematically adjusted to pay the corrected 1202 rate. In the coming weeks, remittance advices may contain claims processed from January through March 2013 that have been systematically adjusted to pay the corrected 1202 rate. We apologize for the inconvenience.

Providers whose claims denied for Edit 1010-RENDERING PROVIDER NOT A MEMBER OF THE GROUP should go onto the Provider Online Service Center (POSC) to update their provider profiles.

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.

For assistance on how to update your provider file on the POSC, you may access the job aid by going to www.mass.gov/masshealth and select the link for Medicaid Management Information System (MMIS). Select Provider Online Service Center (POSC), and then select the link Need Additional Information or Training. Click on the Get Trained link. The job aid is located under Provider Profile Maintenance. For questions, please contact MassHealth Customer Service at providersupport@masshealth.net or call 800-841-2900.

Reminder to Group Providers – Rendering Provider NPI Must Be Affiliated With Group

Group providers: you are reminded that claims billed with a rendering provider NPI that is not affiliated with your group will deny for Edit 1010 – RENDERING PROVIDER NOT A MEMBER OF BILLING GROUP. Please verify that your group’s provider affiliations are up-to-date and accurate within your profile.

To submit provider profile changes through the Provider Online Service Center (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.

For help with POSC updating, you can access the job aid by going to www.mass.gov/masshealth. Select the link for Medicaid Management Information System (MMIS). Select the link Need Additional Information or Training. Select the Get Trained link. The job aid is located under Provider Profile Maintenance. For questions, please contact MassHealth Customer Service at providersupport@mahealthnet or call 1-800-841-2900.

Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Wednesday, July 17, 2013
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 one of five PERM Provider Webinar/Conference calls during PERM Cycle 2 (2013), hosted by the Centers for Medicare & Medicaid Services (CMS).

As a webinar participant, you 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# 4964
Webinar: https://webinar.cms.hhs.gov/permcycle2web5/

To test your connection in advance, launch https://webinar.cms.hhs.gov/common/help/en/support/meeting_test.htm

For more information on PERM, please see MassHealth All Provider Bulletin 231, February 2013.

Claims Suspended for Edit 819 – Paper Claim Submission under Review

Therapy providers are reminded: you must submit all claims electronically unless you have been approved for an electronic claim submission waiver. Paper claims will suspend for edit 819-PAPER CLAIM SUBMISSION UNDER REVIEW. If an electronic claim submission waiver form is not submitted and approved within thirty (30) days of the suspended claims, the paper claims will be denied with edit 7750-PAPER CLAIM NOT ALLOWED. Please refer to All Provider Bulletin 223 dated February 2012 at www.mass.gov/masshealthpubs for further instructions. For questions, contact Customer Service at providersupport@masshealth.net or 800-841-2900.

Messages from the Week of June 17, 2013

June 17, 2013

Clinical Review of Acute Inpatient Claims for Edit 2614

This is to remind Massachusetts Acute Inpatient Hospitals that they must submit the following documentation to MassHealth for review of Edit 2614 – MANAGED CARE SHOULD BE PAID BY BEHAVIORAL HEALTH:

-Cover letter: include the patient name, MassHealth ID number, date of service, hospital contact person, hospital contact phone number and a brief description why MassHealth needs to review the claim.
-Remittance advice showing the 2614 denial.
-Medical records (only the following should be submitted):

-Face sheet
-Emergency Department history and physical exam
-Admission history and physical exam
-Social worker/Case management notes
-Admission orders
-Discharge summary
-Consultation notes

Claims requiring review should be sent via Direct Data Entry (DDE) using delay reason code 11 and include the required documentation.   Claims which are submitted without the required documentation may cause delays in review and claims processing or claims denials.

Please note: only providers with a paper waiver can submit paper claims and required documentation to: Utilization Management Department, 100 Hancock Street - 6th Floor, Quincy MA 02171.

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

June 19, 2013

System Maintenance

The MMIS POSC, including the internal MMIS application, MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 06/23/2013 from 6.00 AM to 5:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.  If you have any questions please contact the EHS Customer Support Center at 617-367-5500 or email SystemsSupporthelpdesk@Massmail.state.ma.us.

Messages from the Week of June 10, 2013

June 10, 2013

Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Tuesday, June 18, 2013
Time: 3:00-4:00 p.m. 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 (2013), hosted by the Centers for Medicare & Medicaid Services (CMS).

As a webinar participant, you 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# 4964
Webinar: https://webinar.cms.hhs.gov/permcycle2web3/

To test your connection in advance, launch https://webinar.cms.hhs.gov/common/help/en/support/meeting_test.htm

Presentation materials and participant call-in information are available at the cms.gov website.

Messages from the Week of June 3, 2013

June 3, 2013

Attention Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

DentaQuest will launch its new Claims Processing System and Provider Web Portal (Windward) on Thursday, June 27, 2013. All MassHealth Dental providers who use CDT service codes and submit claims, either electronically or by paper with a waiver, need to be aware of the following changes leading up to the implementation.

The Provider Web Portal will temporarily close from June 15, 2013 through June 26, 2013. It is therefore important to note:

-All claims sent electronically via a clearing house/vendor will be held in a pending status during this time period. Be prepared for a delay of confirmation from your clearing house/vendor regarding claim acceptance.

-If you have a waiver to submit paper claims, you should continue to submit claims at this time, as they will be scanned during the downtime and will enter the system on June 24th.
-You may submit prior authorizations via paper during this period.  They will move through the regular process, although determination letters will not go out during this period.
-You may still use the Web Portal during this time to view eligibility, remittance information, status of claims and prior authorizations.

Please refer to Dental Provider Bulletin DEN-42, dated May 2013, for details of all activities that will occur in preparation of DentaQuest’s new Claims Processing System and Provider Web Portal.

Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. Click on Provider Bulletins, then 2013 Bulletins, then May. For questions, contact MassHealth Dental Customer Service at 1-800-207-5019 or e-mail: inquiries@masshealth-dental.net.

Provider Profile Maintenance for Group Practices

In preparation for revalidation with MassHealth, as mandated by the Affordable Care Act (ACA), it is imperative that you ensure that the individual practitioners linked to the group are accurate and current on the group’s MassHealth provider file.   Please take the time to validate this data on the Provider Online Service Center (POSC).

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.

For assistance on how to update your provider file on the POSC, you may access the job aid by going to www.mass.gov/masshealth and select the link for Medicaid Management Information System (MMIS). Select Provider Online Service Center (POSC), and then select the link Need Additional Information or Training. Click on the Get Trained link. The job aid is located under Provider Profile Maintenance.

The completion of this group provider file clean-up is in preparation for revalidation. To assist group practices with the revalidation of the individual practitioners that are linked to their groups, MassHealth intends to update the security profiles of each individual group member. This will allow a designated individual at the practice to complete the revalidation for each individual practitioner in the group via the POSC.

As a reminder, per regulation 130 CMR 450.215, any change in your relationship with Masshealth must be communicated to MassHealth Provider Enrollment and Credentialing to maintain accurate information on your provider file.

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

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from May 2013:
-All Provider Bulletin 234: Predictive Modeling Initiative
-Dental Bulletin 42: New Claims Processing System and Web Portal Preparation for MassHealth Dental Providers Who Bill Current Dental Terminology (CDT) Service Codes 

Transmittal Letters from May 2013:

-ALL-200: Emergency Adoption of Mental Health Parity Regulations 
-AOH-30: New Modifiers for National Correct Coding Initiative
-CHC-97: New Modifiers for National Correct Coding Initiatives 
-FPA-48: New Modifiers for National Correct Coding Initiatives  
-PHY-138: New Modifiers for National Correct Coding Initiatives 
-POD-68: New Modifiers for National Correct Coding Initiatives
-SAT-17: 2013 HCPCS  

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

To sign up for e-mail alerts when Bulletins and Transmittal Letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of May 27, 2013

May 28, 2013

Chronic Disease and Rehabilitation Outpatient Crossover Denials

MassHealth has resolved an issue that was causing Medicare crossover claims submitted by Chronic Disease and Rehabilitation outpatient hospitals to deny for edit 4801 - PROCEDURE NOT COVERED BY PROVIDER CONTRACT. Medicare crossovers processed after 05/22/2013 will no longer deny for this edit. MassHealth plans to reprocess the previously denied crossovers on a future remittance advice. However, providers may resubmit denied crossovers at this time. For questions, please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.

Non-Group Providers Billing With a Rendering NPI

MassHealth has recently identified an issue which resulted in erroneous payments for claims from non-group providers billing with a rendering NPI. MassHealth will systematically adjust these claims on a future remittance advice. Any adjusted claims where the provider is a non-group provider billing with a rendering NPI will deny for edit 1010 – RENDERING PROVIDER NOT A MEMBER OF BILLING GROUP. Providers are reminded when billing MassHealth that a rendering NPI is required for group practices only. Any claims submitted by a non-group practice with a rendering NPI will be denied with error EOB code 1010 - RENDERING PROVIDER NOT A MEMBER OF BILLING GROUP.

We apologize for any inconvenience this may have caused. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Messages from the Week of May 20, 2013

May 23, 2013

System Maintenance

The MMIS POSC, including the internal MMIS application, MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 05/26/2013 from 6:00 PM to 11:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.  If you have any questions please contact the EHS Customer Support Center at 617-367-5500 or email SystemsSupporthelpdesk@Massmail.state.ma.us.

May 20, 2013

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. Below outlines the modified payment schedule.

RA DATE: 07/02/2013
PAYMENT DATE CHECKS: 07/05/2013
PAYMENT DATE EFT: 07/08/2013

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: 7/16/13
PAYMENT DATE CHECKS: 7/19/13
PAYMENT DATE EFT: 7/22/13

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

Messages from the Week of May 20, 2013

Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Tuesday, May 21, 2013
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 one of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2013), 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# 4964
Webinar: https://webinar.cms.hhs.gov/permcycle2web1/

To test your connection in advance, launch https://webinar.cms.hhs.gov/common/help/en/support/meeting_test.htm

Presentation materials and participant call-in information are available at the cms.gov website.

Reminder to Enroll all Provider Service Locations

MassHealth requires that providers enroll all service locations where services are provided to MassHealth members, with the exception of outpatient satellites. Failure to enroll all locations is a violation of MassHealth regulations 130 CMR 450.222 and 450.223, located in the All Provider Regulations. If you have any unenrolled service location(s), please contact MassHealth Customer Service at 1-800-841-2900 to request an application and enroll the site(s) as soon as possible.

Messages from the Week of May 6, 2013

May 6, 2013

Adult Day Health Retroactive Rate Increase

This remittance advice (RA) may contain adjusted claims due to a retroactive rate increase. If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Claims Reprocessed – Edit 4801 – Procedure Not Covered by Provider Contract

For certain Community Health Centers that are also MassHealth Mental Health Center providers, claims that were submitted with Mental Health codes 90832, 90833, 90834, 90836 and 90791 were denied erroneously with Edit 4801 – PROCEDURE NOT COVERED BY PROVIDER CONTRACT. This issue has been resolved and the claims have been reprocessed. The reprocessed claims may appear on this or future Remittance Advices. No action is required by providers.

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

Transportation Providers – Billing with Invalid Modifiers

MassHealth is reminding Transportation providers to submit claims with valid modifiers. Claims that are submitted with invalid modifiers will deny with Edit 251 - FIRST MODIFIER NOT COVERED and/or Edit 252 – SECOND MODIFIER NOT COVERED.

Transportation providers must use service codes and modifiers that accurately reflect the services provided. 

For questions, contact MassHealth Customer Service 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 from April 2013:

-Acute Inpatient Hospital Bulletin 147: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility
-Community Health Center Bulletin 75: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility
-Long-Term Care Facility Bulletin 107: Annual Accounting for Personal Needs Account (PNA) Funds
-Nursing Facility Bulletin 136: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility
-School-Based Medicaid Bulletin 23: Claiming Medicaid Reimbursement for Students Placed in the Judge Rotenberg Center


Transmittal Letters from April 2013:

-AIH-48: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center
-CHC-96: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center
-CDR-28: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center
-MHC-45: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center
-NF-59: Revised Appendix G - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center
-PIH-21: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

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

To sign up for e-mail alerts when Bulletins and Transmittal Letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of April 29, 2013

April 29, 2013

Hospice Election Form Reminder

In accordance with 130 CMR 437.412(C), Hospice providers must submit a completed and signed MassHealth Hospice Election Form before billing for members who elect hospice services. You must complete this form whenever a MassHealth member chooses to elect or stop hospice services, to change hospice providers or when a member is disenrolled from hospice.

If you do not submit a completed and signed Hospice Election Form, the member will not be properly coded to the hospice provider ID/service location. Claims will be denied with Edit 2800 – MEMBER NOT TIED TO HOSPICE FOR DATE OF SERVICE.

A completed Hospice Election form includes (but is not limited to):

-MassHealth PID/SL
-MassHealth member ID
-Hospice disenrollment reason (section D, if applicable)

To download a copy of the MassHealth Hospice Election Form, go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/ and then click on MassHealth Provider Forms.

You may fax the completed form to 617-886-8133 or 617-886-8134 or mail the form to:

MassHealth Hospice Unit
UMMS-CHCF
529 Main Street
Charlestown, MA 02129

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

Hospice Providers – Eligibility Verification System (EVS)

Hospice providers are reminded to check member eligibility in EVS before submitting completed hospice election forms to the hospice unit for processing. When checking member eligibility in EVS, providers are reminded to click on both the member information and eligibility information tabs.  The eligibility information tab includes detailed information, such as, restrictive messages, other insurance, coverage types, managed care and long term care.

In accordance with 130 CMR 508.000, members in MCO and PCC plans are subject to specific requirements regarding hospice enrollment. The hospice benefit is a covered service for members enrolled in SCO and PACE plans and payment for the hospice benefit is the responsibility of the SCO or PACE plan. Providers should contact SCO or PACE plans directly for hospice billing instructions at the telephone numbers listed on the eligibility screen.

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

Independent Nurses – Billing Weekend Nursing Services

Independent Nurses are reminded that they should not use the UJ (NIGHT) modifier to indicate nursing services on a weekend.  The weekend rate will automatically be paid for nursing services provided on the weekend. 

Please refer to Subchapter 6 of the Independent Nurses Manual for definitions of nursing hours and modifiers.  Independent Nurse providers must use service codes that accurately reflect the nursing services provided.

Rates for home health nursing services can be found under Home Health Services (114.3 CMR 50.00) at www.mass.gov/eohhs/gov/laws-regs/hhs/regs.html. Click on Regulations.

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

Messages from the Week of April  22, 2013

April 23, 2013

This remittance advice (RA) may contain adjusted claims due to a retroactive rate increase.  If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Messages from the Week of April  15, 2013

April 17, 2013

System Maintenance

The MMIS POSC, including the internal MMIS application, MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 4/21/2013 from 4:00 AM to 7:00 AM due to system maintenance. MAP and CBHI will also be impacted.

If you have any questions please contact the EHS Customer Support Center at 617-367-5500 or email SystemsSupporthelpdesk@Massmail.state.ma.us

Deadline Extended on Health Safety Net Billing Waiver Extension

The Health Safety Net (HSN) has further extended the billing waiver for submission of HSN 837I and 837P claims to MMIS from April 30 to June 30, 2013. Providers should note that, effective July 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.

Attention Masshealth Providers

Providers are reminded that only emergency services that are necessary to treat an acute medical condition requiring immediate care are allowed for members who have MassHealth limited coverage as described in 130 CMR 450.105 (G)(1):

Covered Services. For MassHealth limited coverage members (please see 130 CMR 505.008 AND 519.009), MassHealth will only pay for the treatment of a medical condition (including labor and delivery) that manifests itself by acute symptoms of sufficient severity that the absence of immediate medical attention reasonably could be expected to result in:

(A) Placing the member’s health in serious jeopardy,

(B) Serious impairment to bodily functions, or

(C) Serious dysfunction of any bodily organ or part.

For questions, please contact MassHealth Customer Services at 1-800-841-2900 or email your inquiry to providersupport@mahealth.net.

Messages from the Week of April  8, 2013

April 8, 2013

Edit 4038 - Claims Adjustments

A recently identified system issue resulted in erroneous payments for certain claims.  This remittance advice may contain adjusted claims where line items are denied for Edit 4038 as a result of the erroneous payments. If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Messages from the Week of April 1, 2013

April 1, 2013

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from March 2013:

-ALL-199: Revised Regulations about Electronic 90-Day Waiver and Final Deadline Appeals file size 5MB

-ALL-198: Emergency Adoption of Mental Health Parity Regulations

-FAS-26: 2013 HCPCS

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

To sign up for e-mail alerts when Bulletins and Transmittal Letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Health Safety Net Billing Waiver Extension

The Health Safety Net (HSN) has extended the billing waiver for submission of HSN 837I and 837P claims to MMIS through April 30, 2013. Providers should note that, effective May 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.

Attention Dental Providers

Providers are reminded that only emergency services that are necessary to treat an acute medical condition requiring immediate care are allowed for members who have MassHealth Limited Coverage as described in 130 CMR 450.105 (G)(1):

Covered Services. For MassHealth limited coverage members (please see 130 CMR 505.008 AND 519.009), MassHealth will only pay for the treatment of a medical condition (including labor and delivery) that manifests itself by acute symptoms of sufficient severity that the absence of immediate medical attention reasonably could be expected to result in:

(A) Placing the member’s health in serious jeopardy,

(B) Serious impairment to bodily functions, or

(C) Serious dysfunction of any bodily organ or part.

MassHealth will cover the following Dental Codes for members with limited coverage:

D0140, D0220, D0230, D0330, D7140, D7210 AND D9110

For questions, please contact MassHealth Dental Customer Services AT 1-800-325-5231 or email your inquiry to: INQUIRIES@MASSHEALTH-DENTAL.NET.

Billing Reminder for Therapy Providers: Modifier HA is Required for Services Codes 97001, 97003, and 92506 for Members Age 21 and Under

Therapy providers are reminded that they must follow the billing guidelines in Subchapter 6, Service Codes and Descriptions. Refer to Transmittal Letter THP-25, dated June 2011.  Modifier HA must be used when billing therapy evaluation service codes 97001, 97003 and 92506 for members aged 21 and under. Refer to Transmittal Letter THP-20, dated November 2003. To access these Transmittal Letters, go to www.mass.gov/masshealthpubs.

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

Messages from the Week of March 18, 2013

March 18, 2013

ACA Section 1202 Rates for Physicians Who Provide Primary Care Services

MassHealth has identified underpayments of ACA section 1202 enhancement rates on certain claims submitted between January 01, 2013-March 01, 2013. The enclosed remittance advice may contain claims that were systematically adjusted to pay the enhanced fee. We apologize for the inconvenience.

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

Early Intervention Service Code T1024 Denials for Edit 8155

MassHealth understands that due to a unit-counting issue, MMIS inappropriately adjudicated a number of Early Intervention (EI) provider claims for service code T1024 (EI assessment) with edit 8155 (limit 40 units in 12 months), not allowing for the maximum of 40 units per 12- month period.

To appropriately allow the maximum of 40 units per 12-month period, units of T1024 for dates of service on or after July 01, 2011 are being counted based on a MOVING DATE OF SERVICE (DOS) anniversary date, with MassHealth beginning to count the 40 units based on the first DOS for which the claim for T1024 is filed. For example, if an EI provider submits an a claim for T1024 with the first DOS of March 06, 2013, the EI provider may then bill an accumulation of 40 units of T1024 during the 12-month period beginning on DOS March 06, 2013 and ending March 05, 2014. After March 05, 2014 and having reached the 12-month mark from the first DOS on the claim, MassHealth will begin counting another 40 units toward the next 12-month period, based on the DOS of the T1024 claim that is received after March 05, 2014. For example, if a claim is submitted with the first DOS of May 06, 2014, then MassHealth will again begin counting up to 40 units in the 12-month period beginning May 06, 2014 and ending May 05, 2015.

MassHealth will systematically reprocess previously adjudicated claims for T1024 due to edit 8155, for DOS July 01, 2011 and following, on future remittance advices. No action is required on the part of the provider.

We apologize for any inconvenience this may have caused. For questions, including information on the appeals process, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Updated Hospice Rates

Please be advised that the Executive Office of Health and Human Services (EOHHS) has updated the Hospice Rates for MassHealth Hospice Providers, pursuant to regulation 101 CMR 343.00. The updated Hospice rates are effective for dates of service October 01, 2012 –September 30, 2013. MassHealth will process mass retro rate adjustments in April 2013. No further action is required by Hospice Providers.

If you have questions, contact MassHealth Customer Service at 1-800-841-2900. Updated Hospice Rates are available at EOHHS’s website at www.mass.gov/eohhs/gov/laws-regs/hhs/regs.html.

New MassHealth Publication Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from February 2013:

-Acute Outpatient Hospital Bulletin 28: Drug Screen/Quantitative Drug Test Claim Edit; Drug Screens Performed For Residential Monitoring
-All Provider Bulletin 233: Revisions to the 90-Day Waiver Procedures
-All Provider Bulletin 232: Revisions to the Final Deadline Appeal Procedures
-All Provider Bulletin 231: Payment Error Rate Measurement (PERM) Project
-Community Health Center 74: Drug Screen/Quantitative Drug Test Claim Edit; Drug Screens Performed For Residential Monitoring
-Independent Clinical Laboratory Bulletin 9: Drug Screen/Quantitative Drug Test Claim Edit; Drug Screens Performed For Residential Monitoring
-Physician Bulletin 94: Drug Screen/Quantitative Drug Test Claim Edit; Drug Screens Performed For Residential Monitoring

Transmittal Letters from February 2013:

-ALL-197: Revised Appendix C

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

To sign up for e-mail alerts when Bulletins and Transmittal Letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of February 25, 2013

February 25, 2013

Health Safety Net Billing Waiver Extension

The Health Safety Net (HSN) has extended the billing waiver for submission of HSN 837I and 837P claims to MMIS through April 30, 2013. Providers should note that, effective May 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.

Notification of Change Requirements

As a MassHealth provider, you are reminded that, in accordance with MassHealth regulation 130 CMR 450.223(B), you must notify MassHealth in writing within 14 days of any profile information that has changed since your initial enrollment. This includes, but is not limited to, changes in ownership or control, criminal convictions, address changes or license status. Failure to notify MassHealth constitutes a breach of the provider contract and may result in termination of the provider contract or other sanctions. The absence of notification constitutes confirmation of no changes.

To submit changes through the Provider Online Service Center (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. Providers without Internet access may submit changes in writing to Provider Enrollment and Credentialing, PO Box 9118, Hingham, MA 02043.

Provider Online Service Center (POSC) Security

The POSC was designed with security protocols that allow access to a provider’s information by only authorized individuals. This process is accomplished with the assignment of a primary user for each provider. The primary user then has the responsibility to grant subordinate permissions to provider staff for the functions they need. The primary user is also required to maintain user IDs by removing access for those who leave the provider or change job functions.

Maintaining subordinate access is a requirement that is mandated by regulation to notify MassHealth of any change in information. If a primary user no longer has that role, the provider must assign a new primary user and remove the previous user’s access as necessary. Providers are not permitted to continue to use the primary user ID of someone who is no longer employed. Providers should audit their primary user(s) and subordinate(s) to be certain that they are up-to-date.

Messages from the Week of February 11, 2013

February 13, 2013

To all Health Safety Net (HSN) Providers

Please note that weekly maintenance of the HSN eligibility web service occurs on Sundays between 4:00 p.m. – 7:00 p.m. EST. HSN claims should not be submitted to the POSC during this time. Claims submitted during this time may be suspended or denied for eligibility. Questions should be directed to the HSN Help Desk at (800) 609-7232 or hsnhelpdesk@state.ma.us. Thank you.

Messages from the Week of January 28, 2013

February 1, 2013

Billing for Influenza Vaccine – Notice for Physicians, Group Practices and Independent Nursing Practitioners

In response to the flu vaccine crisis, MassHealth wants to inform physicians, group practices and independent nurse practitioners that you will be reimbursed for privately-purchased flu vaccine if you exhaust your state-provided supply from local boards of health or the Massachusetts Department of Public Health (MDPH).

In accordance with 130 CMR 433.443 (c)(2)(a), reimbursement for privately-purchased vaccine can be obtained by using the following codes: 90655, 90656, 90657, 90658, 90660, 90661 and 90662.

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

Billing for Influenza Vaccine – Notice for Community Health Centers

In response to the flu vaccine crisis, MassHealth wants to inform community health centers that they will be reimbursed for privately-purchased flu vaccine if they exhaust their state-provided supply from local boards of health or the Massachusetts Department of Public Health (MDPH).

Reimbursement for privately-purchased vaccine can be obtained by using the following codes: 90655, 90656, 90657, 90658, 90660, 90661 and 90662.

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

Billing for Influenza Vaccine – Notice for Limited Services Clinics

In response to the flu vaccine crisis, MassHealth wants to inform limited services clinics that they will be reimbursed for privately-purchased flu vaccine if they exhaust their state-provided supply from local boards of health or the Massachusetts Department of Public Health (MDPH).

Reimbursement for privately-purchased vaccine can be obtained by using the following codes: 90655, 90656, 90657, and 90658.

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

Notice to Providers Submitting Direct Data Entry (DDE) Claims Using Delay Reason Code 11

All Provider Bulletin 225, dated April 2012, communicates the circumstances in which to use each Delay Reason Code when submitting Direct Data Entry (DDE) claims via the Provider Online Service Center (POSC). Delay Reason Code 11 – OTHER includes, but is not limited to, NCCI/MUE related reviews and special circumstances. DDE claims for submissions of Final Deadline Appeals (9) or 90-Day Waiver Requests (1, 4 or 8) should be submitted with the appropriate Delay Reason Code, as noted. Additionally, claims submitted with TPL attachments, Sterilization forms, Hysterectomy forms or Invoices are not required to submit with Delay Reason Code 11 unless the circumstance is specifically outlined in the bulletin referenced above.

Please remember to include a brief cover letter as to why special handling is needed and include the supporting documentation, as well as any applicable remittance advices, with your DDE claim submission. Erroneous selections of Delay Reason Codes may cause delays in claims processing or result in claims denials.

Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. Click on Provider Bulletins, then 2012 Bulletins, then April. For questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

 

Messages from the Week of January 14, 2013

January 18, 2012

System Maintenance

Due to Scheduled System Maintenance, the MMIS Internal application and MMIS POSC will not be available between 4:00 AM EST to 7:00 AM EST on Sunday,  01/20/2013. MAPIR (Medical Assistance Provider Incentive Repository) application will also be unavailable during this window.

January 14, 2013

Substance Abuse Service Code H0020 Denials for Edit 5930

MassHealth understands that due to the October CMS NCCI quarterly update, MMIS has been denying Substance Abuse provider claims for service code H0020 (alcohol and/or drug services methadone administration and/or service) when more than one unit is billed, with denial edit 5930 (MUE units exceeded). MassHealth has reviewed this matter and has implemented a change to the billing procedures so that H0020 may only be used to bill Methadone Administration. Counseling services provided as part of the Methadone program should be billed separately with the codes listed below.

The new codes allowed for counseling are:

H0004 TF - Behavioral Health counseling and therapy (Methadone/Opioid counseling) per 15-minute unit (individual counseling, intermediate level of care, four units maximum per day)

T1006 HR - Alcohol and/or substance abuse services (Methadone/Opioid counseling) per 30-minute unit (family/couple counseling, two units maximum per day)

H0005 HQ - Alcohol and/or drug service group counseling by a clinician (Methadone/ Opioid counseling) per 45-minute unit (two units maximum per day)

The following codes, previously allowed for counseling, will no longer be valid effective January 16, 2013: H0020 TF, H0020 HR and H0020 HQ.

Providers who have denied claims with service code H0020 due to the MUE quarterly update must resubmit their claims using the new substance abuse counseling codes and modifiers. 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.

Chronic Disease and Rehabilitation Hospital UMP Post-Payment Reviews

The Chronic Disease and Rehabilitation Hospital Utilization Management Program (UMP) will begin post-payment reviews this month on inpatient claims. The UMP will send written correspondence to the hospitals identified for the post-pay review, listing the claims being reviewed.

The UMP will also request that hospitals submit medical records as needed, in accordance with MassHealth regulation at 130 CMR 450.205. Medical record requests will continue on a monthly basis. If you have any questions regarding the review process, please contact Martina McCormack, UMP Manager, at 617-847-3748.

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from December 2012

  • Nursing Facility Bulletin 135: Updates to Nursing Facility Pay for Performance (NF P4P) Program for Fiscal Year (FY) 2013
  • All Provider Bulletin 230: Section 1202 Rates for Physicians Who Provide Primary Care Service

You can download a copy of a bulletin or transmittal letter from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of January 7, 2013

January 11, 2013

Scheduled System Maintenance

Due to Scheduled System Maintenance, the MMIS Internal application and POSC will be unavailable between 6.00 PM EST to 8:00 PM EST on Sunday, 01/13/2013.  MAPIR application (Medical Assistance Provider Incentive Repository) will also be unavailable during this window.

If you have any questions please contact the EHS Customer Support Center at 617-367-5500 or email SystemsSupporthelpdesk@Massmail.state.ma.us.

Messages from the Week of December 31, 2012

January 3, 2013

Provider Online Service Center (POSC) Security

The POSC was designed with security protocols that allow access to a provider’s information by only authorized individuals. This process is accomplished with the assignment of a primary user for each provider. The primary user then has the responsibility to grant subordinate permissions to provider staff for the functions they need. The primary user is also required to maintain user IDs by removing access for those who leave the provider or change job functions.

Maintaining subordinate access is a requirement that is mandated by regulation to notify MassHealth of any change in information. If a primary user no longer has that role, the provider must assign a new primary user and remove the previous user’s access as necessary. Providers are not permitted to continue to use the primary user ID of someone who is no longer employed. Providers should audit their primary user(s) and subordinate(s) to be certain that they are up-to-date.

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from December 2012

  • All Provider Bulletin 230: Section 1202 Rates for Physicians Who Provide Primary Care Service

You can download a copy of a bulletin or transmittal letter from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of December 24, 2012

December 28, 2012

MMIS POSC Maintenance

Due to Scheduled System Maintenance, the MMIS POSC will be available intermittently between 11:00 AM to Noon on Saturday 12/29/2012 . This will also result in intermittent access to the MAPIR application (Medical Assistance Provider Incentive Repository).

If you have any questions please contact the EHS Customer Support Center at 617-367-5500 or email SystemsSupporthelpdesk@Massmail.state.ma.us.

December 24, 2012

2012 Preventive Care Guidelines and Immunization Schedules Now Available

The Massachusetts Health Quality Partners (MHQP) has released the 2012 Pediatric and Adult Preventive Care Guidelines and Immunization Schedules. They can be accessed via the MHQP web site.

For Pediatric Preventive Care Recommendations, go to: www.mhqp.org/guidelines/pedPreventive/pedPreventive.asp?nav=041100

For Adult Preventive Care Guidelines, go to: www.mhqp.org/guidelines/adultPreventive/adultPreventive.asp?nav=040900

Important Message For Group Practice Providers Submitting Medicare Crossover Part B Claims

MassHealth has implemented a processing change for Part B crossover claims billed by group practice providers.

As of 12/16/12, all Part B crossover claims submitted by group practice providers will be priced based on the rendering provider ID submitted in the claim detail. Previously, MassHealth priced these claims based on the billing provider ID. The rendering provider ID must be on file with MassHealth and is required on the claim submission. The following informational edits will appear on your remittance advice if the rendering provider ID is not on file or is not eligible to bill the service: Edit 1007 -DETAIL RENDERING PROVIDER I.D. NOT ON FILE or Edit 1002 -DTL PERFORMING PROV NOT ELIG AT SERV LOC FOR PROG.

Group practice providers are responsible for ensuring that all individuals who practice as rendering providers in the group are enrolled and active providers with MassHealth before claims may be submitted for payment. Failure to do so may result in claims denials.

New NCCI Modifiers

Effective January 01, 2013, four (4) modifiers have been added to the list of modifiers that providers can use, when medically appropriate and in accordance with CMS regulations, to bypass National Correct Coding Initiative (NCCI) procedure code to procedure code (PTP) edits.

The following two new HCPCS modifiers will be added to the list of allowable PTP associated modifiers for Medicaid fee-for-service claims subject to the Practitioner (PRA) NCCI edits and Outpatient Hospital (OPH) NCCI edits:

LM – LEFT MAIN CORONARY ARTERY
RI – RAMUS INTERMEDIUS CORONARY ARTERY

The following two existing CPT modifiers will be added to the list of designated PTP-associated modifiers for use for Medicaid fee-for-service claims subject to PRA NCCI edits, but not for claims subject to OPH NCCI edits:

24 – UNRELATED MANAGEMENT AND EVALUATION SERVICE BY THE SAME PHYSICIAN DURING POST-OPERATIVE PERIOD
57 – DECISION FOR SURGERY

Note that these two modifiers have previously been allowable by MassHealth for purposes of bypassing global surgery edits. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900. For general information on modifier use, please see Provider Bulletin 227.

Messages from the Week of December 17, 2012

December 17, 2012

Important Message about Third Party Liability Claims for Qualified Medicare Beneficiaries (QMB) Members with Medicare Advantage Plans

On 12/02/2012, MassHealth implemented a system change to allow third party liability claim payment for MassHealth non-covered services provided to MassHealth QMB members with Medicare Advantage Plan coverage. Claims processed on or after 12/02/2012 for MassHealth non-covered services provided to members with Medicare Advantage will be paid if there is a remaining MassHealth liability on the claim.

As a result of this change, providers may see the following new EOB codes on remittance advices:

1806 - PAID PATIENT RESPONSIBILITY AMOUNT (header)
1807 - PAID PATIENT RESPONSIBILITY AMOUNT (detail)

MassHealth plans to reprocess previously denied claims and will provide an update in a future message. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

TPL Edits Setting on Nursing Home Claims

Nursing Facility providers are reminded that they must follow the billing guidelines in Bulletin 133, dated May 2012, as well as the guidelines published in Transmittal Letter NF 58, dated December 2011, when billing claims for members with Medicare, Medicare Advantage and/or other insurance coverage.

Claims denying for Edit 2528 - POTENTIAL MEDICARE A IN FIRST 100 DAYS, Edit 2556 – POTENTIAL MEDICARE C IN FIRST 100 DAYS or Edit 2557 – POTENTIAL PRIVATE INSURANCE IN FIRST 100 DAYS can be resolved by following the instructions in the above-mentioned publications. Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/ and click on the links for Bulletins and Transmittal Letters. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Multiple Payer Non-Covered Amounts

MassHealth has resolved an issue with some TPL exception claims that were incorrectly denying for other insurance with Edit Code 2502 - MEMBER COVERED BY OTHER INSURANCE or Edit 2505 – MEMBER COVERED BY MEDICARE when there are multiple payers reported on the claim and one of the payers has a total non-covered amount. The issue was resolved on 12/02/12 and the affected claims will be reprocessed on future remittances. Providers may also re-submit the affected claims to MassHealth. For any questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

New Edit Setting on Medicare Part B Denied Services

MassHealth implemented a new edit, 410 – MEDICARE DENIAL ON CROSSOVER CLAIM, on 12/02/12 for certain Part B crossover claim lines when Medicare has denied the service. Claims denied for Edit 410 may be resubmitted to MassHealth, including the COB adjudication details and any other required documentation, if Medicare has denied the claim for reasons other than a correctable error. For any questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

December 11, 2012

Coordination of Benefits (COB) - Direct Data Entry (DDE) Enhancements on the POSC

Providers are advised that MassHealth has made enhancements on the POSC for all COB claim submissions.  Certain COB fields in the Coordination of Benefits and Procedure tabs will now auto-populate for you:

Coordination of Benefits Tab: In the “Coordination of Benefits (COB) Detail” panel, if the “Relationship to Subscriber,” is “18-Self”,  there is now an option to click “Populate Subscriber” which will auto-populate the following data fields that have already been entered on the “Billing and Service” tab:

-Subscriber Last Name

-Subscriber First Name

-Subscriber Address

-Subscriber City

-Subscriber State

-Subscriber Zip Code

Procedure tab: In the COB Line Details panel, the following data fields will auto-populate from the information that has been entered on the “Coordination of Benefits” tab and “Institutional/Professional Service Detail” panel:

-Carrier Code (if multiple carrier codes have been entered from the “Coordination of Benefits” tab, there will be a drop down to select the appropriate carrier code)
-Paid Units of Service
-Revenue Code (applies to Institutional claims)
-Procedure Code

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

Vision Care CPT Code 92340- MUE Edit

Effective 10/01/2012, service code 92340 (Fitting of spectacles, except for aphakia; monofocal) was included on the NCCI Medically Unlikely Edit list, limiting this service code to one unit per date of service. 

To receive payment for fitting two pairs of eyeglasses instead of bifocals for members, providers must now bill service code 92340 with a single unit on two claim lines.  The first claim line must be reported with no modifier and the second claim line with modifier 59 (Distinct procedural service).  For claims which have already denied under edit code 5930 (MUE Units Exceeded), please re-bill these claims as described above rather than submitting an appeal.

Procedure Code Changes for Mental Health Centers

The 2013 Current Procedural Terminology (CPT) manual, published by the American Medical Association (AMA), has made some major changes to psychiatric procedure codes. 

The following codes, previously allowed for Mental Health Centers, will no longer be valid for dates of service after January 01, 2013: 90801, 90862, 90804, 90806, 90816 and 90818.  Medication Management services previously billed under 90862 should now be billed as an evaluation and management office visit (99213). 

New psychiatric codes covered for Mental Health Centers include:

90791 - Psychiatric Diagnostic Evaluation
90832 - Psychotherapy, 30 minutes with patient and/or family member
90833 - Psychotherapy, 30 minutes with patient and/or family member when performed with E&M service
90834 - Psychotherapy, 45 minutes with patient and/or family member
90836 – Psychotherapy, 45 minutes with patient and/or family member when performed with E&M service
99213 - Office or other outpatient visit for evaluation and management

Please refer to the 2013 CPT manual for details regarding these codes.

Early Intervention Service Code T1015 Denials for Edit 5930

MassHealth understands that due to the recent CMS NCCI quarterly update, MMIS has been denying Early Intervention provider claims for service code T1015 –TL (clinic visit/encounter, all-inclusive) when more than one unit is billed, with denial edit 5930 (MUE units exceeded).

MassHealth has reviewed this matter and has implemented a change to address this issue to ensure that future Early Intervention claims for T1015 TL will process according to MassHealth regulations and as stated in subchapter 6 of the Early Intervention provider manual. We will systematically reprocess previously adjudicated claims for T1015 denied due to edit 5930 on future remittance advices. No action is required on the part of the provider.

We apologize for any inconvenience this may have caused. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Messages from the Week of December 10, 2012

December 11, 2012

Coordination of Benefits (COB) - Direct Data Entry (DDE) Enhancements on the POSC

Providers are advised that MassHealth has made enhancements on the POSC for all COB claim submissions.  Certain COB fields in the Coordination of Benefits and Procedure tabs will now auto-populate for you:

Coordination of Benefits Tab: In the “Coordination of Benefits (COB) Detail” panel, if the “Relationship to Subscriber,” is “18-Self”,  there is now an option to click “Populate Subscriber” which will auto-populate the following data fields that have already been entered on the “Billing and Service” tab:

-Subscriber Last Name

-Subscriber First Name

-Subscriber Address

-Subscriber City

-Subscriber State

-Subscriber Zip Code

Procedure tab: In the COB Line Details panel, the following data fields will auto-populate from the information that has been entered on the “Coordination of Benefits” tab and “Institutional/Professional Service Detail” panel:

-Carrier Code (if multiple carrier codes have been entered from the “Coordination of Benefits” tab, there will be a drop down to select the appropriate carrier code)
-Paid Units of Service
-Revenue Code (applies to Institutional claims)
-Procedure Code

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

Vision Care CPT Code 92340- MUE Edit

Effective 10/01/2012, service code 92340 (Fitting of spectacles, except for aphakia; monofocal) was included on the NCCI Medically Unlikely Edit list, limiting this service code to one unit per date of service. 

To receive payment for fitting two pairs of eyeglasses instead of bifocals for members, providers must now bill service code 92340 with a single unit on two claim lines.  The first claim line must be reported with no modifier and the second claim line with modifier 59 (Distinct procedural service).  For claims which have already denied under edit code 5930 (MUE Units Exceeded), please re-bill these claims as described above rather than submitting an appeal.

Procedure Code Changes for Mental Health Centers

The 2013 Current Procedural Terminology (CPT) manual, published by the American Medical Association (AMA), has made some major changes to psychiatric procedure codes. 

The following codes, previously allowed for Mental Health Centers, will no longer be valid for dates of service after January 01, 2013: 90801, 90862, 90804, 90806, 90816 and 90818.  Medication Management services previously billed under 90862 should now be billed as an evaluation and management office visit (99213). 

New psychiatric codes covered for Mental Health Centers include:

90791 - Psychiatric Diagnostic Evaluation
90832 - Psychotherapy, 30 minutes with patient and/or family member
90833 - Psychotherapy, 30 minutes with patient and/or family member when performed with E&M service
90834 - Psychotherapy, 45 minutes with patient and/or family member
90836 – Psychotherapy, 45 minutes with patient and/or family member when performed with E&M service
99213 - Office or other outpatient visit for evaluation and management

Please refer to the 2013 CPT manual for details regarding these codes.

Early Intervention Service Code T1015 Denials for Edit 5930

MassHealth understands that due to the recent CMS NCCI quarterly update, MMIS has been denying Early Intervention provider claims for service code T1015 –TL (clinic visit/encounter, all-inclusive) when more than one unit is billed, with denial edit 5930 (MUE units exceeded).

MassHealth has reviewed this matter and has implemented a change to address this issue to ensure that future Early Intervention claims for T1015 TL will process according to MassHealth regulations and as stated in subchapter 6 of the Early Intervention provider manual. We will systematically reprocess previously adjudicated claims for T1015 denied due to edit 5930 on future remittance advices. No action is required on the part of the provider.

We apologize for any inconvenience this may have caused. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Messages from the Week of December 3, 2012

December 4, 2012

December 3, 2012

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from November 2012

-All Provider Bulletin 229: Physician Designees and the Ambulance Medical Necessity Form   

-Nursing Facility Bulletin 134: Nursing Facility Pay for Performance (NF P4P) Program for 

 Fiscal Year (FY) 2013  

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Prior Authorization Requests

Effective Monday, December 3, 2012, providers who submit Prior Authorization (PA) requests via the MMIS Provider Online Service Center (POSC) will no longer be able to add a line item to a previously adjudicated PA. 

To modify an existing PA on the POSC, providers must submit a NEW PA request for the procedure code and the number of units being requested for review.  When submitting a new PA request for an adjustment or modification, providers must enter ADJUSTMENT/MODIFICATION in the PROVIDER COMMENTS section and, if applicable, include the active PA number to be adjusted/modified along with units already used/billed. With the exception of adjustment requests to change the size of absorbent products, the provider must include all required documentation to justify the medical necessity of the request, including a letter signed by the member’s prescribing provider that states the reason for the adjustment/modification and prescription, if required.

Upon receipt of the adjustment/modification request, the Prior Authorization Unit (PAU) will review for medical necessity and adjudicate the request as appropriate.

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

Messages from the Week of November 12, 2012

November 13, 2012

ICD-10 Provider Survey

In an effort to help providers meet the ICD-10 compliance date of October 1, 2014, MassHealth and other Massachusetts health plans have collaborated to issue a second online ICD-10 provider survey. The survey will help to assess statewide compliance efforts underway, provider testing strategies, and will be used to identify resources to aid providers in their ICD-10 preparations.  Please complete this brief survey, located at: https://www.surveymonkey.com/s/HCAS_ICD10_Survey by December 1, 2012.   Since only one survey should be submitted per organization, please be sure to forward this survey request to the individual(s) that are responsible for the ICD-10 implementation effort within your organization.

Notification of Change Requirements

In accordance with MassHealth regulation, 130 CMR 450.223(B), providers are reminded that they must notify MassHealth in writing within 14 days of any change in any information submitted in their application, including, but not limited to, changes in ownership or control, criminal convictions, or license status. Failure to notify MassHealth constitutes a breach of the provider contract and may result in termination of the provider contract or other sanctions. The absence of notification constitutes confirmation of no changes. Any changes must be submitted to MassHealth. To submit changes through the Provider Online Service Center (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. Providers without Internet access may submit changes to Provider Enrollment and Credentialing, PO Box 9118, Hingham, MA 02043.

 

Messages from the Week of November 5, 2012

November 5, 2012

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from October 2012

- FPA-47: 2012 HCPCS

- ALL-196: Updates to Appendices U and V to All Provider Manuals to Reflect Changes in DPH-Designated Serious Reportable Events (SREs) and CMS-Designated Provider Preventable Conditions (PPCs)

- PRT-24: Changes to MassHealth Prosthetic Regulations

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of October 22, 2012

October 23, 2012

Outpatient Claims Suspended for Edit 829

MassHealth is currently experiencing delays in processing suspended claims submitted via Direct Data Entry (DDE) with Delay Reason Code 11.  In order to maintain a 120-day suspension period for edit 829 - NCCI APPEAL/SPECIAL HANDLE UNDER REVIEW, MassHealth is working diligently to review claims requiring special handling.

Providers are advised to select the appropriate delay reason code for special handling claims, as outlined in All Provider Bulletin 225, April 2012, Special Circumstances for Electronic Claims. Erroneous selections may cause delays in review and claims processing or claims denials.  Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/.  Click on Provider Bulletins, then 2012 Bulletins, then April.

We apologize for the delay and thank you for your patience.  If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

New Bulletin information added since first posted on 10/05/12:

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from September 2012

  • DEN-89: Corrections to Service Codes
  • ORT-23: 2012 HCPCS
  • PHY-137: Certified Registered Nurse Anesthetists
  • PRT-23: 2012 HCPCS

Provider Bulletins for September 2012

  •  Acute Inpatient Hospital Bulletin 146: Notification of Birth (NOB-1) Form Update
  • Acute Inpatient Hospital Bulletin 145: Express Lane Renewal Process
  • Acute Outpatient Hospital Bulletin 27: New Department of Revenue (DOR) Job Update Process
  • Acute Outpatient Hospital Bulletin 26: Express Lane Renewal Process
  • Community Health Center Bulletin 73: New Department of Revenue (DOR) Job Update Process
  • Community Health Center Bulletin 72: Express Lane Renewal Process
  • Home Health Agency Bulletin 48: Introduction of the New Homebound Assessment Form
  • Psychiatric Inpatient Hospital Bulletin 23: Annual Accounting of Personal Needs Allowances

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of October 15, 2012

October 20, 2012

NewMMIS POSC will be unavailable Sunday, 10/21/2012 from 12 Midnight to 9:00 AM

The MMIS POSC, including the internal MMIS application, MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 10/21/2012 from 12 Midnight to 9:00 AM due to system maintenance.

MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

Messages from the Week of October 9, 2012

October 9, 2012

ADMISSION HOUR REQUIRED FOR ACUTE OUTPATIENT HOSPITAL CLAIMS

It is important that all acute outpatient hospital claims are submitted with the admission hour. This information is necessary for MMIS to determine whether another claim, billed for the same date of service for the same member, is valid or a duplicate claim. If no admission hour is entered on the claim, subsequent claims for the same member on the same date of service could be denied.

REMINDER TO PREVENT CLAIMS FROM DENYING FOR EDIT CODE 2502: MEMBER COVERED BY OTHER INSURANCE

Providers are reminded to verify member eligibility using the Provider Online Service Center (POSC) before rendering services.

In addition, before submitting claims, please be sure to check all tabs and view the member's eligibility details by clicking on the date range to verify whether the member has other health insurance, is assigned to a Primary Care Clinician (PCC) Provider for referrals or has any other eligibility restrictions.

The Verify Member Eligibility online job aid offers instructions for this function. Go to the MassHealth web site (www.mass.gov/masshealth). Select the Information for MassHealth Providers link; click New Medicaid Management Information System (NewMMIS and the Provider Online Service Center (POSC)). Click Using the POSC for the First Time, and then click Get Trained. Under Eligibility Verification, click Verify Member Eligibility.

REMINDER ABOUT GLOBAL SURGERY EDITS

Remember to check the global time frame attached to the service code being billed for a member in order to avoid the following edits:

  • 8175 – SERVICE PROVIDED ON THE SAME DAY OF A GLOBAL SURGICAL PROCEDURE IS INCLUDED IN FEE AMOUNT
  • 8176 – SERVICE PROVIDED ON THE DAY OF AND DURING 10-DAY GLOBAL SURGICAL PROCEDURE INCLUDED
  • 8177 – SERVICE PROVIDED DAY BEFORE AND DURING 90-DAY GLOBAL SURGICAL PROCEDURE INCLUDED
  • 8253 – VISIT AND SURGERY NOT ALLOWED SAME DAY/SAME POS

Please refer to Payment for Global Surgical Package regulations (130 CMR 433.452(B)) located in the MassHealth Physician Manual. For additional information about the National Correct Coding Initiative (NCCI) and associated modifiers, please refer to MassHealth All Provider Bulletin 209 (April 2011) and All Provider Bulletin 227 (June 2012).

NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from September 2012

  • DEN-89: Corrections to Service Codes
  • ORT-23: 2012 HCPCS
  • PHY-137: Certified Registered Nurse Anesthetists
  • PRT-23: 2012 HCPCS

Provider Bulletins for September 2012

  • Home Health Agency Bulletin 48: Introduction of the New Homebound Assessment Form
  • Psychiatric Inpatient Hospital Bulletin 23: Annual Accounting of Personal Needs Allowance

Messages from the Week of September 24, 2012

September 25, 2012

Validate all ICD-9 Procedure Codes and Dates on Institutional Claims

Please ensure that all ICD-9 procedure codes on your claims are valid and payable codes. Acute inpatient claims submitted with incorrect ICD-9 procedure codes or dates will be denied with the following edits:

473-ICD9 Procedure 7-24 INVALID
474-ICD9 Procedure 7-24 OR DATE MISSING
475-ICD9 Procedure 7-24 DATE IS INVALID
4128-ICD9 Procedure 7-24 NOT ON FILE

Personal Needs Allowances Filing Deadline has Passed

The deadline for filing the annual accounting for personal needs allowances (PNA) has passed. If you have not yet filed and you are required to do so, please go to www.mass.gov/eohhs/docs/masshealth/bull-2012/ltc-106.pdf for instructions on how to file in 2012.  If you have additional questions, please contact PNAReview@umassmed.edu via e-mail.

Messages from the Week of September 10, 2012

September 12, 2012

NPI DEFECTS (**Revised Message – Original dated August 27, 2012)

Due to a system problem with the MMIS NPI crosswalk, certain claims are denying erroneously for the following edits:

1007 DETAIL RENDERING PROVIDER ID NOT ON FILE   

1051 HEADER RENDERING PROVIDER ID NOT VALID   

1945 MULT SAK PROV LOCS FOR BILLING PROV SPEC

1946 MULT SAK PROV LOCS FOR PERFORMING PROV SPEC

1952 MULT SAK PROV LOCS FOR DTL PERFORM PROV SPEC

 553 ADJUSTMENT NPI TRANSLATION ISSUE

 550 ADJUSTMENT FAILED

MassHealth has identified the problems and is working to resolve them as quickly as possible. Claims erroneously denied for one of these edits will be systematically reprocessed on future remittance advices. We apologize for any inconvenience this may have caused. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.


Messages from the Week of September 3, 2012

September 5, 2012

NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB

MassHealth has posted the following publications on the MassHealth website:

Provider bulletin from August 2012

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

 

UPDATED PAYMENT AND COVERAGE GUIDELINES TOOL POSTED FOR DURABLE MEDICAL EQUIPMENT (DME), AND OXYGEN PROVIDERS

Pharmacy, DME and Oxygen Providers are advised that the MassHealth DME and Oxygen Payment Coverage Guidelines Tool has been updated and posted to the MassHealth Web site. To confirm that you are using the most recent version of the applicable tool, visit www.mass.gov/masshealthpubs. Click on Provider Library and then on the MassHealth Payment and Coverage Guideline Tools link at the bottom of the page. For more information about DME coding, refer to Transmittal Letter DME-32-2012 HCPCS. Transmittal Letters can be accessed from the Provider Library at www.mass.gov/masshealthpubs. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.


Messages from the Week of August 27, 2012

08/27/12

NPI Defects

Due to a system problem with the MMIS NPI crosswalk, certain claims are denying erroneously for the following edits:

1007 DETAIL RENDERING PROVIDER I.D. NOT ON FILE  

1051 HEADER RENDERING PROVIDER ID NOT VALID  

1945 MULT SAK PROV LOCS FOR BILLING PROV SPEC

1946 MULT SAK PROV LOCS FOR PERFORMING PROV SPEC

1952 MULT SAK PROV LOCS FOR DTL PERFORM PROV SPEC

553 ADJUSTMENT NPI TRANSLATION ISSUE

MassHealth has identified the problem and anticipates that a correction will be made to MMIS by September 10, 2012. Claims erroneously denied for one of these edits will be systematically reprocessed on future remittance advices. We apologize for any inconvenience this may have caused.  For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

Financial Compliance Audit of Crossover Payments

MassHealth has identified overpayments of Chronic Rehab Inpatient Hospital crossover claims paid in July 2006 through May 2009.  Affected providers have been notified and the claims are being reprocessed. Providers will see the resulting void claim information to recoup the overpayments in remit notices with EOB code 9090-CROSSOVER CLAIM ADJUSTED FOR COORDINATION OF BENEFITS PAYMENT. Please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900 for additional information.

Important Information for DME, Oxygen/Orthotics/Prosthetics and Therapy Providers

The Prior Authorization Unit (PAU) has a dedicated e-mail address for inquiries related to prior authorization (PA) requests that are submitted to MassHealth.  To communicate items such as PA corrections (date of service, unit, or provider ID errors), calculation issues, line item questions or modifications, please contact the PAU at PriorAuthorization@umassmed.edu and include the PA tracking number in your email.   Please do not contact clinical reviewers directly with these questions, as all inquiries will be directed to PriorAuthorization@umassmed.edu or the PAU provider line at 1-800-862-8341.  Inquiries to the PAU e-mail address will receive an automatic response confirming receipt.  If the e-mail inquiry results in a change to the PA and generation of a MMIS notice, there will be no further response to the provider.  In addition, please refer to the POSC for the status of any PA request, if it has not been 15 days since submission (21 days for Therapy PAs).  These inquiries should not be sent via e-mail to the PAU.  Thank you. 

Rate Adjustment                  

The attached Remittance Advice (RA) may contain rate adjustments resulting from corrections to or revisions of rates by MassHealth. Please review this RA for accuracy. Proposed corrections must be submitted in writing within 30 days from the date of this RA to MassHealth Customer Service, PO Box 9118, Hingham, MA 02043.  See 130 CMR 450.249.  If the net result of this activity has created a recoupment account (representing a debt of the facility to MassHealth), we will begin collecting this debt immediately. Collection of this recoupment could be reflected on this RA. For more information about RAs, go to www.mass.gov/masshealth/newmmis.  Click Need Additional Information or Training, then click Get Trained, and then access the View Remittance Advice Reports job aid. If you have any questions, please call MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of August 13, 2012

August 13, 2012

WIC Message

The Massachusetts WIC Nutrition Program is excited to announce that, beginning this fall, nutrition staff will be utilizing the 2006 World Health Organization growth curves to assess growth patterns and determine nutritional risk among children under the age of two. This change in practice is based upon recommendations from the Centers for Disease Control and Prevention and is in response to a nationwide USDA policy change.  Although many pediatric providers are likely using the new grids, there may be some who continue to assess growth for children 0 – 24 months based on the 2000 CDC grids.  In an effort to ensure that families receive consistent messages about growth status, WIC is eager to work with the medical community to smoothly implement the transition to the 2006 WHO/CDC grids.  Local WIC nutrition staff will be reaching out to providers this fall to further discuss this change.  Providers can also contact Rachel Colchamiro, Director for Nutrition Services at 617-624-6153 or rachel.colchamiro@state.ma.us for more information.  For access to the WHO charts and to read CDC’s recommendations regarding their use, please visit http://www.cdc.gov/growthcharts.

Anesthesia Services Reminder

Please be reminded that Anesthesia Services billed with service codes that do not have a specific time period defined in the description of the code must be reported using minutes. Health Insurance Portability and Accountability Act (HIPAA) version 5010 mandates that reporting units for these anesthesia services be reported in one minute units. One unit equals one minute. Please reference the MassHealth Physician Bulletin 91 dated July 2011. Please note this change is effective for any claim submitted on or after January 1, 2012 not for DOS on or after January 1, 2012 as originally stated in Physician Bulletin 91.

Edit 203 Update (Member ID Number Missing/Invalid)

MassHealth has corrected the system issue that resulted in erroneous claim denials for Edit 203, Member ID Number Missing/Invalid, for certain professional claims since July 15, 2012. MassHealth has reprocessed the erroneous denials on this week’s remittance advice. If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of August 6, 2012

August 7, 2012

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletin from July 2012
- All Provider Bulletin 228: Information about ICD-10-CM/PCS

Transmittal Letter from July 2012
- EIP-20: Revised Service Codes and Descriptions - New Early Intervention Specialty Service

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

Edit 203 (Member ID Number Missing/Invalid)

MassHealth has identified a system problem that is resulting in erroneous claim denials for Edit 203- Member ID Number Missing/Invalid for certain professional claims. The problem has been occurring intermittently for certain electronic batch submissions since July 15, 2012.  MassHealth will correct this problem immediately and reprocess all affected claims. If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900.

Updated Federally Required Disclosures Form

MassHealth has updated the Federally Required Disclosures form (PE-FRD).  Please use this new version when submitting new provider applications or updates.  The updated form is available for download by going to www.mass.gov/masshealth. Click on Information For MassHealth Providers, then MassHealth Provider Forms, then Federally Required Disclosures form.  If you do not have access to the web, please call MassHealth Customer Service at 1-800-841-2900.

MassHealth Application Fee

As required by the Affordable Care Act (ACA), MassHealth has implemented an application fee. The application fee is effective August 1, 2012, and requires all providers applying for MassHealth enrollment to pay an application fee of $523. Individual physicians and non-physician practitioners are exempt from this fee. For details on the application fee, the enrollment process, provider types affected, fee waivers and hardship exceptions, please go to www.mass.gov/masshealth and select the link for Information about National Health Care Reform (Affordable Care Act) and then select Provider Application Fees.  If you have additional questions, please call MassHealth Customer Service at 1-800-841-2900 or email at providersupport@mahealth.net.

New Web Page: Affordable Care Act

MassHealth has implemented a new web page: Information about National Health Care Reform (Affordable Care Act). The new link is found on the MassHealth home page at www.mass.gov/masshealth.  MassHealth will continue to update the new web page with information about the different parts of the law as they are rolled out. Currently there are two links you may access: Provider Application Fee and Information for MassHealth Providers about ACA Program Integrity Provisions. Please refer to these new pages often as the information will be updated regularly.

Messages from the Week of July 30, 2012

July 31, 2012

Edit 5070 (Conflict - Outpatient VS. Crossover)

This is a republished message of banner message #2126.

Be advised that your remittance advice (RA) may contain a denied outpatient hospital claim with edit 7540 (DUPLICATE VOIDED/PAID ON CROSSOVER CLAIM TYPE). This pertains to a claim for a dually entitled member paid by MassHealth on an outpatient claim with missing or incomplete Medicare data because the claim was missing or had incomplete Medicare data. Subsequently, MassHealth received the same claim as a resubmitted cross-over claim with complete Medicare information from you or from Medicare. That claim was suspended for edit 5070 (CONFLICT – OUTPATIENT VS. CROSSOVER C). As a result, the paid outpatient hospital claim is being denied and the money will be recouped. The suspended claim has been released and will adjudicate as a crossover claim on this or future remittance advices. In the future, any claims inadvertently paid as an outpatient hospital claim for dually entitled members billed with Medicare approved services should be voided immediately by providers and resubmitted to MassHealth with the appropriate Medicare data. If you have questions, contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of July 23, 2012

July 23, 2012

Professional Crossover Adjustments

MassHealth has adjusted professional crossover claims that contain at least one detail service line with edit 5007 (SUSPECT DUPLICATE - PHYSICIAN CROSSOVER- DIFF PROV).  Service lines that were previously paid in error with edit 5007 will now be denied appropriately with edit 5006 (EXACT DUPLICATE - PHYSICIAN CROSSOVER) if the billing provider is the same on a previously paid claim for the same member, service and dates of service. The adjusted claims will appear on this and future remittance advices. For any questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Messages from the Week of July 16, 2012

July 16, 2012

TPL Exception Claim Denials

MassHealth has identified an issue with some TPL exception claims that are incorrectly denying, for other insurance with edit code 2502 or 2505 (2502-MEMBER COVERED BY OTHER INSURANCE-DENY or 2505-MEMBER COVERED BY MEDICARE-DENY), when there are multiple payers reported on the claim and one of the payers has a total non-covered amount. A system change in MMIS to resolve will occur in late 2012, at this time affected claims will be reprocessed. Providers should continue to bill their claims to MassHealth accordingly. For any questions please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Messages from the Week of July 2, 2012

July 3, 2012

Correction to Transmittal Letter FAS-24

Please note Transmittal Letter FAS-24 incorrectly listed modifier G Ambulatory Surgical Center (ASC) facility service. Please note the modifier should be SG. MassHealth is working on issuing a corrected transmittal letter. We apologize for any inconvenience.

Community Health Center Manual (2012 HCPCS and Vaccine Codes)

MassHealth has updated the MMIS to reflect the changes to Subchapter 6 of the CHC Program Manual as noted in Transmittal Letter CHC-94 (http://www.mass.gov/eohhs/docs/masshealth/transletters-2012/chc-94.pdf) MassHealth has added certain influenza vaccine service codes to Subchapter 6. The revised Subchapter 6 is effective for dates of service on or after January 1, 2012, with the exception of the specific influenza vaccine codes listed in the Transmittal Letter CHC-94, which are effective for dates of service on or after September 1, 2011.

Providers with timely filing issues should follow the 90-Day Waiver process. For more information regarding the submission of 90 Day Waivers, refer to All Provider Bulletins 220 (dated December 2011) and 225 (dated April 2012).

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

New Masshealth Publications Posted to The Web

MassHealth has posted the following publications on the MassHealth website.

Provider Bulletins from June 2012

- All Provider Bulletin 227: Modifier Coverage and National Correct Coding Initiative (NCCI) Updates

- All Provider Bulletin 226: Final Deadline Appeal Submissions – New Request for Claim Review Form

- School-Based Medicaid Bulletin 22: Update to School-Based Medicaid Program Interim Rates

Transmittal Letters from June 2012

- TL ALL-195: MassHealth Billing Instructions for Provider Preventable Conditions (PPCs); Serious Reportable Events; and Rules about PPCs That Are National Coverage Determinations

- TL ABR-15: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL AOH-29: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL AOH-28: 2012 HCPCS

- TL CHC-95: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL DEN-88: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL DEN-87: Addition of New Service Codes, Revised Orthodontic Form, Dental Policy Clarifications, and Reminders for Covered Services and Conditions of Payment

- TL FAS-25: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL FPA-46: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL IDTF-11: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL PHY-136: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL POD-67: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL ROC-2: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL STR-17: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

- TL VIS-41: New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our website, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

 

Messages from the Week of June 25, 2012

June 29, 2012

MAPIR (Medical Assistance Provider Incentive Repository) will be unavailable Sunday,7/1/2012, from 5:00 PM to 7:00 PM due to system maintenance. Other systems will not be impacted.

We apologize for any inconvenience this may cause.

Messages from the Week of June 18, 2012

June 18, 2012

MassHealth Direct Data Entry (DDE) Coordination of Benefits (COB) Training Webinar

MassHealth Customer Service and Third Party Liability Unit will provide Direct Data Entry (DDE) “walk-through” Webinar training with emphasis on how to submit Coordination of Benefits (COB) claims using DDE transactions in the Provider Online Service Center (POSC). COB claims are MassHealth claims containing adjudication details from another insurance.  This training will provide steps and information about the appropriate tabs and fields that must be completed to ensure proper COB processing and DDE navigation.

The webinars will take place on three separate sessions on Wednesday, June 27, 2012. Each webinar session is set up to walk through data entering a claim for a specific transaction. Please note the session details in order to make sure that providers register for the correct session.  Providers may sign up for more than one session depending on the type of transactions they bill.  However, preregistration is required.

Webinar sessions are as follows (each session time will only cover the transaction type listed):

  • 10:00am – 11:30am – Professional COB (837P/CMS1500/Professional DDE)
  • 1:00pm – 2:30pm – Institutional Inpatient COB (837I/UB04/Institutional DDE) specifically  Institutional Room and Board only
  • 2:30pm - 4:00pm – Institutional Inpatient COB (837I/UB04/Institutional DDE) specifically  Institutional Outpatient, Nursing Home ancillary, Home Health, Hospice, Community Health Center

To pre-register for the MassHealth DDE COB Training, please contact MassHealth Customer service at 1-800-841-2900 or providersupport@mahealth.net. Please make sure that you provide your provider ID, contact name, phone number and email as registration confirmation and instructions will be emailed to registered participants. If you need to attend more than one webinar, please indicate the session(s) needed.

90 Day Wavier Request Form reminder

Providers are reminded that 90 Day Waivers may be submitted electronically. All requests must include, but not limited to, the 90 Day Wavier Request Form. Failure to include the required 90 Day Wavier Request Form will result in your waiver request being denied.

For more information regarding the submission of 90 Day Waivers, refer to All Provider Bulletins 220 (dated December 2011) and 225 (dated April 2012).

Present on Admission (POA) Indicator Required On Chronic Disease and Rehabilitation, Psychiatric and Semi- Acute Inpatient Hospital Claims

Effective with dates of service on and after 7/1/2012, MassHealth will require a POA Indicator on Chronic Disease and Rehabilitation, Psychiatric and Semi- Acute inpatient hospital claims for any principal, external cause of injury and other diagnosis codes. If the POA Indicator is missing, the claim will deny with edit 401 PRESENT ON ADMISSION INDICATOR MISSING.  If the POA Indicator is invalid, 837I transactions will not pass billing compliance and providers will receive a 999R. Paper claims submissions will deny with edit 402 PRESENT ON ADMISSION INDICATOR INVALID.  If a POA Indicator is entered on a diagnosis code that does not allow it, EDI transactions will not pass billing compliance and providers will receive a 999R. Paper claims will deny with edit 403 PRESENT ON ADMISSION IND PRESENT WHERE NOT ALLOWED.  Direct Data Entry (DDE) claims have a dropdown list available in the Extended Services Tab that lists the POA indicator options. For any questions please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.


Messages from the Week of June 11, 2012

June 13, 2012

June 11, 2012

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 June. The payment schedule will be modified by approximately 2 weeks.  Below outlines the modified payment schedule.

RA DATE: 07/03/2012
PAYMENT DATE CHECKS: 07/06/2012
PAYMENT DATE EFT: 07/09/2012

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

COMMUNITY HEALTH CENTER (CHC) PROFESSIONAL CROSSOVER CLAIM ADJUSTMENTS

MassHealth has adjusted CHC professional crossovers claims with dates of service 5/26/2009 through 3/22/2012 that were billed with HCPCS code T1015 CLINIC VISIT/ENCOUNTER, ALL INCLUSIVE. These crossovers will begin to appear on this and future remittance advices with EOB code 8158 (service cannot be billed on a professional crossover). Professional crossovers that are processed on or after 3/23/2012 and billed with T1015 will be denied with 8158. An additional EOB code 5097 (service has been paid on an institutional crossover) will appear on your claim if you have been paid on an institutional crossover for the same service and same member on the same date of service. MassHealth reimburses CHCs for the clinic visit on the institutional claim that crosses over from Medicare. If you need to resubmit a denied claim or adjust a paid claim, you should correct and resubmit or adjust the institutional crossover that has adjudicated in MMIS.  The claim should not be rebilled to MassHealth as a professional crossover. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.


Messages from the Week of June 4, 2012

June 7, 2012

NEW MASSHEALTH PUBLICATIONS POSTED TO THE WEB

MassHealth has posted the following publications on the MassHealth Web site.

Provider Bulletins from May 2012

- Acute Inpatient Hospital Bulletin 144: Clarification of Policy for Members’ Home Use of Nebulizers

- Acute Outpatient Hospital Bulletin 25: Clarification of Policy for Members’ Home Use of Nebulizers

- Community Health Center Bulletin 71: Clarification of Policy for Members’ Home Use of Nebulizers

- Durable Medical Equipment Bulletin18: Clarification of Policy for Members’ Home Use of Nebulizers

- Nursing Facility Bulletin 133: Update to Third-Party-Liability Claim Submissions

- Oxygen and Respiratory Therapy Equipment Bulletin 14:  Clarification of Policy for Members’ Home Use of Nebulizers

- Physician Bulletin 93: Clarification of Policy for Members’ Home Use of Nebulizers

Transmittal Letters from May 2012

- Transmittal Letter ALL-194: Out-of-State Services

- Transmittal Letter AOH-27: Out-of-State Services

- Transmittal Letter CDR-27: Out-of-State Services

- Transmittal Letter COH-7: Out-of-State Services

- Transmittal Letter LAB-40: Update to 2012 HCPCS

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our Web site, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.


Messages from the Week of May 21, 2012

May 21, 2012

ADJUSTED CLAIMS REMINDER

Providers are reminded that adjustments can be made to paid claims only. Claims that are denied must be resubmitted to MassHealth for payment. Initial claims must be received within 90 days of the service date (if billing another insurance, 90 days from the date of the explanation of benefits).

If you have a claim in a paid status and want to adjust it, generally, you can submit a replacement claim with additions, deletions, or corrections to any detail lines for up to one year (or 18 months with other insurance) from the date of service (DOS) on the claim if the original DOS remains the same and the original claim was received by MassHealth within the specified 90-day timeframe. When adjusting a paid claim, you must submit all lines (including those that were previously paid).

For more information, visit the FAQs about MassHealth’s Electronic-Claims Policy page on the MassHealth Web site. Go to www.mass.gov/masshealth and click the Information for MassHealth Providers link. Also, since claim processing varies with claim type, please refer to Part 6 (Claim Status and Correction) of the Administrative and Billing Instructions (Subchapter 5) of your MassHealth provider manual for further instruction. Part 6 describes procedures for correcting and rebilling claims by claim type. You can access your MassHealth provider manual from the online Provider Library at www.mass.gov/masshealthpubs.

 

ELECTRONIC FUNDS TRANSFER MANDATE

The Office of the Comptroller and the Office of the State Treasurer have mandated January 1, 2012, as the conversion date for all payments issued by the Commonwealth to be conducted using Electronic Funds Transfer (EFT). Therefore, all MassHealth providers are expected to be paid via electronic payments. If you currently receive payments electronically from MassHealth no further action is required.

If you are already enrolled as a MassHealth provider but do not currently receive electronic payments, you are required to complete the EFT form and return it to MassHealth as soon as possible. Please send only one form per MassHealth provider number. EFT participation is now required when a provider submits a new enrollment application to MassHealth. The EFT Form will be processed upon enrollment.

Individual practitioners who are enrolled/enrolling as part of a group practice and will not submit claims for payment under their individual national provider identifier (NPI) must enroll with MassHealth as a “no pay” provider. EFT is not required. Enrolling as a “no pay” provider also eliminates the requirement of submitting the Massachusetts Substitute W-9, Data Collection Form (DCF), and Trading Partner Agreement. Applicants submitting paper applications should write “no pay” in Section I of the application, to the right of Field 11. Those submitting applications via the Provider Online Service Center (POSC) must include a “no pay” statement when they submit the Provider Agreement.

Applications received without an EFT form or “no pay” designation will be returned to the provider for completion. Documents not returned within the 14-day enrollment period will be denied.

Exceptions to this mandate are not expected.

To receive payment through EFT, you must print and complete the EFT form. You can download the EFT form online from the MassHealth home page (www.mass.gov/masshealth), then click the link MassHealth Provider Forms in the Publications panel, and select EFT/Direct Deposit Application (EFT-1). Please refer to the new online EFT Tip Sheet for important EFT form completion and submission guidelines as well as requirements for documentation that must accompany the EFT form. Go to www.mass.gov/masshealth. Click on Information for MassHealth Providers, then click on Tips for Completing the Electronic Funds Transfer (EFT) Form.

The completed form and required documentation must be mailed to MassHealth Customer Service, ATTN: Provider Enrollment and Credentialing, P.O. Box 9118, Hingham, MA 02043. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900. Dental Providers should mail their signed, completed form and required documentation to DentaQuest, Attn: Customer Service: MassHealth Dental, 12121 N. Corporate Parkway, Mequon, WI, 53092.


Messages from the Week of May 14, 2012

May 14, 2012

REMINDER FOR ACUTE INPATIENT AND OUTPATIENT HOSPITALS: SUBMISSION OF REBILLS FOLLOWING A MASSHEALTH INPATIENT CLAIM DENIAL BY PERMEDION

You must attach a copy of your Notice of Denial from Permedion to every claim you rebill to MassHealth. Permedion conducts MassHealth’s Acute Hospital Utilization Management program. The rebilled claim and notice should be submitted to MassHealth using direct data entry (DDE). MassHealth will not accept a paper rebilling, unless the hospital has an approved waiver to submit paper claims. All rebilled claims must be submitted to MassHealth within the timeframe designated in your Notice of Denial from Permedion.

For example, if a claim for an inpatient admission (with dates of service from 4/1/12 through 4/2/12) has been denied and the hospital is rebilling for two days of outpatient services, then the hospital must submit a copy of the denial notice from Permedion for the outpatient services for EACH date of service being rebilled.

For more information about the rebilling process, refer to regulations at 130 CMR 415.414(B)(3). You can access MassHealth regulations from the Publications panel on the MassHealth Web site at www.mass.gov/masshealth. If you have questions, please contact Permedion at 617-398-1407.

REMINDER FOR ACUTE INPATIENT AND OUTPATIENT HOSPITALS : REBILLING OF OUTPATIENT SERVICES FOLLOWING POSTPAYMENT REVIEW BY PERMEDION

When an outpatient service (claim line) has been denied by Permedion, MassHealth’s Acute Hospital Utilization Management contractor, the ENTIRE claim is also voided. To receive payment for the service(s) that were not denied, the hospital must submit a new claim, without the claim lines for the denied service(s), and attach a copy of the Notice of Denial from Permedion. The rebilled claim and notice should be submitted to MassHealth using direct data entry (DDE). MassHealth will not accept a paper rebilling, unless the hospital has an approved waiver to submit paper claims. All rebilled claims must be submitted to MassHealth within the timeframe designated in your Notice of Denial from Permedion. If you have questions, please contact Permedion at 617-398-1407.

PHYSICIAN AND COMMUNITY HEALTH CENTER PAYMENT NOTIFICATION FOR FLUORIDE VARNISH APPLICATION SERVICES BY MEDICAL ASSISTANTS

Effective March 15, 2012, MassHealth revised its regulations to allow payment to physicians and community health centers for the application of fluoride varnish to children under the age of 21 by medical assistants under the supervision of a physician. Previously MassHealth regulations allowed payment for application of fluoride varnish only by physicians, nurse practitioners, registered nurses, licensed practical nurses, and physician assistants. To qualify to apply fluoride varnish under MassHealth requirements, the individual must complete an online MassHealth approved training on the application of fluoride varnish, maintain proof of completion of the training and provide such proof to MassHealth upon request. You can access the MassHealth approved, self-administered online fluoride varnish application training options, as well as detailed instructions for completing the trainings and the required Proof of Completion Document on the MassHealth Fluoride Training for Health Care Professionals Web page (http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/fluoride-varnish-training-for-health-care.html).

Once on-line training has been completed, physicians and qualified personnel may schedule an in-office visit with the MassHealth Outreach Coordinator to reinforce how to implement the use of fluoride varnish in your office and how to bill for the service. To schedule an in-office visit, contact the Outreach Coordinator directly at Megan.Mackin@Dentaquest.com or 617-886-1728.

Messages from the Week of April 30, 2012

May 4, 2012

NCCI REPROCESSING FOR PROFESSIONAL SERVICES AND OUTPATIENT HOSPITAL SERVICES

To conform to the National Correct Coding Initiative (NCCI) methodology from the Centers for Medicare and Medicaid Services (CMS), MassHealth began enforcing new NCCI editing guidelines as described in All Provider Bulletin 209 (dated April 2011). MassHealth completed the system implementation for the coding updates at the end of October 2011. This change resulted in certain claims being incorrectly processed between 4/1/2011 and 10/31/2011. MassHealth is reprocessing the affected claims that contained NCCI procedure codes with dates of service between 10/1/2010 and 10/31/2011. The reprocessed claims will begin to appear on this or future remittance advices. If you have questions, please contact MassHealth Customer Service at providersupport@mahealth.netor 1-800-841-2900.

 

PHARMACY FINAL DEADLINE APPEAL SUBMISSIONS FOR PROFESSIONAL SERVICES AND PHARMACIES

Pharmacy providers should continue to follow the final deadline appeals process described in Appendix A of the MassHealth Pharmacy Online Processing System (POPS) Billing Guide (www.mass.gov/eohhs/docs/masshealth/pharmacy/pops-billing-guide.pdf). 

 

Please Note: Pharmacy providers billing for durable medical equipment (DME) services using a CMS-1500 claim form should submit final deadline appeals through direct data entry (DDE) via the Provider Online Service Center (POSC) using delay reason code 9. For information and instructions about this process, refer to instructions in All Provider Bulletin 221 (dated December 2011). You can access MassHealth publications from the online Provider Library at www.mass.gov/masshealthpubs.

 

To check the status of a pending appeal, e-mail your inquiry to FDEAppeals@state.ma.us or call 617-847-3115. 

If you have questions about POPS billing and claims, you can contact the Xerox Technical Help Desk at 1-866-246-8503, 24 hours a day, seven days a week.

 

HOSPICE CLAIM ADJUSTMENT

MassHealth has identified a system issue that may have resulted in underpayments for claims processed with service code T2046 from 3/5/12 through 3/7/12. The affected claims are being systematically adjusted and should begin appearing on remittance advice 100158 (dated 6/5/12). No further action is required by providers. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

 

April 30, 2012

EDIT 5010 REPROCESSING for Acute Outpatient Hospitals and Hospital Licensed Health Centers who bill for Outpatient Services

This remittance advice may contain claims that were previously processed and denied at the header with at least one detail denied for edit 5010 (Exact duplicate – outpatient claim). The affected claims, with dates of service from 10/01/09 through 09/30/10, were denied because there were no HCPCS codes included on the line(s) with edit 5010.

For those paid claims with multiple lines, containing lines denied with edit 5010, MassHealth encourages providers to resubmit for consideration ONLY those lines that were denied for edit 5010 AND that contained no HCPCS codes. MassHealth suggests that you resubmit just those high charge lines that would move an episode to outlier in the payment amount per episode (PAPE) calculation. You must send any qualifying claims on a disc to the attention of Lydia Hatch at MassHealth, 100 Hancock Street, 6th Floor, Quincy, MA 02171. Discs must be received by 5/11/12 for consideration.

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

USING THE PROVIDER ONLINE SERVICE CENTER (POSC)

The POSC is a Web-based portal that includes the functions described below. Providers are encouraged to use the POSC to accomplish these tasks independently. Regularly accessing the many online tools available on the POSC can help improve your efficiency when completing the business transactions you need to conduct with MassHealth. From the Online Services panel of the MassHealth home page (www.mass.gov/masshealth), click on Provider Online Service Center.

POSC Functions:

-enroll as a MassHealth provider and manage profile information, such as changes to provider profile (see Manage Provider Information);
-add to and update subordinate accounts (see Administer Account);
-perform direct data entry (DDE) real-time, continuous, interactive claims processing, verify member eligibility, submit batch claim, check claim status, resubmit DDE (see Manage Claims and Payments);
-manage service authorizations: enter, update, and inquire about preadmission screening (PAS), prior authorization (PA), and Primary Care Clinician (PCC) referrals; request nonemergency transportation for members; and upload and download batch service authorizations (see Manage Service Authorizations);
-view publications such as forms for downloading, transmittal letters and bulletins, news, training registration and materials, and MassHealth regulations; access links to mass.gov (news,  publications, related updates) (see Reference Publications);
-view notifications, including any new EOHHS notices, Broadcast Messages, contracts, letters and documents (for example, view PAS, PA and PCC notices), reports, metrics, and financial data; generate financial and claim denial reports; and download remittance advices (see Manage Correspondence and Reporting);
-enroll and disenroll members for Senior Care Options (SCO) and Program of All-inclusive Care for the Elderly (PACE), and submit Management Minutes Questionnaires (MMQ) (see Manage Members); and
-change password and manage Subordinate User accounts (see Administer Account).

Several online job aids offer instruction for these functions. You can access these job aids on the MassHealth Web site (www.mass.gov/masshealth ). Select the Information for MassHealth Providers link, click New Medicaid Management Information System (NewMMIS) and the Provider Online Service Center (POSC). Click Using the POSC for the First Time, and then click Get Trained.


Messages from the Week of April 23, 2012

April 25, 2012

HIPAA 5010 837 MEDICARE CROSSOVER CLAIM PROCESSING COMPLETED– for all Providers who bill Medicare crossover claims

MassHealth has resolved the system compliance issues that caused delays in processing of HIPAA 5010 837 institutional and professional Medicare crossover claim files transmitted from the Coordination of Benefits Contractor (COBC). All affected COBC claims have been processed and will appear on this and future remittance advices (RAs). Thank you for your patience. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.


Messages from the Week of April 16, 2012

April 20, 2012

CHANGE OF ADDRESS WHEN CORRECTING CLAIMS

For providers with one national provider identifier (NPI) corresponding to multiple MassHealth Provider ID/Service Locations (PID/SLs), MassHealth uses the doing business as (DBA) address provided on the claim that corresponds to the unique service location to define where services were provided. When correcting paid claims, changing information such as the DBA or provider ID on your claim, will cause the replacement claim to adjudicate to a different service location from the one initially billed and will result in the claim being denied.

If more than 90 days have passed since the oldest date of service on the claim, and you want to change the DBA address, member ID, provider ID or claim type, please refer to the 90-day waiver procedures found in your MassHealth provider manual. You can access your MassHealth provider manual from the online Provider Library at www.mass.gov/masshealthpubs.

REPROCESSING OF LAB CODES G0431 AND G0434 FOR ACUTE OUTPATIENT HOSPITALS AND HOSPITAL LICENSED HEALTH CENTERS WHO BILL FOR OUTPATIENT SERVICES

MassHealth has identified an issue that resulted in certain outpatient claims for lab services that were submitted with service codes G0431 and G0434 to be bundled into the payment amount per episode (PAPE) when they should have been processed according to the lab fee schedule. The affected claims were submitted with dates of service from 12/1/11 to 4/2/12. MassHealth is reprocessing these claims and the adjustments will begin to appear on this and future remittance advices.

Please Note: Claims that were submitted and paid a PAPE during this time frame will now show the PAPE portion of the payment taken back and the lab fee amount paid. If you have questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Messages from the Week of April 2, 2012

April 7, 2012

FEDERALLY QUALIFIED HEALTH CENTER (FQHC) INSTITUTIONAL MEDICARE CROSSOVER CLAIM ADJUSTMENTS FOR COMMUNITY HEALTH CENTERS 

MassHealth has adjusted FQHC crossover claims with dates of service from 5/26/2009 to 8/29/2011 that were underpaid. The affected claims should begin appearing on this and future remittance advices (RAs). If the visit has been paid on both the institutional and professional claim, then informational Explanation of Benefits (EOB) code 5097 (Same service on professional crossover will be voided) will appear on the RA with the adjusted institutional crossover claim. Providers will be notified when the adjustment of these professional crossover claims has been processed.

Please Note: FQHC institutional crossover claims processed on or after 8/30/2011 have been paid correctly. Providers should continue to check Broadcast Messages and future RAs for updated information about the processing of these FQHC claims. If you have questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

MASSHEALTH PRIOR AUTHORIZATION (PA) GUIDELINES

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 the request. In addition to program regulations, 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 www.mass.gov/masshealthpubs.

MassHealth reviews PA requests on the basis of medical necessity only and does not establish or waive any other prerequisites for payment, including eligibility or referral. Please remember to request a new PA for any subsequent request for the same service. The approval of a PA is not a guarantee of payment. You must still verify the member’s eligibility, other insurance, and any other restrictions before providing service. 

MassHealth strongly encourages all providers to request PA using the Provider Online Service Center (POSC) at www.mass.gov/masshealth/providerservicecenter. Providers can submit PA requests, all attachments (including supplemental and paper PA forms), and any subsequent PA requests, as well as review the status of their PA requests, electronically via the POSC. 

MassHealth has noticed an increase in the number of claims being submitted with incomplete or erroneous PA information. Some of the common denials being reported are listed below, followed by suggested resolution tips. Please make every effort to follow these PA guidelines to avoid claim issues.

  • Edit code 3003 (Procedure code requires PA): Refer to Subchapter 6 of your provider manual and review the Benefit Administration section of the REFERENCE tab for PA restrictions.
  • Edit code 3009 (PA number not on the database): Please ensure that your PA number listed is complete and/or correct. (The PA number can be found on the claim header.)

CUSTOMER SERVICE INQUIRIES

When you need to contact MassHealth Customer Service for further assistance once you have exhausted all automated options and online resources, please make every effort to be prepared with all essential information needed by the Customer Service staff.  Depending on the nature of your inquiry, the following information is essential and must be readily available when contacting Customer Service:

  • provider ID/service location (PID/SL) or national provider identifier (NPI);
  • member identification number;
  • internal control number (ICN);
  • claim status;
  • edit or explanation of benefits (EOB) code(s); and
  • service codes.

Additionally, have copies of any supporting documentation accessible for quick reference to assist the Customer Service staff to efficiently and effectively respond to your inquiry. Please be sure to review your remittance advice (RA), via the Provider Online Service Center (POSC), for all claims-related inquiries. You can access the POSC from the MassHealth home page at www.mass.gov/masshealth. If you do not have POSC access, contact your primary user at your office or facility. 

MassHealth strongly encourages you to visit the MassHealth Web site for POSC instructional aids and other billing and policy resources designed to help you conduct your daily MassHealth business functions and/or to use as references if you encounter any issues or questions. Some of these resources and their online access instructions include the following.

Your cooperation is appreciated.

EDIT 4801 (PROCEDURE NOT COVERED BY PROVIDER CONTRACT) CLAIMS REPROCESS

MassHealth has identified an issue that caused some outpatient and medical claims to be denied erroneously with Edit 4801 (Procedure not covered by provider contract). MassHealth has resolved the issue and is reprocessing the affected claims. The reprocessed claims will appear on this or future remittance advices. No further action is required by providers. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900. 


Messages from the Week of March 26, 2012

March 26, 2012

SUSPENDED CLAIMS REMINDERS FOR ALL PROVIDERS WHO BILL CROSSOVER CLAIMS AND FOR HOME HEALTH AND COMMUNITY HEALTH, LONG TERM CARE, PHYSICIAN, PROFESSIONAL, DME, SUBSTANCE ABUSE, MENTAL HEALTH OR TRANSPORTATION SERVICES

A suspended claim appears on a remittance advice (RA) for information only and requires NO action by a provider. Please do not correct or rebill a suspended claim.

Claims appear in a “SUSPEND” status for many reasons. The most common is that the claim must be manually reviewed by MassHealth to determine the appropriate fee, or the medical necessity of the service. Claims also suspend to allow time for the member eligibility or other files to be updated.

The majority of claims that suspend are adjudicated within 45 days of the suspense date.

Rebilling a claim already in suspense will only cause the subsequent claim submission to suspend as well.

You can track the status of a suspended claim using your internal control number (ICN), which can be found on your RA. To verify the status of a claim submitted to MassHealth for services provided to MassHealth members, you can use either batch HIPAA transaction sets 276/277 or the direct data entry (DDE) panel on the Provider Online Service Center (POSC).

Once the claim has adjudicated, it will appear on a subsequent RA as either “PAID” or “DENIED.” You should contact MassHealth Customer Service (1-800-841-2900) for assistance with your suspended claim only if your claim does not appear on your RA as adjudicated within 45 days of the suspension notice.

SUSPENDED CLAIMS REMINDERS FOR ALL PROVIDERS WHO BILL FOR HOSPITAL INPATIENT OR OUTPATIENT SERVICES

A suspended claim appears on a remittance advice (RA) for information only and requires NO action by a provider. Please do not correct or rebill a suspended claim.

Claims appear in a “SUSPEND” status for many reasons. The most common is that the claim must be manually reviewed by MassHealth to determine the appropriate fee, or the medical necessity of the service. Claims also suspend to allow time for the member eligibility or other files to be updated.

The majority of claims that suspend are adjudicated within 60 days of the suspense date.
Rebilling a claim already in suspense will only cause the subsequent claim submission to suspend as well.

You can track the status of a suspended claim using your internal control number (ICN), which can be found on your RA. To verify the status of a claim submitted to MassHealth for services provided to MassHealth members, you can use either batch HIPAA transaction sets 276/277 or the direct data entry (DDE) panel on the Provider Online Service Center (POSC).

Once the claim has adjudicated, it will appear on a subsequent RA as either “PAID” or “DENIED.” You should contact MassHealth Customer Service (1-800-841-2900) for assistance with your suspended claim only if your claim does not appear on your RA as adjudicated within 60 days of the suspension notice.

MASSHEALTH’S ELECTRONIC CLAIMS SUBMISSION POLICY

Effective January 1, 2012, MassHealth implemented a 90-day grace period of the claims submission policy to allow providers additional time to convert to electronic claims submission or to apply for the electronic claim submission waiver. MASSHEALTH’S GRACE PERIOD ENDS ON APRIL 1, 2012. If you are still submitting paper claims, and have not requested a waiver to the electronic claims submission policy, you must convert to electronic claims submission, or request and meet the waiver criteria before April 1, 2012. Paper claims received on or after April 1, 2012, will be suspended, and may be ultimately denied, unless you are in compliance with the policy. Refer to All Provider Bulletins 212 (dated May 2011) and 217 (dated September 2011) for more information about the claims submission and waiver policy changes. If you have any questions, please contact MassHealth Customer Service at providersupport@mahealth.net (1-800-841-2900) or Provider Outreach at 1-857-472-5675 for assistance.

AUTOMATED PRICING FOR HOSPICE ROOM AND BOARD IN THE NURSING FACILITY

Nursing facility providers: Please review the recent message text below to hospice providers regarding automated pricing for hospice room and board claims in nursing facilities.

HOSPICE PRICING FOR SERVICE CODE T2046
MassHealth recently implemented automated pricing for hospice services on claims submitted with Service Code T2046 (Hospice long term care, room and board only; per diem) for members receiving hospice services in a nursing facility. MassHealth’s claim processing system is now able to calculate the correct payment for the member’s casemix score and the nursing facility’s rate for that casemix score, multiplied by the number of units at 95 percent, less any applicable patient paid amount (PPA). Hospice providers should continue to bill for services using Service Code T2046 as usual.

Nursing facility providers please also be sure to submit your Management Minutes Questionnaires (MMQ) in accordance with the instructions in MassHealth Transmittal Letter NF-53 (dated May 2009). If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.


Messages from the Week of March 12, 2012

March 16, 2012

HOSPICE ELECTION FORM REMINDER 

As directed under 130 CMR 437.412(C), hospice providers must submit a completed and signed MassHealth Hospice Election Form according to the form’s instruction, before billing for MassHealth members who elect hospice services. This form must be completed whenever a MassHealth member chooses to elect or stop hospice services, to disenroll from hospice services, or to change hospice provider. 

If you do not submit a completed and signed Hospice Election Form the member will not be properly coded to the hospice provider’s ID/service location (PID/SL). Claims submitted by a hospice provider for members who are not coded under the hospice provider’s PID/SL will be denied with edit 2800 (Member not tied to hospice for date of service).

Please note: A completed Hospice Election form includes (but is not limited to)

-MassHealth PID/SL;
-MassHealth member ID; and
-insertion of hospice disenrollment reason (section D, if applicable)

To download a copy of the MassHealth Hospice Election Form (HOS-1) from the MassHealth Web site homepage (www.mass.gov/masshealth), click the MassHealth Provider Forms link in the Publications panel.

You can fax the completed form to: (617) 886-8133 or (617) 886-8134 OR mail the form to:

MassHealth Hospice Unit
UMMS-CHCF
529 Main Street
Charlestown
, MA 02129

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

NEW VISION CARE MATERIAL ORDER FORM 

In accordance with newly established 5010 HIPAA transaction standards, all MassHealth claim submissions must include a valid diagnosis code, effective January 1, 2012. For the MassHealth vision care contractor (MassCor) to comply with these new HIPAA claim standards, VIS-1 order forms must now include a valid diagnosis code. The VIS-1 has been revised to reflect the new requirement.

To download a copy of the Vision Care Material Order Form (VIS-1) from the MassHealth Web site homepage (www.mass.gov/masshealth), click the MassHealth Provider Forms link in the Publications panel.

You can access the Vision Care Bulletin 16 (dated February 2012) from the online Provider Library (www.mass.gov/masshealthpubs) for more information about this change.

March 15, 2012

UPDATE FOR HIPAA 5010 837 MEDICARE CROSSOVER CLAIM PROCESSING DELAY – for all Providers who bill Medicare crossover claims

MassHealth continues to work with Medicare and the Medicare Coordination of Benefits Contractor (COBC) to resolve system compliance issues that occur on HIPAA 5010 837 institutional and professional Medicare crossover claim files and have caused a processing delay. Please do not submit these crossover claims to MassHealth. MassHealth has begun processing some of the affected claims and they should begin appearing on this and future remittance advices (RA). Thank you for your patience. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

March 12, 2012

HOSPICE PRICING FOR SERVICE CODE T2046

MassHealth recently implemented automated pricing for hospice services on claims submitted with Service Code T2046 (Hospice long term care, room and board only; per diem) for members receiving hospice services in a nursing facility. MassHealth’s claim processing system is now able to calculate the correct payment for the member’s casemix score and the nursing facility’s rate for that casemix score, multiplied by the number of units at 95 percent, less any applicable patient paid amount (PPA). Providers should continue to bill for services using Service Code T2046 as usual.

Please Note: MassHealth identified a defect that may have resulted in underpayments for claims processed with Service Code T2046 from 03/05/2012 through 03/07/2012. These claims will be systematically adjusted for correction. No further action is required by providers. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

MEDICARE CROSSOVER CLAIMS WITH MEDICARE COVERED AND NONCOVERED DAYS (MID-STAY) DURING AN INPATIENT STAY- for Acute Inpatient & Chronic Inpatient Hospitals

Medicare crossover claims for dually eligible members that contain both Medicare covered and noncovered days will be automatically transmitted from the coordination of benefits contractor (COBC) to MassHealth for processing. These crossover claims will suspend with edit 1803 (Recycle Medicare Part A claim). MassHealth will systematically collect the Medicare Part B ancillary payments associated with the inpatient stay, and will deduct the Medicare Part A and Part B payments from the final mid-stay crossover claim payment.

PLEASE NOTE: For all claims processed on or after 9/25/11, the payment for the Medicare covered and noncovered days is included in the MassHealth mid-stay crossover claim payment. Therefore, you should not bill MassHealth for the Medicare noncovered days.

If 60 days have passed since receipt of the Medicare payment, or the member has other insurance in addition to Medicare and MassHealth, and the claim has not appeared on a MassHealth crossover remittance advice, you may submit these claims to MassHealth electronically. Follow the MassHealth COB requirements in Appendix D (Supplemental Instructions for Claims with Other Insurance) of your MassHealth provider manual.

When billing Medicare inpatient mid-stay claims that contain Medicare covered and noncovered days for dually eligible members to MassHealth, providers should not report the Medicare Part B ancillary payments associated with the inpatient stay on their inpatient claim submission nor should they bill the Medicare noncovered days separately to MassHealth. The MassHealth payment for mid-stay claims includes the Medicare noncovered days and the Medicare Part B ancillary payments. Providers should follow instructions found in MassHealth billing guides for claims submissions.

MEDICARE CROSSOVER CLAIMS WITH MEDICARE COVERED AND NONCOVERED DAYS (MID-STAY) DURING AN INPATIENT STAY for Psychiatric Inpatient & Semi-Acute Inpatient Hospitals

Medicare crossover claims for dually eligible members that contain both Medicare covered and noncovered days will be automatically transmitted from the coordination of benefits contractor (COBC) to MassHealth for processing.

PLEASE NOTE: For all claims processed on or after 9/25/11, the payment for the Medicare covered and noncovered days is included in the MassHealth mid-stay crossover claim payment. Therefore, you should not bill MassHealth for the Medicare noncovered days.

If 60 days have passed since receipt of the Medicare payment, or the member has other insurance in addition to Medicare and MassHealth, and the claim has not appeared on a MassHealth crossover remittance advice, you may submit these claims to MassHealth electronically. Follow the MassHealth COB requirements in Appendix D (Supplemental Instructions for Claims with Other Insurance) of your MassHealth provider manual.

When billing Medicare inpatient mid-stay claims that contain Medicare covered and noncovered days for dually eligible members to MassHealth, providers should not report the Medicare Part B ancillary payments associated with the inpatient stay on their inpatient claim submission nor should they bill the Medicare noncovered days separately to MassHealth. Providers should follow instructions found in MassHealth billing guides for claims submissions.


Messages from the Week of March 5, 2012

March 7, 2012

HIPAA 5010 837 MEDICARE CROSSOVER CLAIM PROCESSING DELAY

As a result of system compliance issues that are occurring on HIPAA 5010 837 institutional and professional Medicare Crossover claim files received from the Medicare Coordination of Benefits Contractor (COBC), there has been a delay with the processing of some Medicare crossover claims. MassHealth is working with Medicare and the COBC to resolve these errors as soon as possible. Providers should not submit these crossover claims to MassHealth. Once the issue has been resolved, these claims will be processed and appear on future remittance advices (RA). Please continue to check Broadcast Messages and your RA for future updates on this matter. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.


Messages from the Week of February 27, 2012

March 2, 2012

DELAY REASON CODES IN DIRECT DATA ENTRY (DDE)

MassHealth has revised its claim submission procedures. Effective January 1, 2012, all claims must be submitted electronically. Only providers with an approved Electronic Claim Waiver Request form may submit paper claims. To download a copy of the Electronic Claim Waiver Request from the MassHealth Web site (www.mass.gov/masshealth), click the MassHealth Provider Forms link located in the Publications panel.

You must submit claims that require attachments and delay reason codes using DDE.

Claims that should be submitted with delay reason codes through DDE include:

90-Day Waivers (Please Note: The only delay reason codes for 90-Day Waivers are):

-1 (Proof of eligibility unknown or unavailable)

-4 (Delay in certifying provider)

-8 (Delay in eligibility determination)

For questions or instructions about accompanying documentation requirements for submission of these claims, refer to All Provider Bulletin 220, dated December 2011.

Final Deadline Appeals (Please Note: The only delay reason code for final deadline appeals is):

-9 (Original claim rejected or denied due to a reason unrelated to the billing limitation rules)

For questions or instructions about accompanying documentation requirements for submission of these claims, refer to All Provider Bulletin 221, dated December 2011.

National Correct Coding Issue (NCCI)/Medically Unlikely Edits (MUE) Appeal Requests and Certain Claims that Require Special Consideration (Please Note: The only delay reason code for this circumstance is):

-11 (Other)

Refer to message texts on your remittance advices (RA).

MassHealth communicates these messages weekly. You can access archived RA message texts as well as former bulletins from the online Provider Library at www.mass.gov/masshealthpubs. 

An incorrect delay reason code may delay the processing of your claim. 

You can obtain instructions on submitting DDE claims from the POSC job aids. From the MassHealth Web site (www.mass.gov/masshealth), select the Information for MassHealth Providers link. Click MassHealth Provider Trainings, then click NewMMIS Provider Training.

Please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900, if you need assistance with the POSC.

DENIED CLAIMS FOR EDIT 2614 (MANAGE CARE SERVICE SHOULD BE PAID BY MASSHEALTH BEHAVIORAL HEALTH)

MassHealth has revised its claim submission procedures. Effective January 1, 2012, all claims must be submitted electronically. Only providers with an approved Electronic Claim Waiver Request form may submit paper claims. To download a copy of the Electronic Claim Waiver Request from the MassHealth Web site (www.mass.gov/masshealth), click the MassHealth Provider Forms link located in the Publications panel.

Providers must submit claims that denied for edit 2614 (Manage care service should be paid by MassHealth behavioral health) electronically via direct data entry (DDE) with delay reason code 11 (Other).

Providers must include scanned copies of the cover letter, medical records, and the remittance advice (RA) showing the 2614 denial, with the DDE claim submission. Please be sure to use the “Attachment” tab to upload the documents.

These claims will appear in a suspense status on your RA with edit 829 (NCCI appeal/special handle under review), while under review. Decisions will be reflected when your reprocessed claim appears on a future RA.

You can obtain instructions on submitting DDE claims from the POSC job aids. From the MassHealth Web site (www.mass.gov/masshealth), select the Information for MassHealth Providers link. Click MassHealth Provider Trainings, then click NewMMIS Provider Training.

Please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900 if you need assistance with the POSC.

SUBMITTING CLAIMS AFTER PERMEDION HEALTH MANAGEMENT SYSTEMS, INC. (HMS) REVIEW

MassHealth has revised its claim submission procedures. Effective January 1, 2012, all claims must be submitted electronically. Only providers with an approved Electronic Claim Waiver Request form may submit paper claims. To download a copy of the Electronic Claim Waiver Request from the MassHealth Web site (www.mass.gov/masshealth), click the MassHealth Provider Forms link located in the Publications panel.

Please remember to submit claims reviewed by Permedion Health Management Systems (HMS), electronically via direct data entry (DDE) using delay reason code 11 (Other).

Instances of when to use delay reason code 11 for such claim submissions include:

-claims that were denied inpatient admission by Permedion HMS and the claims are allowed to be billed as outpatient.

-Outpatient claims when Permedion HMS denied some claim lines (resubmit claims, omitting the denied lines);

-Inpatient claims that were billed incorrectly when Permedion HMS instructs the provider to correct and resubmit the claim; or

-Permedion HMS initially denied the inpatient claim but overturned the denial following a subsequent review and instructed the provider to submit a new claim.

To resubmit claims from the above instances when instructed by Permedion HMS, you must scan and submit the letter from Permedion HMS and any other supporting documentation to support your request for review. If you are submitting multiple claims for the same member, submit each DDE claim separately along with the scanned letter from Permedion HMS and other supporting documentation. Please be sure to use the “Attachment” tab to upload the documents.

These claims will appear on your remittance advice (RA) in a suspense status with edit 829 (NCCI appeal/special handle under review), while under review. Decisions will be reflected when your claim appears on a future RA.

Please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900 if you need assistance with the POSC.

February 27, 2012

REPROCESS FOR G0431 AND G0434 CLAIM DENIALS

Certain claims for the new drug screening codes G0431 and G0434, which became effective on 12/1/11, were previously denied in error with edit codes 4021 (Procedure not covered for benefit plan), 4801 (Procedure not covered by provider contract), or 4831 (No reimbursement rule for service). These claims will be systematically reprocessed and begin to appear on this and subsequent remittance advices (RA). If you have questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

UPDATED REPROCESS INSTRUCTIONS FOR CLAIMS SUBMITTED FOR ANESTHESIA SERVICES

As previously noted in remittance advice RA 100143 (dated 2/21/12), MassHealth identified an issue that caused claims for anesthesia services submitted between January 1, 2012 and February 13, 2012, with dates of service (DOS) between 7/1/2011 and 12/31/2011, to overpay. Providers were advised to refrain from submitting any adjustments to these claims while a modification was made to correct the issue so that impacted claims could be correctly reprocessed by MassHealth.

The reprocessed claims will begin appearing on RA 100145 (dated 3/6/12). If necessary, you may submit adjustments for claims affected by this issue. Please reference the most recent ICN on your adjustment. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

HOME HEALTH AGENCY PROVIDERS: NOTICE ON MASSHEALTH REVIEW OF HOME HEALTH ADVANCE BENEFICIARY NOTICE (HHABN)

The HHABN is required by Section 1879 of the Social Security Act whenever a home health provider believes that the services to be delivered are not covered by Medicare. The home health provider must issue the HHABN for the services believed to be non-covered before initiation of those services, when there is a reduction in services, and at the termination of services. The HHABN is used to advise, or give legal notice to home health patients, who were either receiving Medicare or are eligible to receive Medicare that services delivered are not covered services.

All MassHealth home health providers must comply with MassHealth third party liability (TPL) regulations at 130 CMR 450.316 through 450.318. If a home health agency does not exercise diligent efforts, as defined at 130 CMR 450.316 (A), as making every effort to identify and obtain payment from all other liable third parties, including insurers, MassHealth may subject the provider to sanctions and recover any overpayments paid to the provider (See 130 CMR 450.316(C). Examples of failure to exercise diligent efforts are located at 130 CMR 450.316 (B) and include noncompliance with the billing and authorization requirements of the insurer. You can view MassHealth regulations from the Publications panel of the MassHealth Web site (www.mass.gov/masshealth).

PLEASE NOTE: To ensure that home health providers are using the HHABH as required by Medicare and are in compliance with MassHealth TPL regulations 130 CMR 450.316 through 450.318, MassHealth will be reviewing provider practices as part of the TPL review criteria in the issuance of the HHABN for episodes beginning on and after January 1, 2011, and may sanction and recover any overpayments paid to the provider that are out of compliance with Medicare HHABN or other billing requirements.

CROSSOVER CLAIMS: MEDICARE NEGATIVE PAYMENT

MassHealth will not process a crossover claim that contains a negative Medicare payment. Providers whose claims have denied for edit 442 (Medicare paid amount not numeric) should submit their claim to MassHealth with a zero Medicare paid amount for the coordination of benefits (COB) information. The claims can be submitted via 837 batch or direct data entry (DDE). For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

5010 REMINDERS

Effective January 1, 2012, MassHealth implemented changes to meet the Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 5010 federal requirements. As of January 1, 2012, MassHealth only accepts electronic transactions in the new HIPAA mandated 5010 format.

Please be sure to submit the relevant 5010 data elements when submitting 5010 transactions in production to avoid unnecessary denials. It is a good practice to validate receipt of a 999 file acknowledgement following any batch file submissions to MassHealth. A 999A file acknowledgement means that your file has been received successfully by MassHealth. A 999R file acknowledgement means your file was received but not processed. The ISA of your file provides confirmation that you submitted your file correctly. Please refer to the MassHealth Companion Guide for instruction about electronic claims submissions, and other useful information that can help you perform many online claim submission functions to MassHealth. You can access the Companion Guide from the 5010 Web site at www.mass.gov/masshealth/5010.

If you are seeking additional assistance or training on how to use MassHealth’s Provider Online Service Center (POSC) claims functionality to better understand the HIPAA changes and how they may impact you (to include testing and production file submission issues), contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.


Messages from the Week of February 21, 2012

February 21, 2012

INCLUDE FULL ZIP CODE EXTENSIONS ON YOUR THIRD PARTY LIABILITY (TPL) MEDICARE CLAIM SUBMISSIONS

Providers with national provider identifier (NPIs) are required to include them on all claims (including those billing for Medicare services). If you are a provider with one NPI that corresponds to multiple MassHealth Provider ID/Service Location (PID/SL) numbers, it is important that you submit your claims to Medicare using the full 9-digit U.S. Postal Service’s ZIP code. A Medicare system issue is causing claims that do not include the 4-digit ZIP code extension to default to “9998” in this field, resulting in a discrepancy between the claim data and the MassHealth provider ID information on file. This discrepancy is causing claims to be denied with Edit 1945 (Mult sak prov locs for billing prov spec). It is important that you report your full 9-digit ZIP code to both Medicare and MassHealth as soon as possible to ensure proper claim adjudication. This is a requirement for 5010 claim submissions and was communicated in Provider Bulletin 208, dated February 2011 (MassHealth 5010 Key Concepts).

If you submitted a claim after January, 1, 2012 that denied with this NPI error (edit 1945), you must resubmit it to MassHealth with the corrected full 9-digit ZIP. If you have not reported your full 9-digit ZIP code to MassHealth, you can update this information via the Provider Online Service Center (POSC). Log onto the POSC from the MassHealth Web site (www.mass.gov/masshealth). From the POSC homepage, select the Manage Provider Information link, click Service Locations, and then add or update your doing business as (DBA) ZIP code. You can also update this information by completing a Change of Address form and faxing it to the number indicated on the form. You can download a copy of the form from the MassHealth Web site by clicking the MassHealth Provider Forms link in the Publications panel. Please allow two business days after MassHealth receipt of a change request before resubmitting your corrected claims.


To determine the 4-digit extension to your standard ZIP code, refer to the U.S. Postal Service’s ZIP Code Lookup tool, which can be accessed at http://tools.usps.com/go/ZipLookupAction!input.action.


MassHealth urges you to work with your software vendors to ensure that they capture the full nine digits for all billing provider and service facility addresses. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

REPROCESS FOR CLAIMS SUBMITTED FOR ANESTHESIA SERVICES

MassHealth has identified a system issue that caused certain claims for anesthesia services using the new 5010 qualifier of MJ (minutes) to pay incorrectly. MassHealth has implemented a change to correct this issue. Affected claims submitted between January 1, 2012 and February 13, 2012, with dates of service (DOS) between 7/1/2011 and 12/31/2011, will be reprocessed on a future remittance advice (RA). If you submitted a claim containing anesthesia service codes with the above DOS, please do not make any adjustments to the claim. MassHealth will communicate any updated instructions about the reprocessing of the affected claims via POSC broadcast messages and your weekly RA. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

MENTAL HEALTH CENTER (MHC) AND COMMUNITY HEALTH CENTER (CHC) THIRD PARTY LIABILITY (TPL) INSURANCE BILLING REMINDER

To ensure that MassHealth is the payer of last resort, MHC and CHC providers must generally make diligent efforts to obtain payment from other resources prior to billing MassHealth (see MassHealth All Provider regulations at 130 CMR 450.316). Providers may submit coordination of benefits (COB) claims with a remaining patient responsibility to MassHealth by following instructions found in the HIPAA 837 implementation guides (www.wpc-edi.com) and the MassHealth companion guides (www.mass.gov/masshealth/5010) and provider specific appendices, where applicable.  For mental health services rendered by a clinician who is not certified by Medicare, MHC and CHC providers may submit claims directly to MassHealth using the “Total Non-Covered Amount” field as instructed in Appendix D of your MassHealth provider manual. You can access the provider manuals from the online provider library at www.mass.gov/masshealthpubs. MHC and CHC providers are authorized to use this field only to submit claims for mental health services rendered by a Medicare non-certified clinician. Mental Health services that are denied by other insurers should be billed to MassHealth using the applicable HIPAA adjustment reason code(s).


Messages from the Week of February 13, 2012

February 13, 2012

MENTAL HEALTH CENTER (MHC) AND COMMUNITY HEALTH CENTER (CHC) THIRD PARTY LIABILITY (TPL) INSURANCE BILLING REMINDER

To ensure that MassHealth is the payer of last resort, MHC and CHC providers must generally make diligent efforts to obtain payment from other resources prior to billing MassHealth (see MassHealth All Provider  regulations at 130 CMR 450.316). Providers may submit coordination of benefits (COB) claims with a remaining patient responsibility to MassHealth by following instructions found in the HIPAA 837 implementation guides (www.wpc-edi.com) and the MassHealth companion guides (www.mass.gov/masshealth/5010) and provider specific appendices, where applicable.

For services rendered by a clinician who is not certified by Medicare, MHC and CHC providers may submit claims directly to MassHealth using the “Total Non-Covered Amount” field as instructed in Appendix D of your MassHealth provider manual. You can access the provider manuals from the online provider library at www.mass.gov/masshealthpubs. MHC and CHC providers are authorized to use this field only to submit claims for services rendered by a Medicare non-certified clinician. Services that are denied by other insurers should be billed to MassHealth using the applicable HIPAA adjustment reason code(s).

TPL RESOURCE REMINDER

The MassHealth Web site contains billing guides, instructions and job aids to assist providers in submitting claims to MassHealth. Refer to the MassHealth billing instructions described in the MassHealth billing guides and companion guides (www.mass.gov/masshealth/5010) when submitting claims to MassHealth. These documents also contain specific instructions for submitting coordination of benefits (COB) claims.

POSC direct data entry (DDE) job aids are also available to instruct providers on how to submit institutional and professional COB claims. To access the COB claim submission job aids, go to www.mass.gov/masshealth. Select the Information for MassHealth Providers link and click New Medicaid Management Information System (NewMMIS and the Provider Online Service Center (POSC). Click Using the POSC for the First Time, and then click Get Trained. Refer to the Third Party Liability (TPL) heading.

The provider types listed below should refer to the appropriate appendix of their MassHealth provider manual for TPL exception instructions that may be applicable to their claim submissions. Please Note: The TPL appendices supplement instructions contained in the HIPAA implementation guides, MassHealth billing guides, and MassHealth companion guides.

- Acute Inpatient Hospitals (Appendix D)
- Chronic Disease and Rehabilitation Inpatient Hospitals (Appendix D)
- Community Health Centers (Appendix D)
- Home Health Agencies (Appendix D)
- Mental Health Centers (Appendix D)
- Nursing Facilities (Appendix G)
- Psychiatric Inpatient Hospitals (Appendix D)

The MassHealth provider manuals are located on the online provider library at www.mass.gov/masshealthpubs.

5010 REMINDERS

Effective January 1, 2012, MassHealth implemented changes to meet the Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 5010 federal requirements. As of January 1, 2012, MassHealth only accepts electronic transactions in the new HIPAA mandated 5010 format. If you have not completed testing for 5010, it is important that you complete this as soon as possible, to avoid impact to claims payment. For assistance on testing, call MassHealth at 1-855-253-7717 through January 31, 2012.

Beginning February 1, 2012, all issues (testing and production file submissions) should be directed to MassHealth Customer Service at 1-800-841-2900.

If you are seeking additional assistance or training on how to use MassHealth’s Provider Online Service Center (POSC) claims functionality to better understand the HIPAA changes and how they may impact you, please send an email to providersupport@mahealth.net. A representative can help assist you on the use of the POSC and provide additional training as needed.

5010 PRODUCTION SUBMISSION ISSUES

Reminder: Please be sure to submit the relevant 5010 data elements when submitting 5010 transactions in production to avoid unnecessary denials during implementation. MassHealth has posted a document that outlines common testing issues that will help submitters avoid encountering these issues in production. Please review the document (Most Common 5010 Trading Partner Testing Errors) located under the Frequently Asked Questions header on the 5010 Web site (www.mass.gov/masshealth/5010).

If you upload a batch file to MassHealth, please ensure you follow-up approximately 15 minutes later, to validate you have received a 999 (formerly known as a 997) file acknowledgement. A 999A file acknowledgement means your file has been received successfully by MassHealth. A 999R file acknowledgement means your file was received but not processed. Review the MassHealth Companion Guide to review why you received a 999R. If you do not receive any 999 file acknowledgement file, then your file was not recognized by MassHealth. Review the ISA of your file to confirm you have submitted your file correctly. For assistance, email us at EDI@mahealth.net or contact us at 1-800-841-2900, options 1, 8, 3.

 


 

Messages from the Week of February 6, 2012

February 7, 2012

USING THE PROVIDER ONLINE SERVICE CENTER (POSC)

 

The POSC is a Web-based portal that includes the functions described below. Providers are encouraged to use the POSC to accomplish these tasks independently. Regularly accessing the many online tools available on the POSC can help improve your efficiency when completing the business transactions you need to conduct with MassHealth. From the Online Services panel of the MassHealth home page (www.mass.gov/masshealth), click on Provider Online Service Center.

 

POSC Functions:

-enroll as a MassHealth provider and manage profile information, such as changes to provider profile (see Manage Provider Information);

-add to and update subordinate accounts (see Administer Account);

-perform direct data entry (DDE) real-time, continuous, interactive claims processing, verify member eligibility, submit batch claim, check claim status, resubmit DDE (see Manage Claims and Payments);

-manage service authorizations: enter, update, and inquire about preadmission screening (PAS), prior authorization (PA), and Primary Care Clinician (PCC) referrals; request nonemergency transportation for members; and upload and download batch service authorizations (see Manage Service Authorizations);

-view publications such as forms for downloading, transmittal letters and bulletins, news, training registration and materials, and MassHealth regulations; access links to mass.gov (news,  publications, related updates) (see Reference Publications);

-view notifications, including any new EOHHS notices, Broadcast Messages, contracts, letters and documents (for example, view PAS, PA and PCC notices), reports, metrics, and financial data; generate financial and claim denial reports; and download remittance advices (see Manage Correspondence and Reporting);

-enroll and disenroll members for Senior Care Options (SCO) and Program of All-inclusive Care for the Elderly (PACE), and submit Management Minutes Questionnaires (MMQ) (see Manage Members); and

-change password and manage Subordinate User accounts (see Administer Account).

 

Several online job aids offer instruction for these functions. You can access these job aids on the MassHealth Web site (www.mass.gov/masshealth). Select the Information for MassHealth Providers link, click New Medicaid Management Information System (NewMMIS and the Provider Online Service Center (POSC). Click Using the POSC for the First Time, and then click Get Trained.

 

SUBORDINATE USERS ON THE PROVIDER ONLINE SERVICE CENTER (POSC)

 

As a Provider Online Service Center subordinate user, you have been authorized certain access capabilities by the designated primary user at your provider location. Depending on your access, you will be able to perform certain POSC functions such as entering, submitting, and retrieving transactions. You can view the complete list of services from the Provider Services panel after logging into the POSC from the MassHealth home page (www.mass.gov/masshealth). Once you enter your username and password, you can select from this list those tasks that you have been authorized to perform.

 

The primary user is the administrator for your Provider Online Service Center (POSC) account and the individual who has the authority to assign and maintain subordinate identifications (IDs). If you have issues or questions about passwords and permissions for POSC access and functions, you should contact your primary user. 

 

If you need instruction for any POSC functions or to obtain a general overview of the POSC and its services, please refer to the POSC job aids. To access the job aids, select the Information for MassHealth Providers link and click New Medicaid Management Information System (NewMMIS and the Provider Online Service Center (POSC). Click Using the POSC for the First Time, and then click Get Trained. Some of the references related to these functions can be found under the headers: Provider Information & Navigation, Eligibility Verification, Editing Claims Post Submission, and Referrals.

 

MassHealth encourages you to use these resources to help you effectively manage your daily business tasks. You should always make every effort to consult these references and enlist your primary user to complete any POSC-related functions before contacting MassHealth Customer Service.

 

NEW MASSHEALTH PUBLICATIONS POSTED TO THE WEB

 

MassHealth has posted the following publications on the MassHealth Web site.

Provider Bulletins from January 2012

- School-Based Medicaid Bulletin 21: Medicaid National Correct Coding Initiative (NCCI) for School-Based Medicaid Providers

 

Transmittal Letters from January 2012

- Transmittal Letter ALL-190: Revised Administrative and Billing Instructions

- Transmittal Letter ALL-189: Change in Pharmacy Copayment Calendar-Year Maximum

- Transmittal Letter ALL-188: Revised Appendix A to Reflect Changes in Phone and Fax Information for Some MassHealth Business Units

- Transmittal Letter EIP-19: Revised Service Codes and Descriptions

- Transmittal Letter RHB-20: Service Codes and Descriptions

- Transmittal Letter SHC-18: Service Codes and Descriptions

- Transmittal Letter THP-25: Service Codes and Descriptions

 

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

 

To sign up for e-mail alerts when bulletins and transmittal letters have been posted on our Web site, go to www.mass.gov/masshealth/pcm or call MassHealth Customer Service at 1-800-841-2900.

 

HIPAA 5010 837 MEDICARE CROSSOVER CLAIM PROCESSING DELAY

 

As a result of system compliance issues that are occurring on HIPAA 5010 837 Medicare Crossover claim files received from the Medicare Coordination of Benefits Contractor (COBC), there has been a delay with the processing of some Medicare crossover claims. MassHealth is working with Medicare and the COBC to resolve these errors as soon as possible. Providers should not submit these crossover claims to MassHealth. Once the issue has been resolved, these claims will be processed and appear on future remittance advices (RA). Please continue to check Broadcast Messages and your RA for future updates on this matter. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

 

CONFIRM CLAIM SUBMISSIONS IN THE POSC

 

MassHealth has been informed that some software vendors, billing intermediaries and clearinghouses are reporting difficulty submitting claims due to the implementation of 5010 on January 1, 2012. We urge you to check the status of your claims in the Provider Online Service Center (POSC) to determine if your vendor was successful in submitting claims to MassHealth. If you do not see your claims and to avoid any potential impact to your cash flow, you should check with your vendor immediately to determine why the claims were not processed by MassHealth. Some vendors may use a third party to submit their claims to MassHealth. You should confirm that the third party was successful in submitting the claims to MassHealth. If you have questions, contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.

 

5010 MESSAGE UPDATED FOR THE WEEKS OF 2/3/2012-2/10/2012

 

Effective January 1, 2012, MassHealth implemented changes to meet the Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 5010 federal requirements. As of January 1, 2012, MassHealth only accepts electronic transactions in the new HIPAA mandated 5010 format. If you have not completed testing for 5010, it is important that you complete this as soon as possible, to avoid impact to claims payment. For assistance on testing, call MassHealth at 1-855-253-7717 through January 31, 2012.

 

Beginning February 1, 2012, all issues (testing and production file submissions) should be directed to MassHealth Customer Service at 1-800-841-2900.

 

If you are seeking additional assistance or training on how to use MassHealth’s Provider Online Service Center (POSC) claims functionality to better understand the HIPAA changes and how they may impact you, please send an email to providersupport@mahealth.net. A representative can help assist you on the use of the POSC and provide additional training as needed. 

 

5010 PRODUCTION SUBMISSION ISSUES

 

Reminder: Please be sure to submit the relevant 5010 data elements when submitting 5010 transactions in production to avoid unnecessary denials during implementation. MassHealth has posted a document that outlines common testing issues that will help submitters avoid encountering these issues in production. Please review the document (Most Common 5010 Trading Partner Testing Errors) located under the Frequently Asked Questions header on the 5010 Web site (www.mass.gov/masshealth/5010).

 

If you upload a batch file to MassHealth, please ensure you follow-up approximately 15 minutes later, to validate you have received a 999 (formerly known as a 997) file acknowledgement. A 999A file acknowledgement means your file has been received successfully by MassHealth. A 999R file acknowledgement means your file was received but not processed. Review the MassHealth Companion Guide to review why you received a 999R. If you do not receive any 999 file acknowledgement file, then your file was not recognized by MassHealth. Review the ISA of your file to confirm you have submitted your file correctly. For assistance, email us at EDI@mahealth.net or contact us at 1-800-841-2900, options 1, 8, 3.

 


Messages from the Week of January 30, 2012

January 30, 2012

USE ONLY HIPAA VERSION 5010 WHEN SUBMITTING TRANSACTIONS TO MASSHEALTH

Trading partners continue to send a large number of eligibility and claim submission files to our production system in the former 4010 format.

Please note that on January 1, 2012, MassHealth converted to the HIPAA 5010-mandated electronic transaction format. As previously communicated, MassHealth only accepts electronic transactions in the new HIPAA 5010 format. Please refer to All Provider Bulletin 222, for details about the implementation and requirements of this transition.

We strongly urge you to check your files to ensure you are submitting only 5010 required data on your files. You can verify that your claims were successfully processed in the 5010 format by logging into the Provider Online Service Center (POSC) and entering the appropriate information for a claim status inquiry.

Please continue to check the Most Common 5010 Trading Partner Testing Errors document, located under the Frequently Asked Questions header on the 5010 Web site (www.mass.gov/masshealth/5010) for updates on common testing issues that will help submitters avoid encountering issues in production.

 5010 MESSAGE UPDATED FOR THE WEEKS OF 1/27/2012-2/03/2012

Effective January 1, 2012, MassHealth implemented changes to meet the Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 5010 federal requirements. As of January 1, 2012, MassHealth only accepts electronic transactions in the new HIPAA mandated 5010 format. If you have not completed testing for 5010, it is important that you complete this as soon as possible, to avoid impact to claims payment. For assistance on testing, call MassHealth at 1-855-253-7717 through January 31, 2012.

Beginning February 1, 2012, all issues (testing and production file submissions) should be directed to MassHealth Customer Service at 1-800-841-2900.

If you are seeking additional assistance or training on how to use MassHealth’s Provider Online Service Center (POSC) claims functionality to better understand the HIPAA changes and how they may impact you, please send an email to providersupport@mahealth.net. A representative can help assist you on the use of the POSC and provide additional training as needed.


Messages from the Week of January 23, 2011

January 23, 2012

MASSHEALTH ENROLLMENT CENTER (MEC) MOVE

January 20, 2012, was the last day of business for the MassHealth Enrollment Center (MEC) located in Revere. The MEC has moved to Chelsea. The new MEC address is: 

MassHealth Enrollment Center
45-47 Spruce
Street Chelsea, MA 02150

During the week of January 23, 2012, MassHealth will post on its Web site a revised Appendix B for all provider manuals. Information about this posting and additional information about the MEC move can be found in Transmittal Letter ALL-191. You can access this important transmittal letter from the MassHealth online Provider Library at www.mass.gov/masshealthpubs.

 

5010 MESSAGE UPDATED FOR THE WEEKS OF 1/13/2012-1/27/2012

Effective January 1, 2012, MassHealth implemented changes to meet the Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 5010 federal requirements. As of January 1, 2012, MassHealth only accepts electronic transactions in the new HIPAA mandated 5010 format. If you have not completed testing for 5010, it is important that you complete this as soon as possible, to avoid impact to claims payment. For assistance on testing, call MassHealth at 1-855-253-7717 through January 31, 2012.

Beginning February 1, 2012, all issues (testing and production file submissions) should be directed to MassHealth Customer Service at 1-800-841-2900.

If you are seeking additional assistance or training on how to use MassHealth’s Provider Online Service Center (POSC) claims functionality to better understand the HIPAA changes and how they may impact you, please send an email to providersupport@mahealth.net. A representative can help assist you on the use of the POSC and provide additional training as needed.


Messages from the Week of January 9, 2011

January 13, 2012

PAYMENT AMOUNT PER EPISODE (PAPE)/AUTOMATED TEST PANEL (ATP) CLAIMS

MassHealth completed PAPE/ATP claim reprocessing in September 2011 for claims that previously processed in error. MassHealth has identified that in certain instances, the amount paid on the bundled claims had not been recouped as appropriate. MassHealth has corrected the issue and these claims will appear in the Adjustment and Accounts Receivable sections of this or a future remittance advice. No further action is required at this time. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

VIEW TRANSMITTAL LETTER ALL-187

MassHealth Update Postcard No. 11-47, which was issued to certain providers in late December, contained a typographical error. This postcard referred to Transmittal Letter PHY-187 in error. No such transmittal letter exists. The postcard should have referred to Transmittal Letter ALL-187 (Revised Regulations about Claim Submissions). You can access this important transmittal letter from the MassHealth online Provider Library at www.mass.gov/masshealthpubs.

CONFIRM CLAIM SUBMISSIONS IN THE POSC


MassHealth has been informed that some software vendors, billing intermediaries and clearinghouses are reporting difficulty submitting claims due to the implementation of 5010 on January 1, 2012. We urge you to check the status of your claims in the Provider Online Service Center (POSC) to determine if your vendor was successful in submitting claims to MassHealth. If you do not see your claims and to avoid any potential impact to your cash flow, you should check with your vendor immediately to determine why the claims were not processed by MassHealth. Some vendors may use a third party to submit their claims to MassHealth. You should confirm that the third party was successful in submitting the claims to MassHealth. If you have questions, contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.

 

5010 MESSAGE UPDATED FOR THE WEEK OF 1/13/2012-1/20/2012


Effective January 1, 2012, MassHealth implemented changes to meet the Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 5010 federal requirements. As of January 1, 2012, MassHealth only accepts electronic transactions in the new HIPAA mandated 5010 format. If you have not completed testing for 5010, it is important that you complete this as soon as possible, to avoid impact to claims payment. For assistance on testing, call MassHealth at 1-855-253-7717 through January 31, 2012.
Beginning February 1, 2012, all issues (testing and production file submissions) should be directed to MassHealth Customer Service at 1-800-841-2900.
If you are seeking additional assistance or training on how to use MassHealth’s Provider Online Service Center (POSC) claims functionality to better understand the HIPAA changes and how they may impact you, please send an email to providersupport@mahealth.net. A representative can help assist you on the use of the POSC and provide additional training as needed.

EDIT 277 OUTPATIENT CLAIMS REPROCESS


MassHealth has identified an issue that caused some outpatient claims to be denied erroneously with Edit 277 (Admit hour invalid). MassHealth has resolved the issue and is reprocessing the affected claims. The reprocessed claims could appear on this or future remittance advices. No further action is required by providers. Please note that with the 5010 implementation, reporting the admission hour is no longer an outpatient claim submission requirement. If you have questions, contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.

5010 PRODUCTION SUBMISSION ISSUES


Reminder: Please be sure to submit the relevant 5010 data elements when submitting 5010 transactions in production to avoid unnecessary denials during implementation. MassHealth has posted a document that outlines common testing issues that will help submitters avoid encountering these issues in production. Please review the document (Most Common 5010 Trading Partner Testing Errors) located under the Frequently Asked Questions header on the 5010 Web site (www.mass.gov/masshealth/5010).
If you upload a batch file to MassHealth, please ensure you follow-up approximately 15 minutes later, to validate you have received a 999 (formerly known as a 997) file acknowledgement. A 999A file acknowledgement means your file has been received successfully by MassHealth. A 999R file acknowledgement means your file was received but not processed. Review the MassHealth Companion Guide to review why you received a 999R. If you do not receive any 999 file acknowledgement file, then your file was not recognized by MassHealth. Review the ISA of your file to confirm you have submitted your file correctly. For assistance, email us at EDI@mahealth.net or contact us at 1-800-841-2900, options 1, 8, 3.

January 10, 2012

Third Party Liability (TPL) Claims: Reporting a “Total Noncovered Amount” on your HIPAA 5010 Claim

Authorized provider types will use a new data element “Total Noncovered Amount” to report noncovered charges on HIPAA 5010 claims, for specific TPL exception conditions described in your MassHealth provider manual TPL appendix. Providers who are authorized to use a “Total Noncovered Amount” when reporting specific TPL exception conditions are listed below, with their related TPL appendix noted in parentheses:
- Acute Inpatient Hospitals (Appendix D)
- Chronic Disease and Rehabilitation Inpatient Hospitals (Appendix D)
- Community Health Centers (Appendix D)
- Home Health Agencies (Appendix D)
- Mental Health Centers (Appendix D)
- Nursing Facilities (Appendix G)
- Psychiatric Inpatient Hospitals (Appendix D)

The exception instructions are located in the Supplemental Instructions for Claims with Other Insurance in theAppendix section of each provider manual as noted. You can access the provider manuals from the online provider library at www.mass.gov/masshealthpubs.

Provider manual TPL appendices contain specific MassHealth billing instructions for members who have Medicare or commercial insurance. The TPL appendices supplement instructions contained in the HIPAA Implementation Guides and MassHealth Companion Guides and Billing Guides. Providers who are not authorized to use the new 5010 field “Total Noncovered Amount” should report the HIPAA adjustment reason code provided by the other insurer on their MassHealth claim submission to indicate the other insurer has not paid the claim.

Submitting National Correct Coding Initiative (NCCI)/Medically Unlikely Edit (MUE) Requests Electronically

NCCI/MUE requests for review may be submitted electronically on the Provider Online Service Center (POSC) through direct data entry (DDE).
Please refer to All Provider Bulletin 209 (April 2011: Medicaid National Correct Coding Initiative) for instructions and required documentation.

Providers should use the Attachment tab to upload all documents related to the NCCI/MUE request. Only delay reason code 11 (Other) may be used when submitting a NCCI/MUE request.
NCCI/MUE requests will appear in a suspend status on your remittance advice (RA) with edit 829 (NCCI appeal/special handle under review) while your request is under review. Approved and denied requests will appear on a future RA. A final notice of denial will be sent if a request is denied.

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

Urgent Medicare Crossover Claims Notice

On 12/21/11 the Centers for Medicare and Medicaid Services (CMS) notified MassHealth that Medicare did not have the capability to complete conversion of HIPAA 4010A1 837 run out claims to HIPAA Version 5010 for some Coordination of Benefits Agreement (COBA) trading partners that implemented HIPAA Version 5010 on 1/1/12. The affected 4010A1 run out claims (both institutional and professional) were most likely received by Medicare between 12/16/11 and 12/23/11.

MassHealth communicated on several occasions that it would not process 4010A1 837 claim files received after 1/1/12. However, providers may submit their crossover claim directly to MassHealth for payment consideration if their 4010A1 run out claim was received by Medicare between 12/16/11 and 12/31/11 and there is a remaining MassHealth member liability on the claim. Affected claims should be submitted to MassHealth using 837 batch submissions or via the Provider Online Service Center (POSC) using direct data entry (DDE). If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Acute Outpatient Claims Reprocess

MassHealth has reprocessed claims that were denied with edit 4801 (Procedure not covered by provider contract) for acute outpatient providers with dates of service (DOS) between 01/01/2011 and 05/31/2011. The reprocessed claims are included on this remittance advice. No further action is required by providers. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

5010 Message Updated for the Week of 1/06/2012-1/13/2012

Effective January 1, 2012, MassHealth only accepts electronic transactions in the HIPAA mandated 5010 format. If you have not completed testing for 5010, it is important that you complete this as soon as possible, to avoid impact to claims payment. For assistance on testing, call MassHealth at 1-855-253-7717 through January 31, 2012. Beginning February 1, 2012 all issues (testing and production file submissions) should be directed to MassHealth Customer Service at 1-800-841-2900.

5010 Production Submission Issues

Reminder: Please be sure to submit the relevant 5010 data elements when submitting 5010 transactions in production to avoid unnecessary denials during implementation. MassHealth has posted a document that outlines common testing issues that will help submitters avoid encountering these issues in production. Please review the document (Most Common 5010 Trading Partner Testing Errors) located under the Frequently Asked Questions header on the 5010 Web site (www.mass.gov/masshealth/5010).

If you upload a batch file to MassHealth, please ensure you follow-up approximately 15 minutes later, to validate you have received a 999 (formerly known as a 997) file acknowledgement. A 999A file acknowledgement means your file has been received successfully by MassHealth. A 999R file acknowledgement means your file was received but not processed. Review the MassHealth Companion Guide to review why you received a 999R. If you do not receive any 999 file acknowledgement file, then your file was not recognized by MassHealth. Review the ISA of your file to confirm you have submitted your file correctly. For assistance, email us at EDI@mahealth.net or contact us at 1-800-841-2900, options 1, 8, 3.


Messages from the Week of December 27, 2011

December 29, 2011

5010 MESSAGE UPDATED FOR THE WEEK OF 12/28/2011-1/05/2011

If you submitted a 5010 test file to MassHealth by December 16, 2011, you should have received confirmation that you are ready to submit 5010 files as of January 1, 2012. If you have not received confirmation that you have successfully passed testing for 5010, please call the EDI HelpDesk at 1-855-253-7717 for assistance. Beginning January 1, 2012, MassHealth will only accept files in the 5010 format and will not accept any files in the 4010 format. Please remember you may use the Provider Online Service Center (POSC) to submit your claims if you have not started or completed 5010 testing.

MASSHEALTH ELECTRONIC CAPABILITY OPTIONS TO ASSIST YOU IN YOUR 5010 TRANSITION

Reminder – MassHealth offers a number of options for providers to submit 5010 transactions (see below). Please refer to our 5010 Web site at www.mass.gov/masshealth/5010 for further details.

Option 1: EVSpc

For eligibility verification and claim status, MassHealth offers EVSpc. This software, available on www.mass.gov/masshealth, allows you to check eligibility and claim status. You can use EVSpc in a batch mode (several to hundreds of eligibility or claim status checks) or in an individual mode (check one member eligibility or claim status at a time.) This software accepts a ‘batch’ ASCII file that can be imported into the software and the software can generate a report for you to check eligibility. Please note that establishing this processing takes IT support and time to install. If you have EVSpc questions contact MassHealth Customer Service at 1-800-841-2900 and select options 1, then 8, and then 3 to speak to an EDI representative.

Option 2: Provider Online Service Center (POSC)

The POSC is the Web portal that gives you the ability to submit all the HIPAA batch transactions that MassHealth supports, as well as professional and institutional claims individually to MassHealth using the Direct Data Entry (DDE) feature. The POSC also gives you the option to verify member eligibility and check claim status on an individual basis. If you have POSC questions please call MassHealth Customer Service. 

Option 3: Health Care Transaction Service (HTS) 

Providers may submit the 270/271 & 276/277 transactions to MassHealth via a system-to-system method.

December 27, 2011

5010 POSC PROVIDER TRAINING FOR CLAIMS

MassHealth Customer Service will provide a 5010 Webinar Training session to review changes to the Provider Online Service Center (POSC) direct data entry (DDE) for Professional and Institutional claims. The session will be held on Wednesday, December 28th. The session will be split to address claim types: the training for Professional claims will be held at 10 AM and the training for Institutional claims will be held at 2 PM. Each session will take approximately one hour.

In order to prepare for participation in the Webinar, MassHealth suggests that you complete the instructions on the HIPAA Version 5010 Web page, beneath the 5010 POSC Provider Training for Claims header (www.mass.gov/masshealth/5010). The Web page also details Joining instructions to enter the HP Virtual Room and begin the Webinar Session.

To participate in the Webinar, it is necessary for you to be able to simultaneously access the Internet and use a phone line. If you are not able to attend this training session and want to review these changes, please email us at providersupport@mahealth.net with your request.

5010 MESSAGE UPDATED THROUGH 12/28/2011

If you submitted a 5010 test file to MassHealth by December 16, 2011, you should have received confirmation that you are ready to submit 5010 files as of January 1, 2012. If you have not received confirmation that you have successfully passed testing for 5010, please call the EDI HelpDesk at 1-855-253-7717 for assistance. Beginning January 1, 2012, MassHealth will only accept files in the 5010 format and will not accept any files in the 4010 format. Please remember you may use the Provider Online Service Center (POSC) to submit your claims if you have not started or completed 5010 testing. MassHealth offices are closed on January 2, 2013, and will re-open on January 3, 2012. Please refer to December 2011 Provider Bulletin 222 (5010 Implementation Cutover) for further details about this transition. You can download a copy of the bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

REMINDER TO LONG TERM SERVICES AND SUPPORTS PROVIDERS: DO NOT BILL CLAIMS UNTIL YOU HAVE REVIEWED YOUR MANAGEMENT MINUTES QUESTIONNAIRE (MMQ) SUMMARY RESPONSE 

When uploading a batch MMQ file, you must first verify that you have received notification that the batch has been successfully accepted.  Please also review the MMQ Summary Response to validate that the MMQ file has been processed correctly. The summary response is sent the day following the MMQ file submission. Therefore you should only submit a claim after reviewing the MMQ summary response to ensure correct claims adjudication. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.netor 1-800-841-2900. 

ELECTRONIC CLAIM SUBMISSION GRACE PERIOD 

All Provider Bulletins 212 (May 2011: Important Claims Submission Policy Changes) and 217 (September 2011: Waiver Policy for Claim Submissions) announced an important change in the claims submission policy. Effective January 1, 2012, all MassHealth claims must be submitted electronically unless a provider has an approved electronic claim submission waiver.

Effective January 1, 2012, MassHealth will implement a 90-day grace period of the claims submission policy to allow providers additionaltime to convert to electronic claims submission and to apply for the electronic claim submission waiver. MassHealth will issue an all provider bulletin in January that further explains this grace period.

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


Messages from the Week of December 19, 2011

December 19, 2011

MASSHEALTHS ELECTRONIC CAPABILITY OPTIONS TO ASSIST YOU IN YOUR 5010 TRANSITION

Reminder – MassHealth offers a number of options for providers to submit 5010 transactions:

Option 1: EVSpc
For eligibility verification and claim status, MassHealth offers EVSpc. This software, available on www.mass.gov/masshealth, allows you to check eligibility and claim status. You can use EVSpc in a batch mode (several to hundreds of eligibility or claim status checks) or in an individual mode (check one member eligibility or claim status at a time.) This software accepts a ‘batch’ ASCII file that can be imported into the software and the software can generate a report for you to check eligibility. Please note that establishing this processing takes IT support and time to install. If you have EVSpc questions contact MassHealth Customer Service at 1-800-841-2900 and select options 1, then 8, and then 3 to speak to an EDI representative.

Option 2: Provider Online Service Center (POSC)
The POSC is the Web portal that gives you the ability to submit all the HIPAA batch transactions that MassHealth supports, as well as professional and institutional claims individually to MassHealth using the Direct Data Entry (DDE) feature. The POSC also gives you the option to verify member eligibility and check claim status on an individual basis. If you have POSC questions please call MassHealth Customer Service. MassHealth will hold a Webinar to provide instructions for entering professional or institutional claims on the POSC on December 28th. Please refer to our 5010 Web site at www.mass.gov/masshealth/5010 for further details.

Option 3: HealthCare Transaction Service (HTS)
Providers may submit the 270/271 & 276/277 transactions to MassHealth via a system-to-system method.

HOME HEALTH AGENCY PROVIDER REMINDER

MassHealth home health agency providers are required to enter the admission source in Field 15 on the UB-04 claim form. Effective 1/1/2012, claims submitted on the UB-04 that do not include this information will be denied with Edit 229 (Source of Admission Missing).The UB-04 Billing Guide can be found in the Provider Library on the MassHealth Web site (www.mass.gov/masshealthpubs) by clicking on the link MassHealth Billing Guides for Paper Claim Submitters. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

5010 MESSAGE UPDATED FOR THE WEEK OF 12/13/2011-12/20/2011

If you submitted a 5010 test file to MassHealth by December 16, 2011, you should have received confirmation that you are ready to submit 5010 files as of January 1, 2012. If you have not received confirmation that you have successfully passed testing for 5010, please call the EDI HelpDesk at 1-855-253-7717 for assistance. Beginning January 1, 2012, MassHealth will only accept files in the 5010 format and will not accept any files in the 4010 format. Please remember you may use the Provider Online Service Center (POSC) to submit your claims if you have not started or completed 5010 testing. MassHealth offices are closed on January 2, 2013, and will re-open on January 3, 2012. Please refer to December 2011 Provider Bulletin 222 (5010 Implementation Cutover) for further details about this transition. You can download a copy of the bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

5010 POSC PROVIDER TRAINING FOR CLAIMS

MassHealth Customer Service will provide a 5010 Webinar Training session to review changes to the Provider Online Service Center (POSC) direct data entry (DDE) for Professional and Institutional claims. The session will be held on Wednesday, December 28th. The session will be split to address claim types: the training for Professional claims will be held at 10 AM and the training for Institutional claims will be held at 2 PM. Each session will take approximately one hour.
In order to prepare for participation in the Webinar, MassHealth suggests that you complete the instructions on the HIPAA Version 5010 Web page, beneath the 5010 POSC Provider Training for Claims header (www.mass.gov/masshealth/5010). The Web page also details Joining instructions to enter the HP Virtual Room and begin the Webinar Session.


Messages from the Week of December 12, 2011

UPDATED REMINDER: 5010 TEST FILE MUST BE RECEIVED NO LATER THAN 12/16/2011

If you have not yet submitted your file, please send it immediately. MassHealth must receive your 5010 test file by this Friday, December 16, 2011 to ensure sufficient time to process any testing errors that may be encountered before the January 1, 2012 implementation. MassHealth cannot guarantee that you will receive approval in time for January 1, 2012 if your test file is not received by December 16, 2011. If you have not completed 5010 testing, you will need to submit your next test file to MassHealth after January 2, 2011. MassHealth is currently finalizing the review of all remaining test files that have been submitted. If you have not received your test file results, contact the EDI HelpDesk at 1-855-253-7717 for assistance. Please remember you may use direct data entry on the Provider Online Service Center (POSC) to enter your claims until you have completed testing. If you use EVSpc please be aware that the 5010 version is now available for download at www.mass.gov/masshealth/5010. To avoid potential cash flow impact, it is critical that you complete your testing before January 1, 2012.

UPDATED: new Masshealth publications posted to the Web

MassHealth has posted the following publications on the MassHealth Web site.

Provider Bulletins from November

-Acute Inpatient Hospital Bulletin 142: Revisions to the Medical Benefit Request, the Senior Medical Benefit Request, Other Forms, and the Virtual Gateway

-Adult Day Health Bulletin 12: MassHealth Community Services Critical Incident Report Form

-Adult Foster Care Bulletin 8: MassHealth Community Services Critical Incident Report Form

-All Provider Bulletin 219a: 5010 Implementation Readiness – Corrected

-Community Health Center Bulletin 68: Revisions to the Medical Benefit Request, the Senior Medical Benefit Request, Other Forms, and the Virtual Gateway

-Habilitation Bulletin 7: MassHealth Community Services Critical Incident Report Form

-Group Adult Foster Care Bulletin 4: MassHealth Community Services Critical Incident Report Form

-Personal Care Agency Bulletin 6: MassHealth Community Services Critical Incident Report Form

Transmittal Letters from November

-ALL-186: Revised Regulations about NPI

You can download a copy of a transmittal letter or bulletin from the online Provider Library (www.mass.gov/masshealthpubs).

To sign up to receive e-mail alerts when new publications become available, you can click on the Choose Your Preferred Method for Receiving Notification of Provider Bulletin and Transmittal Letters link located under both the Provider Bulletins and Transmittal Letters links in the Provider Library.

Messages from the Week of September 12, 2011

September 13, 2011

ICD-9-CM Diagnosis Code (s) Required on Claims for all Conditions

Psych providers are not consistently reporting the ICD-9-CM diagnosis code(s) according to the instructions outlined in the UB-04 Billing Guide. MassHealth requires providers to enter the ICD-9-CM diagnosis code(s) corresponding to all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received or the length of stay. Providers should refer to the UB-04 Billing Guide for additional information on submitting both electronic and paper claims. If you have additional questions, contact MassHealth Customer Service at providersupport@mahealth.net or 800-841-2900.

New Masshealth publications posted to the Web

MassHealth has posted the following publications on the MassHealth Web site.

Bulletins from September

Provider Bulletin

- All Provider Bulletin 213: Testing Readiness for CMS 5010 Mandate

- All Provider Bulletin 214: New Address for Disability Supplements

- All Provider Bulletin 215: Change In Pharmacy Copayments

- All Provider Bulletin 216: HIPAA 5010 Diagnosis Code Requirement

You can download a copy of a transmittal letter or bulletin from the online Provider Library ( www.mass.gov/masshealthpubs).

To sign up to receive e-mail alerts when new publications become available, you can click on the MassHealth Provider Library E-mail Notifications link.

Messages from the Week of August 15, 2011

August 17, 2011

CLAIM RECOUPMENT RELATED TO RETROACTIVE ELIGIBILITY INVOLVING MCO'S

In response to provider inquiries related to "Retroactive eligibility involving MCO's", MassHealth has determined that there is a system issue involving eligibility received from another state agency. MassHealth is currently working with the state agency to resolve the issue. In the interim, we are working with the MCO's to help minimize recoupments that occur as a result of this issue. It may appear on the MCO Remittance Advice as a payment type defined as recoupment. If you receive a recoupment involving a retroactive change in eligibility contact Lisa Gardner at lisa.m.gardner@state.ma.us. Remember not to send Private Health Information (PHI) information via unsecured email.

UPDATED PAYMENT AND COVERAGE GUIDELINES TOOL POSTED FOR DURABLE MEDICAL EQUIPMENT (DME) AND OXYGEN PROVIDERS

Pharmacy, DME, and oxygen providers are advised that the MassHealth DME and Oxygen Payment Coverage Guidelines Tool has been updated and posted to the MassHealth Web site. To ensure that you are using the most recent version of the applicable tool, visit www.mass.gov/masshealthpubs. Click on Provider Library and then on the MassHealth Payment and Coverage Guideline Tools link at the bottom of the page. For more information about DME and oxygen coding refer to Transmittal Letters DME-31 and OXY-30. Transmittal letters can be accessed from the Provider Library at www.mass.gov/masshealthpubs. MassHealth strongly encourages providers to submit claims using 837P or DDE (direct data entry) instead of paper. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

UPDATED PAYMENT AND COVERAGE GUIDELINES TOOL POSTED FOR ORTHOTICS AND PROSTHETICS PROVIDERS

Orthotics and prosthetics providers are advised that the MassHealth Orthotics and Prosthetics Payment Coverage Guidelines Tool has been updated and posted to the MassHealth Web site. To ensure that you are using the most recent version of the applicable tool, visit www.mass.gov/masshealthpubs. Click on Provider Library and then on the MassHealth Payment and Coverage Guideline Tools link at the bottom of the page. For more information about Orthotics and Prosthetics coding refer to Transmittal Letters ORT-22 and PRT-22. Transmittal letters can be accessed from the Provider Library at www.mass.gov/masshealthpubs. MassHealth strongly encourages providers to submit claims using 837P or DDE (direct data entry) instead of paper. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

MMQ ERROR CODE 691 WHEN UPDATING MEMBER'S LONG TERM CARE IN THE DATABASE (Updated 8/16/2011)

MassHealth recently notified Nursing Facility providers that the systems issue resulting in Management Minute Questionnaires (MMQ's) submissions failing with an error code of 691 (ERROR UPDATING MEMBER'S LONG TERM CARE IN THE DATABASE -PLEASE CALL CUSTOMER SERVICE) had been corrected and all affected MMQ's should be re-submitted. However, some providers have notified MassHealth that they are still receiving error code 691 when submitting MMQ's. MassHealth is working to resolve this new issue. Nursing Facilities that submitted MMQ's on or prior to 07/31/2011 should resubmit all MMQ's. All MMQ's submitted on or after 08/01/2011 that failed for error code 691, should not be re-submitted until further notice. MassHealth apologizes for this inconvenience. If you have questions, contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

NEW MASSHEALTH PUBLICATIONS POSTED TO THE WEB

MassHealth has posted the following publications on the MassHealth Web site.

Transmittal Letters from August

-CHC-90: Revised Service Codes and Descriptions

You can download a copy of a transmittal letter or bulletin from the online Provider Library ( www.mass.gov/masshealthpubs).

To sign up to receive e-mail alerts when new publications become available, you can click on the MassHealth Provider Library E-mail Notifications link.

Messages from the Week of July 18, 2011

July 19, 2011

New Masshealth Publications Posted to the Web

MassHealth has posted the following publications on the MassHealth Web site.

Bulletins from July

Provider Bulletin
- PHY-91: Anesthesia Services and 5010 Requirements

Transmittal Letters from July
-NF-57 - Revised Appendix F
-PHM-59 - Revised Appendix D

You can download a copy of a transmittal letter or bulletin from the online Provider Library ( www.mass.gov/masshealthpubs).

To sign up to receive e-mail alerts when new publications become available, you can click on the MassHealth Provider Library E-mail Notifications link.

Provider Enrollment Applications

MassHealth encourages automated solutions across all functions, including the submission of electronic provider enrollment applications via the Provider Online Service Center (POSC) at https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal/appmanager/provider/desktop. If you have questions when entering an application via the POSC, please remember you may click the help button (?) in the upper right hand corner of each screen. When an enrollment application is not submitted via the POSC, a hard copy application must be obtained by contacting MassHealth Customer Service to request the application. To ensure that the application packet is the most current version, MassHealth strongly discourages submitting applications that have been copied. Please note this may result in an extensive delay in processing the application and/or a denial.

Please contact MassHealth Customer Service at 1-800-841-2900 for any questions or to request a provider enrollment application.


Messages from the Week of June 13, 2011

June 14, 2011

Reminder: National Drug Code (NDC) requirement for Professional Medicare Crossover Claims

Providers must submit NDC information, including the NDC, NDC units, and NDC unit descriptor, on all professional claim submissions to Medicare for dually eligible members (Medicare and MassHealth) when billing for Level II HCPCS for physician-administered drugs. The NDC information will be populated on Medicare Crossover claims transmitted to MassHealth from the Coordination of Benefits Contractor (COBC). If you bill Medicare electronically using the 837P transaction, complete the Drug Identification and Drug Pricing segments in Loop 2410. Providers should verify with their vendor that the NDC data elements are available for Medicare crossover claim submission. Crossover claims that do not contain the required NDC information will be denied with edits 0800 (HCPCS requires NDC), 0820 (NDC HCPCS given with no /invalid units for HCPCS), or 0821 (NDC given with no/invalid measurement for HCPCS). MassHealth is not changing reimbursement for these drugs. For more information, go to www.mass.gov/MassHealth and click on " Information for MassHealth Providers," then on "National Drug Code (NDC) Requirements for Physician-Administered Medications." If you have questions, contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of May 30, 2011

June 2, 2011

MASSHEALTH FINAL DEADLINE APPEAL REGULATION REMINDER

The final deadline appeal regulation at 130 CMR 450.323 states that claims submitted for appeal must have been denied or underpaid as a result of a MassHealth error. All appeals must meet the criteria under 130 CMR 450.323(A). Providers are also reminded that failure to submit the documentation specified under 130 CMR 450.323(B) to substantiate the contention that the claim was denied or underpaid because of MassHealth error, may result in the denial of the appeal. You can access the MassHealth provider regulations from the link in the Publications panel on the MassHealth Web site ( www.mass.gov/masshealth ).


NEW MASSHEALTH WEB PAGE LISTS 5010 ELECTRONIC TRANSACTIONS UPDATES (Updated)

The Centers for Medicare & Medicaid Services (CMS) has mandated that on January 1, 2012, the standards for electronic health care transactions must change from version 4010/4010A1 to version 5010. All entities (i.e., trading partners) that submit electronic transactions to MassHealth must adhere to these new standards. MassHealth is continuing to add to the 5010 Web page with the latest 5010 information. Please check this page frequently ( www.mass.gov/masshealth/5010) to stay informed about any 5010 updates.

Newly posted information you can find:
- All Provider Bulletin 210: 5010 Implementation Preparation
- 276/277, 837P, 837I, 820, 834 inbound & outbound Companion Guides
- Guide to reading the TA1 and 999 Acknowledgements

- Information about batch claims transactions conducted through MMIS from the Healthcare Transactions Services-System-to-System Testing link
- TPL Forms and Supplemental Instructions for the Exception and Attachment forms, as well as draft TPL special supplemental billing instructions for the CMS-1500 submissions. These instructions will also be included in the CMS-1500 billing guide during the last phase of the 5010 project

If you have questions about the 5010 initiatives, contact MassHealth Customer Service at 1-800-841-2900 and ask for an EDI representative, or e-mail your questions to edi@mahealth.net.


NATIONAL CORRECT CODING INITIATIVE (NCCI) MAXIMUM UNITS ALLOWED PER DATE OF SERVICE (DOS) NOTIFICATION TO THERAPISTS

Section 6507 of the federal Affordable Care Act (health care reform law), requires state Medicaid agencies to edit claims in accordance with compatible methodologies of the National Correct Coding Initiative (NCCI). NCCI was implemented by the Centers for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies and to control improper coding to minimize inappropriate payment. On May 1, 2011, MassHealth began enforcing NCCI editing.

To conform with NCCI coding edit guidelines, MassHealth is changing the maximum units allowed for Service Codes 92507, 92508, 92526, and 97150. Service codes and descriptions are listed in Subchapter 6 of your MassHealth provider manual.

Effective for dates of service beginning June 1, 2011, the maximum units allowed per date of service (DOS) for each of these codes is one. In addition, to comply with this initiative, the Division of Health Care and Finance Policy (DHCFP) has revised the rates for these codes to reflect a single unit of service, effective for DOS beginning June 1, 2011. DHCFP rates for rehabilitation clinics, audiological services, and restorative services can be found at www.mass.gov/dhcfp.

More information about NCCI coding changes can be found in the April 2011 All Provider Bulletin 209 (Medicaid National Correct Coding Initiative). MassHealth bulletins and provider manuals can be accessed from the Provider Library at www.mass.gov/masshealthpubs.


NATIONAL CORRECT CODING INITIATIVE (NCCI) MAXIMUM UNITS ALLOWED PER DATE OF SERVICE (DOS) NOTIFICATION TO SPEECH AND HEARING CLINICS

Section 6507 of the federal Affordable Care Act (health care reform law), requires state Medicaid agencies to edit claims in accordance with compatible methodologies of the National Correct Coding Initiative (NCCI). NCCI was implemented by the Centers for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies and to control improper coding to minimize inappropriate payment. On May 1, 2011, MassHealth began enforcing NCCI editing.

To conform with NCCI coding edit guidelines, MassHealth is changing the maximum units allowed for Service Codes 92507 and 92508. Service codes and descriptions are listed in Subchapter 6 of your MassHealth provider manual.

Effective for dates of service beginning June 1, 2011, the maximum units allowed per date of service (DOS) for each of these codes is one. In addition, to comply with this initiative, the Division of Health Care and Finance Policy (DHCFP) has revised the rates for these codes to reflect a single unit of service, effective for DOS beginning June 1, 2011. DHCFP rates for rehabilitation clinics, audiological services, and restorative services can be found at www.mass.gov/dhcfp.

More information about NCCI coding changes can be found in the April 2011 All Provider Bulletin 209 (Medicaid National Correct Coding Initiative). MassHealth bulletins and provider manuals can be accessed from the Provider Library at www.mass.gov/masshealthpubs.


NATIONAL CORRECT CODING INITIATIVE (NCCI) MAXIMUM UNITS ALLOWED PER DATE OF SERVICE (DOS) NOTIFICATION TO REHABILITATION CLINICS

Section 6507 of the federal Affordable Care Act (health care reform law), requires state Medicaid agencies to edit claims in accordance with compatible methodologies of the National Correct Coding Initiative (NCCI). NCCI was implemented by the Centers for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies and to control improper coding to minimize inappropriate payment. On May 1, 2011, MassHealth began enforcing NCCI editing.

To conform with NCCI coding edit guidelines, MassHealth is changing the maximum units allowed for Service Codes 92507, 92508, and 97150. Service codes and descriptions are listed in Subchapter 6 of your MassHealth provider manual.

Effective for dates of service beginning June 1, 2011, the maximum units allowed per date of service (DOS) for each of these codes is one. In addition, to comply with this initiative, the Division of Health Care and Finance Policy (DHCFP) has revised the rates for these codes to reflect a single unit of service, effective for DOS beginning June 1, 2011. DHCFP rates for rehabilitation clinics, audiological services, and restorative services can be found at www.mass.gov/dhcfp.

More information about NCCI coding changes can be found in the April All Provider Bulletin 209 (Medicaid National Correct Coding Initiative). MassHealth bulletins and provider manuals can be accessed from the Provider Library at www.mass.gov/masshealthpubs.
 


Messages from the Week of May 23, 2011

May 23, 2011

Direct Data Entry (DDE) Coordination of Benefits (COB) Training

Following the July 6th, 8th, 14th, 20th and 21st Massachusetts Health Care Training Forum (MTF) meeting and roundtable discussions, MassHealth Customer Service will provide DDE training with emphasis on how to submit coordination of benefits (COB) claims using DDE transactions. COB claims are claims with an explanation of benefits (EOB) from a primary payer, or with an Explanation of Medicare Benefits (EOMB).This training will provide steps and information about the appropriate tabs and fields that must be completed to ensure proper COB processing and DDE navigation.

All trainings will be held from 1:00-3:30 P.M. following the regularly scheduled MTF meeting and roundtable discussions. DDE COB training check-in begins at 12:30 P.M. for each session. However, on-line preregistration is required. Limited space is available at each location, so please preregister early. NOTE, if you are not preregistered, we will be unable to accommodate you at the training facility.

Meeting locations are as follows:
July 6, 2011-- Holiday Inn Taunton: 700 Myles Standish Blvd. (Taunton, MA)
July 8, 2011-- Holiday Inn Holyoke: 245 Whiting Farms Road (Holyoke, MA)
July 14, 2011-- Holiday Inn Tewksbury: 4 Highwood Drive (Tewksbury, MA)
July 20, 2011-- Holiday Inn Boston-Somerville: 30 Washington Street (Somerville, MA)
July 21, 2011--Hoagland Pincus Conference Center: 222 Maple Avenue (Shrewsbury, MA)

To preregister for the MassHealth DDE COB training, please complete the on-line registration form on the MTF Web site any time between Wednesday, May 25th and Wednesday, June 22nd. To access the MTF Web site, go to www.masshealthmtf.org, and click on the registration link found under the Highlights section on the right hand side of the MTF Web page.


Masshealth Timeframes for Bill Paying for Nursing Facility Providers

Attention: Nursing Facilities:

MassHealth will be modifying the timeframes for paying nursing facility claims for May dates of service received by MassHealth in June. The payment schedule will be modified by approximately 2 weeks. Below is the modified payment schedule.

RA DATE: 7/5/2011
PAYMENT DATE CHECKS: 7/8/2011
PAYMENT DATE EFT: 7/11/2011

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


Messages from the Week of May 16, 2011

May 16, 2011

Notice for Professional Medicare Part B Crossover Claims

MassHealth has been advised by the Centers for Medicare and Medicaid Services (CMS) Coordination of Benefits Contractor (COBC) that all Medicare Part B 837 professional claims processed by the Medicare Administrative Contractor (MAC), National Heritage Insurance Company (NHIC), on April 20, 2011, were incorrectly denied with adjustment group code PR and adjustment reason code B7 and did not cross over to MassHealth. The issue has been resolved and NHIC is reprocessing affected Part B claims. Because MassHealth does not receive reprocessed crossover claims from the COBC directly, providers should submit their NHIC reprocessed claim directly to MassHealth for processing. MassHealth strongly encourages providers to submit these claims using 837P COB or DDE and not on paper. For additional information about this issue, visit the NHIC Web site at www.medicarenhic.com/, and click on J14 MAC Part B, then click on Updates. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

 


Messages from the Week of May 9, 2011

May 10, 2011

NEW MASSHEALTH WEB PAGE LISTS 5010 ELECTRONIC TRANSACTIONS UPDATES (Updated)

The Centers for Medicare & Medicaid Services (CMS) has mandated that on January 1, 2012, the standards for electronic health care transactions must change from version 4010/4010A1 to version 5010. All entities (i.e., trading partners) that submit electronic transactions to MassHealth must adhere to these new standards. Continue to look for MassHealth updates on how we are addressing the 5010-mandated changes at www.mass.gov/masshealth/5010. New information is being added as it becomes available.

Newly posted information you can find there:
-updated CMS-1500 Billing Guide
-updated 270/271 and 835 Companion Guides

Existing information to check out

-scheduled milestone activities about testing and compliance dates

-links to related MassHealth Publications (All Provider Bulletin 205: Implementation Approach for HIPAA X12 5010 Electronic Transactions; and All Provider Bulletin 208: Overview of Key Changes to Be Implemented on January 1, 2012, to Support the Centers for Medicare & Medicaid Services 5010 Mandate)

-Provider Information (5010 training and education materials) to include: a FAQ document; details about the notable changes for 5010 that will impact MassHealth providers; training and education opportunities available to assist with preparation for the 5010 changes; and selected slides from the 11/10/2010 presentation

-Related Resources to include: links to various informational CMS Web sites as well as a link to the Workgroups for Electronic Data Interchange (WEDI) that serve to address identified business issues raised during the 5010 transition.

If you have questions about the 5010 initiatives, contact MassHealth Customer Service at 1-800-841-2900 and ask for an EDI representative, or e-mail your questions to edi@mahealth.net.

NEW MEMBER REPORT FOR PRIMARY CARE CLINICIANS (PCCS) ON THE POSC

Attn: Physicians, Nurse Practitioners, Community Health Centers, Acute Outpatient Hospitals, Hospital Licensed Health Centers, Group Practices

Effective 5/1/2011 the newly designed MGD-0054D New Member Report is available for your review on the POSC. This report complements the existing MGD-0055M (monthly) Enrollment Roster report, allowing providers to now track new PCC Plan member enrollments to the PCC panel on a daily basis.

In the past, MassHealth sent letters informing providers when a new member was assigned to their practice. System capabilities now allow MassHealth to make this information available to providers electronically. This change supports MassHealth paper reduction initiatives and allows MassHealth to communicate the information to you more efficiently. The report is generated daily, but PCCs will see a new report only when new members are assigned to their practice.

To access the New Member Report from the POSC home page, click on the Manage Correspondence and Reporting link, and then click on View Metrics/Reports. Choose the correct service location from the drop-down menu, and then click Search to pull up the various online reports available. Select MGD-0054D.

If you have questions about this report, please contact MassHealth Customer Service at 1-800-841-2900.

EDIT CODE 277-ADMIT HOUR INVALID

Attn: Acute Inpatient Hospitals, Chronic Inpatient Hospitals, Psychiatric Inpatient Hospitals, Acute Outpatient Hospitals, Chronic Outpatient Hospitals, Psychiatric Outpatient Hospitals

As a reminder, the Admit Hour is a required field on inpatient and outpatient institutional claims. Claims that are submitted without this required field completed will deny with Edit 277 (Admit hour invalid). Please refer to the National Uniform Billing Committee (NUBC) Instruction Manual at www.nubc.org for the Admit Hour codes. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.
 

EDIT CODES 4185 AND 4252 SET TO DENY

Attn: Acute Inpatient Hospitals, Chronic Inpatient Hospitals, Psychiatric Inpatient Hospitals, Acute Outpatient Hospitals, Chronic Outpatient Hospitals, Psychiatric Outpatient Hospitals

Please ensure that the ICD-9-CM diagnosis codes on your claims are all valid and payable codes.
Inpatient and outpatient claims submitted with incorrect diagnosis codes will be denied with Edit 4185 (7-24 Diagnosis code not covered for date of service) or 4252 (Diagnosis code 6-24 not on file). If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.
 

EDIT 3109 (PA UNITS AND/OR DOLLARS PRESENTLY EXHAUSTED)
Attn: Fiscal Intermediary Services (PCA)

Please be advised that your remittance advice (RA) may contain reprocessed claims that were denied erroneously with Edit 3109 (PA units and/or dollars presently exhausted). No further action is required by providers at this time. If you have any questions, contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of April 18, 2011

April 19, 2011

National Correct Coding Initiative (NCCI) Implementation

Section 6507 of the federal Affordable Care Act (health care reform law), requires state Medicaid agencies to edit claims in accordance with compatible methodologies of the National Correct Coding Initiative (NCCI). NCCI was implemented by the Centers for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies and to control improper coding to minimize inappropriate payment.

Claims with dates of service on or after October 1, 2010, that are processed on or after April 1, 2011, and are billed with HCPCS/CPT codes will be subject to NCCI editing as described in MassHealth All Provider Bulletin 209 (Medicaid National Correct Coding Initiative), dated April 2011. The bulletin describes the background about these changes, how the changes will affect MassHealth claims processing, and the agency review and appeals process. You can download a copy of a transmittal letter or bulletin from the online Provider Library ( www.mass.gov/masshealthpubs).

If you have questions about this process or information as described in the bulletin, contact MassHealth Customer Service at 1-800-841-2900.

Messaes from the Week of March 28, 2011

April 1, 2011

Medicare 837I Part A Crossover Claim Issue Update

MassHealth will not systematically reprocess or adjust specific Part A non-ambulance crossover claims that adjudicated with incorrect service units due to a Medicare Fiscal Intermediary Shared System (FISS) error which occurred on January 3 through 5, 2011, as first communicated in a POSC Broadcast Message and NewMMIS Notice posted on 2/9/2011. Instead, MassHealth recommends that providers resubmit these previously denied claims or adjust the original previously paid MassHealth crossover claim(s) to include the corrected units of service and revised Medicare adjudication information.

MassHealth strongly encourages providers to submit COB claims via 837 batch or Provider Portal DDE and not on paper. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

Reprocessed Claims

Your remittance advice contains reprocessed claims that were originally submitted between 01/11/2011 and 02/16/2011 with service codes 92507, 92508, 97150, and 92526 and were underpaid due to units being reduced in error. MassHealth has corrected this issue in the system to prevent further related processing errors for these service codes. No further action is required for these claims by providers at this time. If you have questions, please contact MassHealth Customer Service 1-800-841-2900.

 

March 29, 2011

NEW MASSHEALTH WEB PAGE LISTS 5010 ELECTRONIC TRANSACTIONS UPDATES (Updated)

The Centers for Medicare & Medicaid Services (CMS) has mandated that on January 1, 2012, the standards for electronic health care transactions must change from version 4010/4010A1 to version 5010. All entities (i.e. trading partners) that submit electronic transactions to MassHealth must adhere to these new standards. Look for MassHealth updates on how we are addressing the 5010-mandated changes at www.mass.gov/masshealth/5010.

Some of the information you can find there includes:

-scheduled milestone activities about testing and compliance dates

-links to related MassHealth Publications (All Provider Bulletin 205: Implementation Approach for HIPAA X12 5010 Electronic Transactions)

-5010 training and education materials

-a Key Concepts document listing transaction types and key changes that must be implemented to meet 5010 guidelines (All Provider Bulletin 208: Overview of Key Changes to Be Implemented on January 1, 2012, to Support the Centers for Medicare & Medicaid Services 5010 Mandate)

-An FAQ document that describes the 5010 initiative; provides information about MassHealth preparations for 5010 and recommendations for how submitters can get ready; gives details about the notable changes for 5010 that will impact MassHealth providers; and informs about training and education that is available to assist with preparation for the 5010 changes

Billing Instructions and Companion Guides will also be posted to this site once they are available.

If you have questions about the 5010 initiatives, contact MassHealth Customer Service at 1-800-841-2900 and ask for an EDI representative, or e-mail your questions to edi@mahealth.net.

March 28, 2011

PROVIDER REFRESHER AND BILLING TRAINING

Following the April 6th, 8th, 14th, 20th and 22nd MA Health Care Training Forum (MTF) sessions, MassHealth Customer Service will be providing a Provider Refresher and Billing Training from 1:30 to 3:30 p.m. This presentation has been developed based on information received from the Provider Billing and Claims survey sent out in January 2011 through the MTF listserv. Preregistration is required for the Provider Refresher and Billing Training and is separate from the MTF April Meeting registration. To preregister for the Provider Refresher and Billing Training please complete the online registration form on the MTF Web site by no later than Monday, April 4, 2011. To access the MTF Web site, go to www.masshealthmtf.org
- click the MTF Updates link on the menu bar at the top of the Home page
- select the Refresher and Billing Training Following April MTF Sessions link under the Recent Updates (March, 2011) header
-click the registration link (please click here) in the MTF meeting announcement

If you have questions about the Provider Refresher and Billing Training, you can contact Sue Kane by e-mail at Sue.Kane@umassmed.edu.

Messages from the Week of March 14, 2011

March 18, 2011

November 25, 2010, Medicare Part B Crossover Claims

MassHealth has been advised by the Centers for Medicare and Medicaid Services (CMS) Coordination of Benefits Contractor (COBC) that 837P professional claims generated by Medicare Administrative Contractor (MAC), National Heritage Insurance Company (NHIC), on November 25, 2010, were not crossed over to MassHealth. Providers should submit claims affected by this issue from this date only, directly to MassHealth for processing. MassHealth strongly encourages providers to submit these claims using 837 COB or DDE and not on paper. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

March 15, 2011

Follow-up to POSC Broadcast Message/NewMMIS Notice from 2/9/2011 About Medicare 837I Part A Crossover Claim Issue

(Update from 2/9/11 Posting)

MassHealth has been advised by the Centers for Medicare and Medicaid Services (CMS) Coordination of Benefits Contractor (COBC) that a Medicare Fiscal Intermediary Shared System (FISS) error that occurred on January 3 through 5, 2011, caused specific Part A non-ambulance crossover claims to adjudicate with incorrect service units. Medicare FISS contractors have resolved the issue and are currently transmitting corrected claim files to the COBC. MassHealth will void original crossover claims that may have been paid incorrectly and will process the corrected crossovers received from COBC. Providers should take no action on these claims at this time. MassHealth first described this issue in a POSC Broadcast Message and NewMMIS Notice posted on 2/9/2011. Please continue to monitor future messages for updates about this issue. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

NEW MASSHEALTH WEB PAGE LISTS 5010 ELECTRONIC TRANSACTIONS UPDATES (Updated from 2/14/11 Posting)

The Centers for Medicare & Medicaid Services (CMS) has mandated that on January 1, 2012, the standards for electronic health care transactions must change from version 4010/4010A1 to version 5010. All entities (i.e. trading partners) that submit electronic transactions to MassHealth must adhere to these new standards. Look for MassHealth updates on how we are addressing the 5010-mandated changes at www.mass.gov/masshealth/5010 .

Some of the information you can find there includes:

-scheduled milestone activities about testing and compliance dates -links to related MassHealth Publications (All Provider Bulletin 205: Implementation Approach for HIPAA X12 5010 Electronic Transactions) -5010 training and education materials -a Key Concepts document listing transaction types and key changes that must be implanted to meet 5010 guidelines (All Provider Bulletin 208: Overview of Key Changes to Be Implemented on January 1, 2012, to Support the Centers for Medicare & Medicaid Services 5010 Mandate)

MassHealth will post some additional updates shortly that include a list of Frequently Asked Questions (FAQs). Billing Instructions and Companion Guides will also be posted to this site once they are available.

If you have questions about the 5010 initiatives, contact MassHealth Customer Service at 1-800-841-2900 and ask for an EDI representative, or e-mail your questions to edi@mahealth.net mailto:edi@mahealth.net.

March 15, 2011

NEW MASSHEALTH WEB PAGE LISTS 5010 ELECTRONIC TRANSACTIONS UPDATES (Updated from 2/14/11 Posting)

The Centers for Medicare & Medicaid Services (CMS) has mandated that on January 1, 2012, the standards for electronic health care transactions must change from version 4010/4010A1 to version 5010. All entities (i.e. trading partners) that submit electronic transactions to MassHealth must adhere to these new standards. Look for MassHealth updates on how we are addressing the 5010-mandated changes at www.mass.gov/masshealth/5010 .

Some of the information you can find there includes:

-scheduled milestone activities about testing and compliance dates -links to related MassHealth Publications (All Provider Bulletin 205: Implementation Approach for HIPAA X12 5010 Electronic Transactions) -5010 training and education materials -a Key Concepts document listing transaction types and key changes that must be implanted to meet 5010 guidelines (All Provider Bulletin 208: Overview of Key Changes to Be Implemented on January 1, 2012, to Support the Centers for Medicare & Medicaid Services 5010 Mandate)

MassHealth will post some additional updates shortly that include a list of Frequently Asked Questions (FAQs). Billing Instructions and Companion Guides will also be posted to this site once they are available.

If you have questions about the 5010 initiatives, contact MassHealth Customer Service at 1-800-841-2900 and ask for an EDI representative, or e-mail your questions to edi@mahealth.net<mailto:edi@mahealth.net>.

March 7, 2011

Reduction of Paper Claim Forms

As stated in the January 2011 All Provider Bulletin 207, a major paper reduction project is underway. To support this initiative, MassHealth is requesting that all possible claim submissions be conducted electronically via Batch 837 submissions or Direct Data Entry (DDE) on the POSC. Please note that coordination of benefit (COB) claims may be submitted electronically using both of these transmission methods. MassHealth is also working on changes that will allow special claims processing, including 90-day waiver requests and final deadline appeals. For more information about this MassHealth Best Practice, refer to All Provider Bulletin 207 (Reduction of Paper Claim Forms). You can access the bulletin from the MassHealth Web site at www.mass.gov/masshealthpubs. Please contact MassHealth Customer Service at 1-800-841-2900 for any questions.

TL PHY-129 To Be Updated

MassHealth will issue a new transmittal letter (TL) shortly to replace TL PHY-129 (Physician Manual, 2011 HCPCS). The new TL includes a correction to Subchapter 6 which previously omitted an SA modifier. The SA modifier applies to a nurse practitioner rendering service in collaboration with a physician. This modifier is to be applied to codes for services billed by a physician that were performed by a non-independent nurse practitioner employed by the physician or group practice. An independent nurse practitioner billing under his/her own individual provider number should not use this modifier. You can access a TL from the online MassHealth Provider Library at www.mass.gov/masshealthpubs.

Notice for Professional and Institutional Outpatient Crossover Claims

MassHealth has been advised by the Centers for Medicare & Medicaid Services (CMS) that due to recent Medicare Physician Fee Schedule (MPFS) corrections, Medicare Claims Administration Contractors (MACS) will be adjusting Medicare Part A and Part B fee for service claims. The CMS Medicare adjustment timelines will vary depending upon claim type, volume and each individual MAC. MassHealth does not receive adjusted crossover claims through the CMS Coordination of Benefits Agreement (COBA) crossover process. Please note, upon completion of the CMS Medicare adjustment process, providers must resubmit previously denied or adjust previously paid MassHealth crossover claim(s) to include the newly adjusted Medicare coordination of benefits (COB) adjudication details. MassHealth strongly encourages providers to submit COB claims via 837 batch or DDE. In addition, claims submitted for durable medical equipment, prosthetics, orthotics, and supply services are not affected by this action. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of February 28, 2011

February 28, 2011

Update on Medicare Crossover Claims Submitted by Renal Dialysis Centers

MassHealth previously informed providers of the transition by Medicare to a bundled payment methodology for renal dialysis services effective 1/1/2011. As a result, MassHealth has implemented measures to ensure that renal dialysis crossover claims with dates of service on or after 1/1/2011 containing Medicare bundled payment information are adjudicated appropriately. If you have questions, please contact MassHealth Customer Service 1-800-841-2900.

FOM and Update Discontinuation Notice

After February 2011, MassHealth is discontinuing publication of the Feature of the Month and the Update provider newsletter. MassHealth will continue to communicate the type of information provided in these publications in other formats on the MassHealth Web site. Posted editions of both publications will remain on the applicable Web pages until further notice. MassHealth encourages providers to continue to reference these Web pages for information that directly impacts their daily business functions with MassHealth. Notice of any posting changes will be communicated to providers. More relevant topics will find a permanent home in related locations on the MassHealth Web site at a later date.

To access Feature of the Month, click on the link in the Publications panel on the MassHealth home page (www.mass.gov/masshealthpubs). To access Update, go to the Provider Library at www.mass.gov/masshealthpubs, and click on the MassHealth Newsletter for Providers - Update.

 


Messages from the Week of February 21, 2011

February 22, 2011

Edit Code 6020 Medical Leave-Of-Absence (MLOA) Days Exceed Max Adjustments

MassHealth has adjusted certain long-term care claims that were processed incorrectly with edit code 6020 (MLOA days exceed max), due to a system issue. As a result, claims that were originally underpaid will now be paid correctly. Claims that were originally paid correctly are not owed any additional funds, so adjustments to these correctly paid claims will appear with no additional payment. The adjusted claims are included on this remittance advice. No further action is required by providers at this time. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

Claims Adjustment for Service Codes H2011-U1 and H2011-U2

MassHealth has corrected a system issue that prevented claims submitted by mental health centers with Service Codes H2011-U1 and H2011-U2 from processing at the correct rate. Any mental health center claims submitted with these service codes for youth mobile crisis intervention services that were adjudicated on or after the inception of the youth mobile crisis intervention program on 6/30/2009, have been adjusted. The adjusted claims will appear on this or future remittance advices. No further action is required by providers at this time. Please contact MassHealth Customer Service at 1-800-841-2900 if you have questions.

Masspro Awarded the Chronic Disease and Rehabilitation HOSPITAL Utilization Management Contract

Masspro will continue to perform chronic disease and rehabilitation hospital utilization management functions for MassHealth under a new contract. As a result of this new contract, beginning on March 1, 2011, Masspro will transition from approving up to 30 administrative days (ADs), to approving up to 60 ADs. Providers are reminded to direct all inquiries and documentation related to this change directly to Masspro. There are no other changes to the utilization management functions at this time.

Masspro can be reached at

Masspro
245 Winter Street
Waltham, MA 02451-1231
1-800-554-5127 (Phone)
1-800-752-6334 (Fax)

Concurrent Review Policy for Chronic Disease And Rehabilitation Hospitals

At times, hospitals have requested concurrent reviews from Masspro or MassHealth after the expiration of the prior approved length of stay. MassHealth Regulation 130 CMR 435.408 (B)(5) states that, prior to the expiration of the approved length of stay, the hospital or attending physician may request an extension of the length of stay if the member continues to require hospitalization beyond the approved period. Hospitals should be aware that MassHealth payment will not be made for hospital days that occur after the expiration date of the last approved length of stay. So, to obtain MassHealth payment, hospitals must request concurrent review prior to the expiration of an approved length of stay. You can access MassHealth Regulations from the online Provider Library at www.mass.gov/masshealthpubs. If you have questions, contact MassHealth Customer Service at 1-800-841-2900.

Discharge Planning Reminder for Chronic Disease and Rehabilitation Hospitals

As a reminder, hospitals are expected to begin the discharge planning process upon admission. Providers must submit all member discharge planning information to Masspro on the first concurrent review and throughout the hospitalization. Discharge planning activities must then commence within 72 hours of admission for every member expected to require post-hospital care or services. Please refer to the MassHealth Chronic Disease and Rehabilitation Inpatient Hospital Regulations at 130 CMR 435.417 for information about the hospital discharge planning process.

You can access MassHealth Regulations from the online Provider Library at www.mass.gov/masshealthpubs asspro can be reached at

Masspro
245 Winter Street
Waltham, MA 02451-1231
1-800-554-5127 (Masspro Phone)
1-800-752-6334 (Masspro Fax)


Messages from the Week of February 14, 2011

February 14, 2011

New MassHealth Web Page Lists 5010 Electronic Transactions Updates

The Centers for Medicare & Medicaid Services (CMS) has mandated that on January 1, 2012, the standards for electronic health care transactions must change from version 4010/4010A1 to version 5010. All entities (i.e. trading partners) that submit electronic transactions to MassHealth must adhere to these new standards. Look for MassHealth updates on how we are addressing the 5010-mandated changes at www.mass.gov/masshealth/5010.

Some of the information you can find there includes:

-scheduled milestone activities about testing and compliance dates

-links to related MassHealth Publications (All Provider Bulletin 205: Implementation Approach for HIPAA X12 5010 Electronic Transactions)

-5010 training and education materials

MassHealth will post some additional updates shortly that include a list of Frequently Asked Questions (FAQ) and a Key Concepts document outlining some of the major changes that will impact claims submission. Billing Instructions and Companion Guides will also be posted to this site once they are available.

If you have questions about the 5010 initiatives, contact MassHealth Customer Service at 1-800-841-2900 and ask for an EDI representative, or e-mail your questions to edi@mahealth.net.

Updated Trading Partner Agreement Form Posted to the MassHealth Web Site

An updated HIPAA Trading Partner Agreement (TPA) form has been posted to the MassHealth Web site. All providers are required to submit a TPA form when they enroll with MassHealth. The TPA form specifies certain requirements necessary when exchanging electronic transactions with MassHealth. Because a TPA is required to be on file at the time of application, most providers will not need to submit a new form at this time. However, new providers, providers who had not previously submitted a form, and providers who need to amend their current TPA, should use this new form.

To access the form, go to www.mass.gov/masshealth and click on the MassHealth Provider Forms link, located in the Publications panel. The TPA form can be found under the All Providers header. 


Messages from the Week of February 7, 2011

February 9, 2011

Medicare 837I Part A Crossover Claim Issue

MassHealth has been advised by the Centers for Medicare and Medicaid Services (CMS) Coordination of Benefits Contractor (COBC) that a Medicare Fiscal Intermediary Shared System (FISS) error which occurred on January 3 through 5, 2011, caused specific Part A non-ambulance crossover claims to adjudicate with incorrect service units. Medicare FISS contractors have resolved the issue and are currently transmitting corrected claim files to the COBC for crossover purposes. MassHealth will void original crossover claims that may have paid incorrectly and will process the corrected crossovers received from COBC. Provider should take no action at this time. Please continue to monitor future messages for updates regarding this issue. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

February 7, 2011

THIRD PARTY LIABILITY CARRIER CODES FOR PAPER CLAIMS

When submitting paper coordination of benefits (COB) claims, providers must write the appropriate MassHealth carrier code on each insurance Explanation of Benefits (EOB) from Medicare and/or a Commercial insurance. If the appropriate carrier codes are not indicated on each EOB, the claims may not be adjudicated accurately or may be denied. Providers are strongly encouraged to submit COB claims electronically via 837 transactions or Direct Data Entry (DDE). You can find MassHealth carrier codes in Appendix C of your MassHealth provider manual. You can access the provider manuals from the online Provider Library (www.mass.gov/masshealthpubs). If you have questions, contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of January 24, 2011

January 28, 2011

Payment Error Rate Measurement (Perm) Project

As MassHealth previously informed you, participation with the Centers for Medicare and Medicaid Services (CMS) on the FY2010 PERM project began in August 2010. During the project, CMS will randomly sample MassHealth provider claims from FY 2010 to test for data processing accuracy and medical necessity.

CMS has begun sending notification to those providers whose claims have been selected for review. Providers whose claims are selected will be contacted directly by a CMS contractor to provide copies of medical records and supporting documentation for the sampled claim(s). Cooperation to furnish the requested records is critical. More information about the PERM project can be found on the PERM Web site at www.cms.gov/PERM. All Provider Bulletin 203, dated March 2010, also discusses PERM. If you have questions, contact David Kerrigan, the Massachusetts PERM Representative by phone at 617-210-5179, or by e-mail at david.kerrigan@state.ma.us.


Check Subchapter 6 of Your Provider Manual For Payable Service Codes

It has been brought to MassHealth's attention that some providers have been checking only the Division of Health Care Finance Policy (DHCFP) fee schedule, and not Subchapter 6 (Services Codes) of their MassHealth provider manual, when billing for services to MassHealth.

Providers are reminded they should always check Subchapter 6 (Service Codes) of their MassHealth provider manual. Subchapter 6, unlike the DHCFP fee schedule, specifies those codes that are payable or not payable under MassHealth depending on your provider type. For most provider types, Subchapter 6 also lists codes with special requirements or limitations or modifiers. Checking Subchapter 6 to verify service coverage before submitting a claim to MassHealth is a recommended MassHealth Best Practice and could prevent your claims from denying.
 

January 24, 2011

1099's Mailing Soon

Please be on the lookout for your IRS Form 1099 for calendar year 2010. You should receive a 1099 only if the total amount received in calendar year 2010 from the Commonwealth of Massachusetts was $600 or more. If you are to receive a 1099, it will be postmarked by 1/31/2011 and mailed from the Office of the Comptroller to your legal address that is on file. Once the 1099s are mailed, an informational copy (without tax IDs) will be available on the VendorWeb at https://massfinance.state.ma.us/VendorWeb/vendor.asp .


Specify Your Masshealth Preferred Method of Communication

Providers are currently notified when a new bulletin or transmittal letter is posted on the MassHealth Web site either by postcard or (if specified) by e-mail. As a Best Practice, MassHealth encourages providers to use online resources when they are available. E-mail notification is a more efficient and less costly alternative and is about a week faster than postcard notification.
If you have not yet chosen your preferred way to get provider bulletins and transmittal letters, go to our Web site at www.mass.gov/masshealth . In the Online Services box, click on Provider Preferred Communication Method. Or call MassHealth Customer Service at 1-800-841-2900.

PCA Fiscal Intermediary Claims Reprocessed

MassHealth is reprocessing certain claims that were adjudicated on or after 5/25/2009, for personal-care-attendant (PCA) services with prior authorizations (PAs) that were underpaid with edit 3108 (PA insufficient available units). The adjusted claims will appear on this or future admittance advices. No further action is required by providers at this time. Please contact MassHealth Customer Service at 1-800-841-2900 if you have questions.

Messages from the Week of January 17, 2011

January 19, 2011

WAIVER BENEFIT PLAN DENIALS

MassHealth is reprocessing certain claims, submitted between 10/15/2010 and 12/21/2010 that were denied with incorrect denial reasons for members enrolled in home and community-based waiver benefit plans. The affected claims will be reprocessed with correct denial reason(s) and appear on future remittance advices. No further action is required by providers. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

ADJUSTMENTS OF INSTITUTIONAL CROSSOVER CLAIMS AFFECTED BY MEDICARE ISSUE

MassHealth has adjusted certain electronic institutional crossover claims that were processed incorrectly during the week of 11/22/10 with Edit 4171 (Units billed less than allowed), due to a Medicare system error. As a result, claims that were originally underpaid will now be paid correctly. Claims that were originally paid correctly are not owed any additional funds, so adjustments to these correctly paid claims will appear with no additional payment. The adjusted claims will appear on future remittance advices.

In addition, any of those claims that were billed for at least one payment amount per episode (PAPE) or automated test panel (ATP) code, will also be adjusted at a future date. No further action is required by providers. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.


MEDICARE CROSSOVER CLAIMS SUBMITTED BY RENAL DIALYSIS CENTERS

The 1/1/2011 implementation of the Medicare End Stage Renal Disease (ESRD) bundled prospective payment system (PPS) may result in changes to MassHealth crossover payment on claims submitted for renal dialysis services. For information about the Medicare ESRD PPS methodology, please refer to the Medicare Web site at www.CMS.gov/esrdpayment. If you have questions, please contact MassHealth Customer Service 1-800-841-2900.

Messages from the Week of January 10, 2011

January 11, 2011

PCC REFERRAL CLAIMS REPROCESS

MassHealth has reprocessed certain claims that denied inappropriately in December 2010 for Edit 3121 (Invalid referral number). The adjusted claims will appear on future remittance advices. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

BILATERAL PROCEDURES: CHANGE TO MODIFIER 50 BILLING

Effective for claims with dates of service (DOS) on or after January 1, 2011, providers must bill on one claim line for bilateral procedures performed during the same operative session. Providers must use the appropriate service code and modifier 50 on the same detail. Claims with DOS on or after January 1, 2011, that do not include the appropriate service code and modifier 50 on the same detail, will be denied with Edit 5095 (Bilateral surgery 1 of same procedure code per day (with or without modifier 50)).

The modifier 50 billed with the service code for bilateral procedures is payable up to 150% of the allowable fee contained in the Division of Health Care Finance and Policy (DHCFP) regulation 114.3 CMR 16.05(4) to be paid to the eligible provider for performance of both bilateral procedures. To ensure maximum payment of 150% of the allowable fee when using modifier 50, providers must bill for services at a rate that is one and one-half of the MassHealth allowable fee or they need to bill one and one-half of their regular rate per service per procedure. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

CONSULTATION CODES

Effective for claims with dates of service (DOS) on or after January 1, 2011, consultation codes are no longer reimbursed by MassHealth. When billing for consultation services, providers should bill with patient evaluation and management (E/M) codes that identify the complexity of the visit performed. For example, in the office or other outpatient setting where a professional consultation is performed, physicians and qualified non-physician practitioners should bill with service codes (99201-99205; 99211-99215) that most appropriately identify the complexity of the visit and indicate whether the patient is a new or established patient to that physician. Likewise, in an inpatient hospital or nursing facility setting, all physicians (and qualified non-physician practitioners where permitted) who perform a professional consultation should bill with the initial hospital care service codes (99221-99223) or nursing facility care service codes (99304-99306) that most appropriately identify the complexity of the visit and indicate whether the patient is a new or established patient for that physician. Claims with DOS on or after January 1, 2011, that do not contain the appropriate E/M codes will be denied with Edit 4801 (Procedure not covered by provider contract). If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

 


Messages from the Week of January 03, 2011

January 03, 2011

ADJUSTMENTS OF MEDICARE CROSSOVER CLAIMS SUBMITTED BY PSYCHOLOGISTS AND COMMUNITY HEALTH CENTERS FOR QUALIFIED MEDICARE BENEFICIARIES (QMB) MEMBERS

MassHealth is adjusting certain crossover claims that adjudicated between 5/26/2009 and 8/31/2010 and were underpaid due to pricing-related edits. Some of the adjusted claims may contain detail claim lines that denied for other non-pricing edit codes on the original claim and have remained in a denied status. The adjusted claims will appear on future remittance advices. If you have questions, please call MassHealth Customer Service at 1-800-841-2900.

NURSING HOME PROVIDERS - SUBMIT MANAGEMENT MINUTE QUESTIONNAIRE (MMQ) DATA IN CHRONOLOGICAL ORDER WHEN SUBMITTING MULTIPLE MMQS FOR THE SAME MEMBER

Nursing facilities must submit their Management Minutes Questionnaires (MMQs) according to policy communicated in Nursing Facility Transmittal Letter NF-53 (dated 05/09). In an instance when a facility must submit multiple MMQs for the same member for services rendered on separate or subsequent days, they should be submitted in chronological order and on separate days. Each MMQ must be submitted in posting order (listing the admissions and conversions dates, and the semi-annual MMQ in order of dates of service). For example, if a facility has two MMQs (an admission MMQ or a conversion MMQ and a semi-annual MMQ) for the same member, the nursing facility should submit the admission MMQ or the conversion MMQ first and then the semi-annual MMQ on a subsequent day.

Submitting MMQs out of chronological order may cause posting issues and could adversely affect the processing of your claim. Please contact MassHealth Customer Service (1-800-841-2900) if you have questions.

Update to Previously Posted - ACUTE INPATIENT HOSPITAL OUTLIER NONCOVERAGE OF SERVICES

Transmittal Letter AIH-46 (dated November 2010) communicated to providers that effective 12/01/2010, MassHealth no longer covers acute inpatient hospital services after 20 days for members who are aged 21 years or older, unless such services are provided in a Department of Mental Health (DMH)-licensed acute psychiatric unit within a Department of Public Health (DPH)-licensed acute hospital or in a rehabilitation unit within a DPH-licensed acute hospital. As a result, outlier claims submitted to MassHealth with dates of service from 12/22/2010 or after, for admissions beginning 12/01/2010, will be denied. However, MassHealth will continue to use outlier days in the reimbursement calculation for Crossover Part A claims for Qualified Medicare Beneficiaries.

You can download a copy of TL AIH-46 from the MassHealth Provider Library at www.mass.gov/masshealthpubs.
 

PROPER USE OF SERVICE CODE S5100

MassHealth issued Transmittal Letter ADH-24 (Revised Service Codes and Descriptions) notifying adult day health (ADH) providers of changes to Subchapter 6 of the ADH Manual. The amended regulations contain two sets of service codes for ADH services provided to eligible members receiving ADH services.

ADH providers seeking payment for ADH services provided for six or more hours per day are instructed to use Service Code S5102 and applicable modifiers. ADH providers seeking payment for ADH services provided for less than six hours per day are instructed to use Service Code S5100 and applicable modifiers. See MassHealth regulations at 130 CMR 404.414(G). These service codes are not interchangeable.

Furthermore, ADH providers are instructed that claims submitted using Service Code S5100 and applicable modifiers are billed in 15-minute increments with a maximum of 23 units per day.

For a full list of adult day health service codes, refer to Subchapter 6 of the MassHealth ADH Manual. You can access the provider manual from the MassHealth Provider Library at www.mass.gov/masshealthpubs.


CLAIMS REPROCESS FOR ENDOSCOPY SERVICES

Beginning in May of 2009, MassHealth incorrectly paid the non-facility rate for endoscopy services performed in a facility setting for physician claims. As a result, MassHealth will reprocess these physician claims so that the correct payment can be made. The adjusted claims can be identified by the region code of 52. These adjustments will appear on the remittance advice dated 12/21/2010.

NEW MASSHEALTH PUBLICATIONS POSTED TO THE WEB

MassHealth has posted the following publications on the MassHealth Web site

  • Transmittal Letter ALL-183 (Revised Appendix C)
  • Transmittal Letter ALL-182 (Elimination of PCC Referral Requirement for Certain Services)
  • All Provider Bulletin 206 (Medicaid Hospice Benefit for Children and Concurrent Curative Treatment)
  • Durable Medical Equipment Bulletin 17 (Guidelines for Medical Necessity Determination for Hospital Beds and Prescription and Medical Necessity Review Form for Hospital Beds)

You can download a copy of a transmittal letter or bulletin from the online Provider Library ( www.mass.gov/masshealthpubs). You can also sign up to receive e-mail alerts when new publications become available, by clicking on the MassHealth Provider Library E-mail Notifications link.