Important. Please Read MMIS Notices - Chronological Archive

Messages from the Week of 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 - 6^th Floor, Quincy MA 02171.

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

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 24^th.
-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

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

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):

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

(B) Serious impairment to bodily functions, or

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 25, 2013

March 29, 2013

Service Outage

The MMIS POSC, including the internal MMIS application, Voice Response application, EVSpc, MAPIR (Medical Assistance Provider Incentive Repository), and all eligibility services will be unavailable from 6:00 p.m. to 10:00 p.m. Sunday, 3/31, due to system maintenance.

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 March 18, 2013

March 20, 2013

Service Outage

The MMIS POSC, including the internal MMIS application, MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable 12:00 midnight to 8:00 am on Sunday, March 24, 2013, 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.

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

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 18, 2013

February 20, 2013

Service Outage

The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, MAPIR (Medical Assistance Provider Incentive Repository), and all eligibility services will be unavailable from 4:00 am to 7:00 am Sunday, 2/24, due to system maintenance.

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 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

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 19, 2012

Service Outage

The MMIS POSC, including the internal MMIS application and MAPIR (Medical Assistance Provider Incentive Repository) will be unavailable Wednesday 12/19/2012 from 8:00 PM to 10:00 PM due to system maintenance.

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.

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 14, 2012

Service Outage

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, 12/16/2012 from 6:00 PM to 10:00 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

December 11, 2012

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

-Subscriber Last Name

-Subscriber First Name

-Subscriber Address

-Subscriber City

-Subscriber State

-Subscriber Zip 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

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.

New psychiatric codes covered for Mental Health Centers include:

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

Early Intervention Service Code T1015 Denials for Edit 5930

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

Service Outage

”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,12/09/2012 from 6:00 PM to 10:00 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”

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 26, 2012

November 29, 2012

Service Outage

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, 12/02/2012 from 2:00 PM to 10:00 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 November 12, 2012

November 15, 2012

Service Outage

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, 11/18/2012 from 4:00 AM to 7:00 AM 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

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 29, 2012

October 31, 2012

Service Outage

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, 11/4/2012 from 6:00 PM to 10:00 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 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

Sepember 28, 2012

Service Outage

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, 9/30/2012 from 7:30 AM to 8:30 AM due to system maintenance.

MAP and CBHI will also be impacted.

During that time, attempts to process transactions on the POSC will trigger an error message.

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

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 17, 2012

September 21, 2012

Service Outage

MAPIR will be unavailable from 7 am to 10:30 am on Monday, September 24th due to a system upgrade. We apologize for any inconvenience.

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

September 18, 2012

Service Outage

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, 9/23/2012 from 1:00 AM to 8:00 AM 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 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

- Long Term Care Facility Bulletin 106: Annual Accounting for Personal Needs Allowances (PNA)

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

08/31/12

Service Outage

Due to required MMIS system maintenance, the following will be unavailable this Sunday, September 2nd from 4:30 PM to 6:30 PM:

POSC-DDE claims submission, AVR, IVR, EVS, CBHI, HSN, MAPIR (Medical Assistance Provider Incentive Repository), CBHI and MAP will also be impacted. Other features of the POSC and internal MMIS systems will be available. If you have any questions please contact the EHS Customer Support Center at 617-367-5500 or email SystemsSupporthelpdesk@Massmail.state.ma.us

We apologize for any inconvenience this may cause.

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

Service Outage

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, 8/5/2012, from 6:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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 17, 2012

MMIS POSC, including HTS, AVR, IVR, EVS

The MMIS POSC, including HTS, AVR, IVR, EVS, are back up and running.

We apologize for any inconvenience this may have caused.

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 9, 2012

July 11, 2012

Service Outage

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, 7/15/2012, from 5:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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 20, 2012

Service Outage

The MMIS POSC, including the internal MMIS application, MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable Saturday,6/23/2012, from 5:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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

Service Outage

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, 6/17/2012, from 4:00 PM to 11:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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 23, 2013

SERVICE OUTAGE

Due to required system maintenance, the Provider Online Service Center (POSC) will be unavailable for MassHealth claims submission (both DDE and Batch) from Sunday, May 27th 10:00 AM to Monday, May 28th 6:00 AM. The POSC will be available for all other services. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

We apologize for any inconvenience this may cause.

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 18, 2012

Service Outage

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, 5/20/2012, from 3:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

May 16, 2012

The MMIS POSC, including the internal MMIS application and MAPIR (Medical Assistance Provider Incentive Repository), will be unavailable tonight, Wednesday, 5/16/2012, from 7:00 PM to 9:00 PM due to system maintenance.

We apologize for any inconvenience this may cause.

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 May 7, 2012

May 11, 2012

Service Outage

The MAPIR (Medical Assistance Provider Incentive Repository) application will be down on Sunday, May 13, 2012 from 6 PM to 9 PM for a planned upgrade. Nothing else in MMIS will be affected.

We apologize for any inconvenience this may cause.

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.

April 19, 2012

Service Outage

The MMIS POSC, including the internal MMIS application, MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable Saturday, 4/21/2012, from 6:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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.

job aids (From the MassHealth Web site, www.mass.gov/masshealth, select the Information for MassHealth Providers link. Click MassHealth Provider Trainings, and then click NewMMIS Provider Training.)
MassHealth provider manuals (applicable sections to site related regulations, service codes, etc.) (At www.mass.gov/masshealthpubs, click on Provider Library.)
transmittal letters or bulletins (At www.mass.gov/masshealthpubs, click on Provider Library.)
copies of RA message texts (At www.mass.gov/masshealthpubs, click on Provider Library.)
MassHealth Billing and Companion Guides (Go to www.mass.gov/masshealth/5010.)

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 28, 2012

SERVICE OUTAGE

The MMIS POSC, including the internal MMIS application, and MAPIR (Medical Assistance Provider Incentive Repository) will be unavailable Sunday, 4/1/2012, from 6:00 PM to 9:00 PM due to system maintenance.

We apologize for any inconvenience this may cause.

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.

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.

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 14, 2012

SERVICE OUTAGE

The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 3/18/2012, from 4:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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

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)

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.

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

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.

March 1, 2012

SERVICE OUTAGE

The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 3/4/2012, 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.

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

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 22, 2012

Service Outage

The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 2/26/2012, from 6:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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

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

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)

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

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

Messages from the Week of January 30, 2012

February 03, 2012

Service Outage

The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Saturday, 2/4/2012, from 6:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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

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

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 16, 2011

January 18, 2012

Service Outage

The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Saturday, 1/21/2012, from 6:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.

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

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

Messages from the Week of December 27, 2011

December 30, 2011

SERVICE OUTAGE

The MMIS POSC application will be unavailable from 10 AM to 6 PM on Sunday, 1/1/2012 due to system maintenance & the cut over to 5010 transaction processing. MAP and CBHI will also be impacted Additionally, POSC service will be impacted from 9 PM today, Friday, Dec. 30, 2011 through 6 PM Monday, Jan. 2, 2012. Only direct data entry eligiblity, notifications, security, and reports will be available for users during this time. Please refer to All Provider Bulletin 222 located at www.mass.gov/masshealth/5010 for more information about the impact to services.

We apologize for any inconvenience this may cause.

December 29, 2011

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

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

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 23, 2011

SERVICE OUTAGE

The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable tonight, Friday, December 23, 2011, from 8:00 PM to 10:00 PM due to system maintenance. We apologize for any inconvenience. Thank you.

December 19, 2011

MASSHEALTH 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

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

December 13, 2011

Service Outage

The MMIS POSC and the internal MMIS application will be unavailable Saturday, 12/17/2011, from 6:00 PM to 8:00 PM due to system maintenance.

We apologize for any inconvenience this may cause.

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 Bulletins and Transmittal Letters link located under both the Provider Bulletins and Transmittal Letters links in the Provider Library.

Messages from the Week of November 14, 2011

Service Outage

The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Saturday, 11/19/2011, from 5:00 PM to 10:00 PM 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 24, 2011

October 25, 2011

Service Outage

The MMIS POSC and the internal MMIS application will be unavailable today, Tuesday, 10/25/2011, from12:00 PM to approximately 12:15 PM due to system maintenance.

We apologize for any inconvenience this may cause.

Messages from the Week of October 17, 2011

October 20, 2011

Service Outage

The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Saturday, 10/22/2011, from 5:00 PM to 10:00 PM 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 10, 2011

October 13, 2011

Service Outage

The MMIS POSC, including the internal MMIS application, EVS, and all eligibility services will be unavailable Sunday, 10/16/2011, from 6:00 PM to 9:00 PM due to system maintenance. MAP and CBHI will not be impacted. AVR and IVR will be available.
We apologize for any inconvenience this may cause.
Messages from the Week of September 19, 2011
September 20, 2011
Service Outage
The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Saturday, 9/24/2011, from 5:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.
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.
August 16, 2011
System Outage
The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Saturday, 8/20/2011, from 6:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.
We apologize for any inconvenience this may cause.
Messages from the Week of July 25, 2011
July 28, 2011
System Outage
The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 7/31/2011 from 6:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.

We apologize for any inconvenience this may cause.
July 26, 2011
System Down Time
The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable tonight, Tuesday, 7/26/2011 from 9:00 PM to 11:00 PM due to system maintenance. MAP and CBHI will also be impacted.
We apologize for any inconvenience this may cause.
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 July 4, 2011
July 6, 2011
System Outage
The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 7/10/2011 from 6:00 PM to 10:00 PM due to system maintenance. MAP and CBHI will also be impacted.
We apologize for any inconvenience this may cause.

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.

May 31, 2011
MMIS Maintenance
The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable today, Tuesday, 5/ 31 /2011 from 6:00 PM to 8:00 PM due to system maintenance.

The MMIS POSC is Back
The MMIS POSC is back up and running.
Thank you for your patience and understanding.
MMIS Notice
We ask all MMIS users who logged on to MMIS before 9:30 AM this morning, to please log out and back in again if you are getting a slow response.
We still ask you to please limit your usage to business critical matters only.
We will continue to keep you updated until we have corrected this matter.
Thank you for your patience and understanding.

Service Outage
All aspects of the MMIS POSC are currently down and we are working on correcting this matter.
Thank you for your patience and understanding.
MMIS Notice
MMIS is currently running at reduced capacity so we ask all internal users if you have to use MMIS today to do so only if the work you need to do in it is mission critical. We will notify you as soon as we have corrected this matter. Thank you for your patience and understanding.
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 18, 2011
Service Outage
The NewMMIS POSC, including the internal NewMMIS base application, Voice Response application, EVSpc, all eligibility services, as well as the Virtual Gateway's My Account Page (MAP) and Children's Behavioral Health Initiative (CBHI) functions will be unavailable during the following times due to system maintenance. We apologize for any inconvenience and thank you for your patience.
- Saturday, 5/21, from 5:00 pm to 9:00 pm, and
- Sunday, 5/22, from 6:00pm to 10:00pm
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 13, 2011
Service Available
Please be advised all MMIS services are now once again available. This includes Provider Online Service Center, Automated Voice Response, HTS, EVSpc and all of MMIS.
Thank you for your patience during the outage.

May 12, 2011
Service Outage
Please be advised all MMIS services are currently down. This includes POSC, AVR, HTS, EVSpc and MMIS.
This issue has been escalated. Further updates will be provided as they become available.
We apologize for the inconvenience. Thank you.
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 May 2, 2011
May 4, 2011
Service Outage
The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 5/8/2011 from 6:00 PM to 10:00 PM due to system maintenance.

We apologize for any inconvenience this may cause.

Messages from the Week of April 25, 2011
April 28, 2011
Service Outage
The MMIS POSC, including the internal MMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 5/1/2011 from 4:00 PM to 11:00 PM due to system maintenance.
We apologize for any inconvenience this may cause.
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.

Messages 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.
Service Outage
The MMIS POSC, AVR, IVR and EVSpc application will be unavailable from 4pm-9pm on Sunday 4/3/2011 for systems maintenance.
We apologize for any inconvenience this may cause.

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 17, 2011
Service Outage
The MMIS POSC, AVR, IVR and EVSpc application will be unavailable from 5am-7am on Friday 3/18 for systems maintenance.
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>.

Messages from the Week of March 7, 2011
March 9, 2011
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday 3/13, from 4:00 PM to 8:00 PM due to system maintenance.
We apologize for any inconvenience this may cause.

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 18, 2011
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 2/20, from 5:00 PM to 10:00 PM due to system maintenance.
We apologize for any inconvenience this may cause.
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
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday 1/30, from 5:00 PM to11:00 PM due to system maintenance.
We apologize for any inconvenience this may cause.

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 05, 2011
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 1/9, from 7:00 AM to 8:00 AM due to system maintenance.
We apologize for any inconvenience this may cause.

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.
Messages from the Week of December 20, 2010
December 21, 2010
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.

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. You can download a copy of TL AIH-46 from the MassHealth Provider Library at www.mass.gov/masshealthpubs.

Update to Previously-Posted 'Limited Services Clinics' Message
Limited Services Clinics - Use Place-of-Service Code 49 Only
Limited services clinics must use Place-of-Service (POS) Code 49 (Independent clinic) when billing claims to MassHealth. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of December 13, 2010
December 13, 2010
NewMMIS Maintenance
The NewMMIS POSC, including the internal NewMMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable tonight, Monday, 12/13, from 10:00 PM to 11:00 PM due to system maintenance.
A HOME HEALTH AGENCY PROVIDER REMINDER
This is to remind all MassHealth home health agency providers that they are required to comply with MassHealth third party liability (TPL) regulations at 130 CMR 450.316 through 130 CMR 450.318.
If a home health agency provider 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.
Additionally, home health agency providers should take notice that pursuant to the above referenced TPL regulations, MassHealth will be reviewing provider practices, beginning with federal fiscal year 2009, regarding compliance with Medicare requirements for the issuance of the Home Health Advanced Beneficiary Notice (HHABN) form to Dual Eligible home health beneficiaries.
The HHABN form is required by Section 1879 of the Social Security Act and is used to advise, or give legal notice to, home health beneficiaries, who were either receiving Medicare, or eligible to receive Medicare, of either termination from Medicare covered services or that services were non-covered services. MassHealth will be ensuring that home health agency providers are using the HHABN form as required by Medicare and in compliance MassHealth TPL regulations.
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.
LIMITED SERVICES CLINICS - DO NOT USE PLACE-OF-SERVICE CODE 11
Limited services clinics must use Place-of-Service (POS) Code 49 (Independent clinic) and not POS Code 11 (Office) in Box 24B (on the CMS-1500 claim form) when billing claims to MassHealth. Any claims submitted by limited services clinics with POS Code 11 in Box 24B, will be denied. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.
CLAIMS REPROCESS FOR EDITS 0284 AND 0285
MassHealth is reprocessing claims that denied between 11/22/2010 and 12/06/2010 for edit 0284 (Primary condition code invalid) or edit 0285 (Second condition code invalid). No further action is required by providers at this time. The reprocessed claims will appear on a future remittance advice. If you have questions, please call MassHealth Customer Service at 1-800-841-2900.
Messages from the Week of December 6, 2010
December 7, 2010
Revised Hospice Election Form
A revised Hospice Election Form has been posted on the MassHealth Web site. The updated form includes a new section (B2) for members under 21 years who elect hospice care. All Provider Bulletin 206 (Medicaid Hospice Benefit for Children and Concurrent Curative Treatment, dated November 2010) describes the related service changes. As explained in the bulletin, effective immediately, MassHealth members under the age of 21 who elect hospice services have coverage for curative treatment and all medically necessary services for which they are eligible.
Hospice providers should begin using the new Hospice Election Form immediately and are reminded that all applicable sections must be completed to include: member information, provider information, and the corresponding sections for election (Section B), revocation (Section C), disenrollment (Section D), or change of hospice (Section E). Incomplete Hospice Election Forms will be returned to the hospice provider and result in delayed payment.
To download a copy of the Hospice Election Form, click on the MassHealth Provider Forms link in the Publications panel on the right side of the MassHealth home page ( www.mass.gov/masshealth ).

New Location For Serious Reportable Events Reports
The Office of Clinical Affairs/Utilization Management Program has relocated to Quincy. Please direct all Serious Reportable Events reports for both acute inpatient/outpatient hospitals and the chronic disease and rehabilitation inpatient/outpatient hospitals to this new location at
EOHHS/MassHealth
Office of Clinical Affairs/Utilization Management Program
Attention: Martina McCormack
100 Hancock Street, 6th Floor, Quincy, MA 02171
(Fax) 617-847-3711
(Phone) 617-847-3768 for Ofelia Solem, RN, MSN
(Phone) 617-847-3748 for Martina McCormack, RN, MBA
Providers should continue to follow customary procedures for submitting admission screenings, concurrent reviews, and retrospective reviews to the applicable Utilization Management Program (UMP) contractor (Permedion, MassHealth's Acute Hospital UMP contractor or Masspro, MassHealth's Chronic/Rehab Hospital UMP contractor) accordingly.
Mental Health Center Providers - Do Not Use Service Code H2012
Mental health center providers should not use Service Code H2012 (Behavioral health day treatment, per hour) when billing claims to MassHealth. Please be advised that Service Code H2012 is for use by psychiatric day treatment providers only. Any claims submitted by mental health center providers with Service Code H2012 on or after February 1, 2011, will be denied. To enroll as a psychiatric day treatment provider, you must complete an application and submit all required documentation. You can obtain an application online from the Provider Online Service Center. If you have questions, the MassHealth provider manuals list payable service codes and descriptions (see Subchapter 6) as well as regulations and requirements for each provider type. You can access the MassHealth provider manuals from the online Provider Library ( www.mass.gov/masshealthpubs).
Prior Authorization Unit Phone And Fax Number Updates
The Prior Authorization Unit (PAU) has relocated. For inquiries related to a procedure or treatment that requires prior authorization (PA), providers should continue to call 1-800-862-8341 (for all services except pharmacy, dental, non-emergency transportation). All 617-451-XXXX local numbers associated with the PAU have been discontinued. In addition, the new PAU fax number is 617-847-3795. Please note that the PAU mailing address, as noted on the PA-1 form, is unchanged.
The phone number has changed for home health agencies requesting prior authorization for skilled nursing visits for members with MassHealth Basic coverage. Effective immediately, home health agencies must now call the PAU at 617-847-3778.
If you have questions about the services requiring PA, Subchapter 6 of your MassHealth provider manual includes service code information. Subchapter 5 details the process for completing a PA request and submitting the required documentation. You can access your provider manual from the Provider Library at www.mass.gov/masshealthpubs.
PA request forms are available on the Provider Online Service Center or by clicking on the Provider Forms link in the Publications panel on the right side of the MassHealth home page.

Messages from the Week of November 29, 2010
November 29, 2010
System Maintenance
The NewMMIS POSC, including EVS and all eligibility services will be unavailable Saturday, 12/4, from 4:00 PM to 12:00 Midnight due to system maintenance. Please note that as of 7:00 PM service may be available, but it could be intermittent.
We apologize for any inconvenience this may cause.
Reprocessing and Adjustments of Medicare Crossover claims for Qualified Medicare Beneficiaries (QMB) members
MassHealth is reprocessing previously denied crossover claims and adjusting underpaid crossover claims that adjudicated between 5/26/2009 and 8/31/2010 due to pricing-related edits. These reprocessed and adjusted claims will appear on future remittance advices. Some of the reprocessed or adjusted claims may contain detail claim lines that have remained in a denied status due to other non-pricing edit reason codes that were on the original claim. Please note that MassHealth already reprocessed or adjusted crossovers claims for this issue for the following provider groups - psychologist, nursing facility, community health center, and QMB-only providers. As a result, this reprocessing and adjustments do not apply to those providers. If you have questions, please call MassHealth Customer Service at 1-800-841-2900.
Sign-up to receive automatic e-mail notifications about online masshealth publications
Feature of the Month and Update are two helpful MassHealth publications that you should check frequently for timely and helpful information that directly impacts the business you conduct with MassHealth. Topics in both these resources are often an outcome of interactions with providers, whether from forums, training, customer service, or outreach contact. These publications allow MassHealth to communicate issues or topics of importance to you that may also apply to the global provider community.
You can sign up for automatic e-mail notifications of each new publication on the MassHealth Web site. For Feature of the Month notifications, click on the link in the Publications panel of the MassHealth Web site ( www.mass.gov/masshealth ). For Update notifications, click on the MassHealth Regulations and Other Publications link, then on Provider Library (or go to www.mass.gov/masshealthpubs).

November 22, 2010
Medicare Crossovers - Reprocessing Of Professional And Institutional Outpatient Crossover Claims
MassHealth is reprocessing Medicare crossover claims that adjudicated between 10/31/2010 - 11/3/2010 and denied erroneously for Edit 0243 (Missing Medicare paid date). The reprocessed claims will appear on future remittance advices. No further action is required by providers.
Messages from the Week of November 8, 2010
November 12, 2010
Fiscal Intermediary Services (PCA) 2010 Holiday Season Schedule For Claim Submissions
For the week of November 22, 2010, there will be no claim submission changes.
To avoid payment delays during the month of December, it is necessary to change the time deadline for submitting claims during the weeks of December 20, 2010, and December 27, 2010, as follows.
For electronic data interchange (EDI) files and direct data entry (DDE) claims, the deadlines for claim submissions those weeks are Thursday, December 23, 2010, and December 30, 2010, at noon. Claims submitted before noon on those days will show on the remittance advice (RA) dated the following Tuesday. Claims submitted after noon on those days will show on the RA one week later.

Independent Nurses 2010 Holiday Season Schedule for Claim Submissions
For the week of November 22, 2010, there will be no claim submission changes.
To avoid payment delays during the month of December, it is necessary to change the deadline for submitting claims during the weeks of December 20, 2010, and December 27, 2010, as follows.
For electronic data interchange (EDI) files and direct data entry (DDE) claims, the deadlines for claim submissions those weeks are Thursday, December 23, 2010, and Thursday, December 30, 2010, at noon. Claims submitted before noon on those days will show on the remittance advice (RA) dated the following Tuesday. Claims submitted after noon on those days will show on the RA one week later.
For paper claims, the deadline for faxing paper claims to MassHealth Customer Service during the holiday season will stay the same. Please continue to fax your claims by Mondays at noon.
System Maintenance
The NewMMIS POSC, including the internal NewMMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 11/ 14, from 6:00 PM to 10:00 PM due to system maintenance.
We apologize for any inconvenience this may cause.

11/09/10
System Maintenance
The NewMMIS POSC, including the internal NewMMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable tonight, Tuesday 11/9, from 10:00 pm to 11:00 pm due to system maintenance.
We apologize for any inconvenience this may cause.
11/08/10
Claim Adjustments for service Code H2014
MassHealth has adjusted claims that were previously underpaid when service code H2014 ((Skills training and development, per 15 minutes) (either with or without modifiers)) were submitted with a from-thru date of service. The adjusted claims can be found on this remittance advice. No further action is required by providers. If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900.
Medicare Crossovers - Adjustments of Professional Pharmacy Service Crossovers
MassHealth has reprocessed certain Medicare crossover claims processed from 5/26/2009 through 3/31/2010 that contained pharmacy services which should have been billed through the Pharmacy Online Processing System (POPS). The adjusted claims will appear on remittance advices beginning 11/9/2010. EOB code 2509 (Member covered by Medicare B (pharmacy) - provider should bill through POPS) will appear as the claim detail for those adjusted services. Any claim for a Medicare-B covered drug, durable medical equipment, or supply that is payable through POPS must be processed through POPS. Claims for such services that are not billed through POPS will be denied with EOB code 2509. MassHealth informed providers of this policy in Pharmacy Facts 50 (dated May 6, 2009). To download a copy of Pharmacy Facts from the MassHealth Web site ( www.mass.gov/masshealth ), click on Information for MassHealth Providers, then on MassHealth Pharmacy Program.

Messages from the Week of November 1, 2010
11/05/10
System Maintenance
The NewMMIS POSC, including the internal NewMMIS application, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday, 11/7, from 8:00 pm to 9:00 pm due to system maintenance. We apologize for any inconvenience this may cause.
11/05/10
Issues with Web Portal Submissions of PAs have been resolved.
Providers can resume electronic submission of PA requests via the POSC. Thank you for your patience and understanding.
We apologize for any inconvenience this may have caused you.

11/04/10
Issues with Web portal submission of PAs
We are aware of issues with Web portal submission of PAs and are working on the solution. We expect that the fix will take place no later than Friday morning. Until then, we suggest you continue to retry submitting your PAs using the POSC. If your PA submissions still fail, please wait until Friday or until you receive notice that this has been fixed. Please note that submitting a paper PA by mail will not be faster nor more efficient for you. We will notify you as soon as this has been rectified. Thank you.
We apologize for any inconvenience this may cause.
11/02/10
System Maintenance
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Tuesday, 11/2, from 7:00 PM to 2:00 AM due to system maintenance. Thank you.
We apologize for any inconvenience this may cause.

11/01/10
Problems with Two Member Search Criteria
Users are reporting problems when using two Member search criteria in NewMMIS. It looks like Member ID, HIC, Other agency and SSN are working all right, but Case Number and Previous IDs are causing errors. For more effective searches please use the IDs that are working and avoid using the other two until further notice.
Thank you.
We apologize for any inconvenience this may cause.
Use the POSC to Check Claim Status and Member Eligibility
MassHealth Customer Service will not provide information on claim status or member eligibility over the telephone. MassHealth encourages providers to use the online tools available through the Provider Online Service Centers (POSC) to perform common business functions like checking claim status and member eligibility. To use the POSC to perform these functions, users must have primary or subordinate access. To check claim status in the POSC, from the home page, click on Manage Claims and Payments, then on Inquire Claim Status. To check member eligibility, click Manage Members, then the Eligibility link, then the Verify Member Eligibility link. POSC job aids are also available with instructions from the NewMMIS Web site ( www.mass.gov/masshealth/newmmis). Refer to the applicable links under the Editing Claims Post Submission and Eligibility Verification headers. Using these best practices allow you to check claim and eligibility status 24 hours a day, seven days a week.
Edit 1945 Claim Denials
If your claim is denied for Edit 1945 (MULT SAK PROV LOCS FOR BILLING PROV SPEC), contact a MassHealth EDI representative at 1-800-840-2900, select option 1, then option 8, and finally option 3. EDI will verify certain information from your denied claim against your provider file. Be prepared to provide the applicable claim internal control number (ICN) at the time of your call.

Messages from the Week of October 25, 2010
10/28/10
System Maintenace
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 10/31, from 5:00 pm to 10:00 pm due to system maintenance. Thank you.
We apologize for any inconvenience this may cause.
10/26/10
Provider Group: Physician Providers
Endoscopic Procedures and Modifier 51 Usage
With the implementation of NewMMIS, MassHealth adopted the endoscopic pricing method where service codes in the same family of codes would not be submitted with a modifier 51 (Multiple procedures). The endoscopic procedure with the highest relative fee schedule amount is reimbursed at 100 percent of the allowable amount. The allowable amount for the base procedure is then subtracted from the allowable amount of the remaining endoscopic procedures billed. When billing multiple endoscopies from a different family of codes, the modifier 51 is used only on the endoscopic procedure(s) from a different family of codes, after the primary family of endoscopies.
Claims submitted with modifier 51 for procedures within the same endoscopic family will encounter edit 703 (Endo Family Mixed Primary/Secondary). For more information, refer to Transmittal Letter PHY-127 (October 2009).
Provider Group: Day Habilitation Providers
Claims Adjustments for Edit 8152
Recently the claims processing system had been underpaying claims that had been submitted with service code H2014 (Skills training and development, per 15 minutes) (either with or without modifiers). For dates of processing from 9/23/10 through 10/06/10, if an affected claim was submitted with a from-thru date of service (DOS), the system paid for only one DOS and the claim received edit 8152 (Day habilitation limit 24 units per day). MassHealth is reprocessing claims that were underpaid with edit 8152. Adjustments will appear on a future remittance advice. No further action is required by providers. If you have any questions please contact MassHealth Customer Service at 1-800-841-2900.
Provider Group: Nursing Facilities
Medicare Crossovers - Adjustments of Nursing Facility Ancillary Crossovers
MassHealth has adjusted crossover claims for nursing facility ancillary services that were previously underpaid due to pricing-related edits. The adjusted claims will appear on future remittance advices (RAs).
For future reference, you can view the above message along with other RA message texts online from the MassHealth Provider Library ( www.mass.gov/masshealthpubs), by clicking on the Remittance Advice Message Text link. You can also access some RA messages via the NewMMIS Web site ( www.mass.gov/masshealth/newmmis) on the Important Please Read NewMMIS Notices links.
Provider Group: All Providers
View Your Remittance Advice from the POSC
You can access a copy of your MassHealth remittance advice (RA) from the Provider Online Service Center (POSC) home page ( www.mass.gov/masshealth/providerservicecenter). Click Manage Correspondence and Reporting, then View Metrics/Reports. From the Provider Search panel, select Provider ID from the drop-down list and click Search. Click Open to view the Remittance Advice report. To review these instructions, see a description of the report sections, and learn how to save a copy of the RA, refer to the POSC job aid, View Remittance Advice Reports on the Get Trained Web page ( www.mass.gov/masshealth/newmmis). Please note that your RA is available for viewing at this site for six months. MassHealth recommends that you print or save a copy of your RA to your own system for future reference.

Messages from the Week of October 18, 2010
10/20/10
System Maintenace
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 10/24, from 6:00 PM to 10:00 PM due to system maintenance. Thank you.
We apologize for any inconvenience this may cause.
Messages from the Week of October 11, 2010
10/15/10
System Maintenace
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 10/17, from 4:00 pm to 6:00 pm due to system maintenance. Thank you.
Messages from the Week of October 4, 2010
10/8/10
National Correct Coding Initiative (NCCI)
Section 6507 of the federal Patient Protection and Affordable Care Act (PPACA, Public Laws 111-148 and 111-152) requires state Medicaid agencies to incorporate compatible methodologies of the National Correct Coding Initiative, effective for claims for dates of service on or after October 1, 2010, or as the federal Centers for Medicare & Medicaid Services (CMS) otherwise authorizes.
MassHealth is currently analyzing the guidance provided on September 1, 2010 by CMS to determine whether we need to make any changes to current practice. While MassHealth implemented NCCI during its conversion to NewMMIS, there may be some differences between our current practice and the guidance from CMS.
We will keep you updated on the process and inform you of any changes that might impact your billing procedures.
New 80100/80101 Unit Restrictions
In September, MassHealth announced updated drug screen testing unit limitations for acute outpatient hospitals, community health centers, independent clinical labs, and physician providers. Effective for dates of service (DOS) beginning October 1, 2010, drug screen Service Codes 80100 (Drug screen, qualitative; multiple drug classes chromatographic method, each procedure) and 80101 (Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class) are limited to a maximum of eight units per DOS. Providers may request additional units when medically necessary through prior authorization. Please refer to the related provider bulletins published in September 2010 for additional information relating to this change.
System Maintenace
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable tonight, Friday, 10/8, from 7:00 PM to 12 midnight due to system maintenance. Thank you.
10/05/10
System Maintenance
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 10/10, from 2:00 pm to 10:00 pm due to system maintenance. Thank you.
We apologize for any inconvenience this may cause.

Messages from the Week of September 27, 2010
09/27/10
Third Party Liability (TPL) Claims Adjustment for Inpatient Professionals, Inpatient and Professional Crossovers
MassHealth has adjusted claims that were previously overpaid when a third party payment was reported on the claim. The adjusted claims will appear on future remittance advices. If you have any questions regarding this notice, please contact MassHealth Customer Service at 1-800-841-2900.
Messages from the Week of September 20, 2010
09/24/10
System Maintenance
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Friday, 9/24, from 9:00 pm to 11:00 pm due to system maintenance
Messages from the Week of September 13, 2010
09/17/10
Important Message About Crossover Claims For Qualified Medicare Beneficiaries (QMBs)
On 09/05/2010, MassHealth implemented a system change to allow crossover claim payment for MassHealth non-covered services provided to Qualified Medicare Beneficiaries (QMBs). Crossover claims processed on or after 09/05/2010 should no longer deny for pricing related edits when there is a remaining MassHealth liability on the claim and the member is a QMB. As a result of this change, providers may see the following new EOB codes on their remittance advice.
1806- Crossover pricing performed (header)
1807- Crossover pricing performed (detail)
1808- No Medicare patient responsibility on the claim (header)
1809- No Medicare patient responsibility on the claim (detail)
MassHealth is currently working on reprocessing the previously denied claims and will provide an update in a future message. MassHealth previously notified providers of this crossover pricing change for QMBs in February 2010. For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
Important Message About Suspended Crossover Claims For Qualified Medicare Beneficiaries (QMBs)
On 09/05/2010, MassHealth implemented a system change to allow crossover claim payment for MassHealth noncovered services provided to Qualified Medicare Beneficiaries (QMB). Crossover claims processed on or after 09/05/2010 should no longer suspend for pricing related edits when there is a remaining MassHealth liability on the claim and the member is a QMB. Crossover claims in suspense for pricing edits have been released and will appear on subsequent remittance advices. As a result of this change, providers may see the following new EOB codes on their remittance advice.
1806- Crossover pricing performed (header)
1807- Crossover pricing performed (detail)
1808- No Medicare patient responsibility on the claim (header)
1809- No Medicare patient responsibility on the claim (detail)
MassHealth previously notified providers of this crossover pricing change for QMBs in February 2010. For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
Medicare Crossovers - Reprocessing of Community Health Center Crossovers
MassHealth has reprocessed crossover claims for community health centers that previously denied due to pricing related edits. Providers should monitor reprocessed crossover claims on subsequent remittances advices. For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
Medicare Crossovers - ReprocESsing of crossovers billed by PSYCHOLOGISTs
MassHealth has reprocessed crossover claims billed by psychologists that previously denied due to pricing related edits. Providers should monitor reprocessed crossover claims on subsequent remittances advices. For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
Medicare Crossovers - ReprocESsing of Nursing Home ancillary Crossovers
MassHealth has reprocessed crossover claims for nursing home ancillary services that previously denied due to pricing related edits. Providers should monitor reprocessed crossover claims on subsequent remittances advices. For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
Medicare Crossovers - ReprocESsing of Crossovers billed by Qualified medicare beneficiary (QMB) providers
MassHealth has reprocessed crossover claims billed by QMB providers that previously denied due to pricing related edits. Providers should monitor reprocessed crossover claims on subsequent remittances advices. For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
New ICD-9-CM Codes
MassHealth has updated the claims processing system to accept new 2011 ICD-9 diagnosis and procedure codes effective 10/01/10. Providers may begin using the new diagnosis and procedure codes for claims with dates of service on or after 10/01/10. Any claim submitted with a date of service on or after 10/01/10 that does not contain valid diagnosis or procedure codes will be denied. Thank you for your cooperation.

Messages from the Week of August 23, 2010
08/27/10
Updated and Consolidated NewMMIS POSC job aids!
As we previously communicated to you, MassHealth has been updating the NewMMIS POSC, provider-related, job aids and relocating them from the NewMMIS Learning Management System (LMS) to a more accessible, centralized location on mass.gov: the Get Trained Web site www.mass.gov/masshealth/newmmis/providertraining. We are pleased to announce that this work has been completed. Be sure to bookmark this new Web site location. Thank you for your patience as we updated and consolidated the NewMMIS POSC job aids!
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 8/29, from 6:00 pm to 10:00 pm due to system maintenance.
We apologize for any inconvenience this may cause.
08/24/10
Nursing Home Providers Submitting Invalid Data on Discharge MMQs
It has come to the attention of MassHealth that some providers are submitting Management Minute Questionnaires (MMQs) with a discharge date that is before the effective date of the MMQ, a condition that causes the entire provider's MMQ batch file to be rejected. Before submitting a Discharge MMQ, please confirm that the MMQ effective date is the same date as the discharge date. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of August 9, 2010
08/10/10
Service Code T1019 Claims Paid For Personal Care Agencies
Your remittance advice may contain payment for claims with Service Code T1019 that were originally denied incorrectly. This pertains to claims that were denied with edit 3108 (UNITS EXHAUSTED) on a previous remittance advice. If your claim appears on this remittance advice as denied, please check that a claim was not already resubmitted. If your claim was previously resubmitted and paid, it will appear as a denial on this remittance advice. If you have questions, please call MassHealth Customer Service at 1-800-841-2900.

New Change Of Address - Provider Requirements Web Page And Form
A new Web page has been added to the MassHealth Web site. The Change of Address - Provider Requirements Web page provides instructions and requirements for how to update your address information with MassHealth based on your provider type. The Change of Address - Provider Requirements Web page is accessible from the MassHealth Web site at www.mass.gov/masshealth . Click on Information for MassHealth Providers, then on MassHealth Provider Enrollment and Credentialing.
The Provider Change of Address Form has also been updated and is accessible by clicking the links on the Change of Address - Provider Requirements Web page. The form may also be accessed from the MassHealth Provider Forms link in the Publications panel on the MassHealth Web site.
Providers must notify MassHealth within 14 days of any changes in information (as stated in 130 CMR 450.223(B)).

Messages from the Week of August 2, 2010
08/04/10
NewMMIS Training Material Notice
NewMMIS is over a year old now and access to the job aids and eLearning is decreasing. MassHealth is taking this opportunity to perform some "housecleaning" of the training materials so they will continue to be helpful to you and your staff. Over the next several weeks, we will update the NewMMIS training job aids, relocate them from the NewMMIS Learning Management System (LMS) and add them to the mass.gov Get Trained Web site. This will ensure that all training materials are in one centralized location. While the LMS was useful during the training period leading up to implementation, the NewMMIS site on mass.gov is now the more logical, permanent home for the job aids. During this interim period, please be aware this work is ongoing and we will notify you when all job aids have been posted to the mass.gov Web site. We appreciate your patience as we work to update and consolidate the NewMMIS job aids!
08/02/10
Shoe Medical Necessity Form Updates
Two new forms are replacing the MassHealth Shoe Medical Necessity Form ORT-1. They are (1) the MassHealth Orthotic and Prosthetic Prescription and Medical Necessity Review Form for Therapeutic Shoes, Inserts, and Modifications (for Diabetics) and (2) the MassHealth Orthotic and Prosthetic Prescription and Medical Necessity Review Form for Foot Orthoses, Footwear, and Modifications (Non-Diabetic). The new forms and their corresponding instructions are available on the MassHealth Web site at www.mass.gov/masshealth . Click on MassHealth Provider Forms under the Publications panel on the right side of the home page. Providers may begin using the above forms immediately. MassHealth will not accept the ORT-1 form after dates of service beginning August 31, 2010, and will deny claims submitted with the old form for dates of service after that date.
Rate Adjustment For Behavioral Health Screening Tests
MassHealth has recouped monies due to an overpayment of behavioral-health screening tests billed with service code 96110 (DEVELOPMENTAL TESTING, LIMITED). An incorrect rate was paid for service code 96110 for the period 12/01/2008 through 6/02/2010. Remittance advice (RA) 100058, dated 7/06/2010, reflects adjustments resulting from this overpayment. With this adjustment, the rate paid is now the same as the rate listed in the Division of Health Care Finance and Policy (DHCFP) fee schedule for this period. MassHealth is required to pay all service codes in accordance with DHCFP regulations. If you have questions, please call MassHealth Customer Service at 1-800-841-2900.
Messages from the Week of July 26, 2010
07/26/10
Updated Payment and Coverage Guidelines Tool Posted For DME and Oxygen Providers and Pharmacy Providers with A DME Specialty
The MassHealth Durable Medical Equipment (DME) and Oxygen Payment and Coverage Guidelines Tool has been updated and posted to the MassHealth Web site. To confirm that you are using the most recent version of this 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. If you have questions, contact MassHealth Customer Service at 1-800-841-2900.
Messages from the Week of July 19, 2010
07/19/10
Prior Authorization
Providers entering Prior Authorization requests are experiencing intermittent issues when attempting to save and submit the PA. In some cases the PA does not complete. Please be advised that NewMMIS has identified the issue and is working to solve the intermittent problem as quickly as possible.

Messages from the Week of July 12, 2010
07/16/10
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 7/18, from 5:00 pm to 10:00 pm due to system maintenance. Thank you.
07/15/10
Conference Call Update For Provider Participation And The Payment Error Rate Measurement (Perm) Project
Starting on August 11, 2010, and continuing into 2011, MassHealth will participate with the Centers for Medicare and Medicaid Services (CMS) in the FY2010 PERM project. During the project, CMS will randomly sample MassHealth provider claims from FY 2010 to test for data processing accuracy and medical necessity. CMS will conduct an information Open Door Forum conference call about PERM for MassHealth providers on August 11th, between 2 and 3:30 pm. The participant dial-in number is (800)603-1774. The conference ID number is 87759280. 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 explains about PERM. You can download the bulletin from the Provider Library on the MassHealth Web site at www.mass.gov/masshealthpubs. For more information, you can fax an inquiry to 617-988-8974 to the attention of MassHealth PERM Representative, or contact MassHealth Customer Service at 1-800-841-2900.
Information Regarding Edit 7540 (Duplicate Voided/Paid On Crossover Claim Type) For Outpatient Services
Be advised that your remittance advice (RA) may an adjusted 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. 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 adjusted 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.
Information Regarding Edit 7540 (Duplicate Voided/Paid On Crossover Claim Type) For Professional Services
Be advised that your remittance advice (RA) may contain an adjusted professional 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 a professional claim with missing or 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 5008 (CONFLICT - PHYSICIAN VS. CROSSOVER B). As a result, the paid professional claim is being adjusted 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 on a professional 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 5, 2010
07/08/10
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 7/11, from 6:00 pm to 10:00 pm due to system maintenance.
We apologize for any inconvenience this may cause.

Messages from the Week of June 28, 2010
06/28/10
Remittance Advice (Ra) Date Change For Run Number 100057
Providers are to be advised of a change in the Remittance Advice (RA) date for run number 100057. The RA normally dated Tuesday 06/29/10 will be dated Thursday 07/01/10. The RA will still be made available to providers on Monday and payments should be received as if the RA is dated Tuesday 06/29/10. Payments will not show in the Comptroller's Vendor Web until Friday 07/02/10. This is a one time occurrence only. Next week the RA will have the normal Tuesday date. Any questions, please contact MassHealth Customer Service at 1-800-841-2900.
Provider Participation And The Payment Error Rate Measurement (Perm) Project
Starting on August 11, 2010, and continuing into 2011, MassHealth will participate with the Centers for Medicare and Medicaid Services (CMS) in the FY2010 PERM project. During the project, CMS will randomly sample MassHealth provider claims from FFY 2010 to test for data processing accuracy and medical necessity. CMS will conduct an information Open Door Forum conference call about PERM for MassHealth providers on August 11 ^th, between 3 and 4 pm. The conference call dial-in and ID access numbers will be available on the CMS PERM Web site at www.cms.gov/PERM. Click on the Providers link in the Overview panel, and then select Providers Open Door Forum Invitation - August. All Provider Bulletin 203, dated March 2010, also explains about PERM. You can download the bulletin from the Provider Library on the MassHealth Web site at www.mass.gov/masshealthpubs. For more information, you can fax an inquiry to 617-988-8974 to the attention of MassHealth PERM Representative, contact MassHealth Customer Service at 1-800-841-2900, or send an email to david.kerrigan@state.ma.us.
Reminder: 90-Day Billing Deadline
A claim must be received no later than 90 days from the date of service or 90 days from the date on an explanation of benefits (EOB) when other insurance is involved. A claim initially submitted beyond the 90-day period will be denied with edit code 850 (BILLING DEADLINE EXCEEDED- DETAIL). If you have questions, contact MassHealth Customer Service at 1-800-841-2900.

Messages from the Week of June 21, 2010
06/24/10
Adjusting Claims With Date Of Service (Dos) Within One Year
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. Since claim processing varies with claim type please refer to Transmittal Letter ALL-169, dated July 2009, that transmits a revised Part 6 (Claim Status and Correction) of the Administrative and Billing Instructions (Subchapter 5) for all provider manuals, which describe procedures for correcting and rebilling claims by claim type.
Masshealth Healthy Start Program Announces Changes For Billing And Payment Of Global Delivery Codes
Effective July, 1, 2010, providers should begin billing eight (8) global delivery codes for Healthy Start Program (HSP) members directly to MassHealth. Currently, providers billing global codes for HSP members must submit claims to both UniCare (administrative vendor) and MassHealth. After July 1, providers billing for global delivery codes for HSP members should submit claims only to MassHealth. The eight (8) global delivery codes are 59400, 59410, 59510, 59515, 59610, 59614, 59618, and 59622. Claims submitted to UniCare for these eight (8) global delivery codes for dates of service on or after July 1, will be denied. All Provider Bulletin 204: Revised Billing Instructions for Healthy Start Program (HSP) Providers (May 2010) describes these changes in detail. You can download a copy of the bulletin from the link in the Publications panel on the POSC home page.
Revised Transportation Reimbursement Guidelines
Effective July 1, 2010, the revised transportation regulations eliminate most personal reimbursement to members for transportation expenses incurred in traveling to MassHealth covered medical services. The regulations continue to provide for transportation arranged through EOHHS vendors, as well as personal reimbursement for public transportation and in exceptional circumstances where MassHealth determines public transportation and transportation provided through the MassHealth agency is not available. Transmittal Letter TRN-32 (June 2010) describes these changes. You can download a copy of the transmittal letter from the Provider Online Service Center (POSC) Publications panel at www.mass.gov/masshealth/providerservicecenter.
Crossover Update For Community Health Center And Mental Health Clinic Providers - New Type Of Bill 77x
MassHealth has completed the changes to the NewMMIS system to adjudicate crossover claims correctly when billed with Type of Bill (TOB) 77X. Crossover claims that were previously held in suspense while the system change was being implemented have been released for adjudication. Crossover claims that previously denied for edit 274 (Type of Bill Code Invalid) will be re-processed by MassHealth on a future date. For more information regarding this change please refer to the broadcast message posted on 6/1/2010. For questions, please contact Mass Health Customer Service at 1-800-841-2900.
Updated Payment And Coverage Guidelines Tool Posted For Orthotics And Prosthetics Providers
Be advised that the MassHealth Orthotics and Prosthetics Payment and 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 questions, contact MassHealth Customer Service at 1-800-841-2900.
Messages from the Week of June 7, 2010
06/11/10
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 6/13, from 3:30 pm to 6:00 pm due to system maintenance.

We apologize for any inconvenience this may cause.
Messages from the Week of May 31, 2010
06/01/10
Notice for Community Health Center and Mental Health Clinic Providers - New Type of Bill 77X
Federally Qualified Health Centers (FQHCs) must use Type of Bill (TOB) 77X on claims submitted to Medicare for dates of service (DOS) on or after 4/1/2010. Medicare no longer accepts TOB 73X from FQHCs for claims with DOS on or after 4/1/2010. MassHealth is currently making changes to the NewMMIS system to adjudicate crossover claims correctly when billed with TOB 77X. To prevent claim denials, any new crossover claims with TOB 77X will be held in suspense until the system change is implemented. When the system change is implemented, crossovers held in suspense will be released for adjudication. Crossovers that previously denied for edit 274 (Type of Bill Code Invalid) will be re-processed. Providers should not re-submit claims with TOB 77X to Mass Health until the system change is implemented. Please check future broadcast messages for updates. For questions, please contact Mass Health Customer Service at 1-800-841-2900.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of May 17, 2010
05/21/10
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 5/23, from 4:00 pm to 10:00 pm due to system maintenance.
We apologize for any inconvenience this may cause.
05/19/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT, Wednesday, 5/19 from 7:00 pm to 9:00 pm
The NewMMIS POSC, including the internal NewMMIS application, will be unavailable from 7 pm to 9 pm tonight, Wednesday, 5/19 for system maintenance. Note that the Automated Voice Response, IVR, and EVSpc and HTS will be available during this time.
We apologize for any inconvenience this may cause.
Messages from the Week of May 10, 2010
05/12/10
Acute Inpatient Hospitals Initial Notice of Denial
When Permedion, the company that conducts MassHealth Acute Hospital Utilization Management, issues an Initial Notice of Denial of payment of an acute inpatient hospital claim, the hospital has the option to request reconsideration or not. If the hospital does not request reconsideration in accordance with 130 CMR 450.209(C)(2), it may rebill MassHealth for the service as an outpatient service in accordance with 130 CMR 415.414(B). If the hospital does not request reconsideration, the Initial Notice of Denial will constitute the final decision. In those cases Permedion will not send out a Final Denial letter. MassHealth regulations at 130 CMR 450.209(C)(2)(b) state that, if the hospital does not submit a request for reconsideration, the denial issued pursuant to 130 CMR 450.209 (C)(1) constitutes the final action of the agency. 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 1-877-735-7416.
Remember Not to Use Legacy Member IDs on Claims
Effective for claims submitted on and after July, 1, 2010, providers must use the 12-digit member IDs created for NewMMIS when submitting claims to MassHealth. To ease the transition after implementation, MassHealth allowed providers to use the legacy 10-digit member IDs on claim submissions. This temporary measure extended to paper and electronic batch claim submissions. During this time frame providers submitting legacy IDs on claims have claims paid with error code 2006 (Claims submitted with legacy Member ID) displayed for informational purposes only on the RAs. On the HIPAA 835 the error code displayed with Adjustment Reason and Remark code 31 (PATIENT CANNOT BE IDENTIFIED AS OUR INSURED). Effective July 1, 2010, MassHealth will no longer accept claims with the legacy member ID numbers. Claims submitted using the legacy member ID after this date will be denied with error code 2006 and HIPAA Reason and Remark code 31. Medicare Crossover claims submitted on paper or through electronic batch submissions will not deny for this edit. If you have questions, please call MassHealth Customer Service at 1-800-841-2900.
Remapping MassHealth EOB Codes to HIPAA Adjustment Reason Codes (ARC) on 835
Previously, EOB codes 9905, 9916, 9918, 9919, 9921, 9928, 9932, 9933, and 9998 were mapped to ARC B5 on the 835. Based on provider feedback, MassHealth recently implemented a change and these codes have been remapped to ARC 45 with the description "Charges exceed your contracted/legislated fee arrangement." EOB 9922 has been remapped to ARC 1 with the description "Deductible amount." Please refer to the MassHealth Crosswalk of EOB Codes to HIPAA Adjustment Reason and Remark.
If you have questions, please call MassHealth Customer Service at 1-800-841-2900.
Messages from the Week of April 19, 2010
04/22/10
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 4/25, from 9:00 am to 6:00 pm due to system maintenance. We apologize for any inconvenience this may cause.
Messages from the Week of April 5, 2010
04/09/10
Service Outage
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services will be unavailable Sunday, 4/11, from 5:00 pm to 10:00 pm due to system maintenance.
We apologize for any inconvenience this may cause.
Messages from the Week of March 22, 2010
03/31/10
To All Nursing Facilities:
Update - Quarterly Nursing Facility Census Data
The new procedures that were outlined in previous communications for submitting census data electronically are being delayed.
Please do not submit census data for April 1, 2010 electronically.

MassHealth is performing additional testing to ensure that transmission of the census data will be a smooth process for facilities. To support this added testing a sample of nursing facilities may be asked to help submit test transmissions of the census data.
The MassHealth Management Minutes Questionnaire (MMQ) nurses who have collected census data in the past will do so again, following past procedures, for the April 1, 2010 census data.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.

03/26/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 3/28 from 2:00 pm to 4:00 pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday, 3/28, from 2:00 P.M. to 4:00 P.M. due to system maintenance.
Messages from the Week of March 8, 2010
03/10/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Wednesday, 3/10 from 8:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, will be unavailable from 8 pm to 10 pm Wednesday, 3/10 for system maintenance. Note that the Automated Voice Response, IVR, and EVSpc and HTS will be available during this time.
To All Providers but Dentists: Final Deadline Appeal Submission Requirements
Providers are reminded to submit the MassHealth remittance advice (RA) that reflects error code 0853 (Final Deadline Exceeded - Detail) or 0855 (Final Deadline Exceeded - Header) as evidence of the final deadline exceeded denial along with the claim form when filing a Final Deadline Appeal. Prints of claim status or other documentation are not acceptable in lieu of the RA. For more information about final deadline appeal submission requirements, refer to All Provider Bulletin 186, dated April 2009. You can download the bulletin from the Provider Library at www.mass.gov/masshealthpubs
To Acute Inpatient Hospitals and Physician Providers: PAS (Preadmission Screening Requests) And PA (Prior Authorization Requests) - There's A Difference.
Acute Inpatient Hospital and physician providers are reminded that admission screening, also known as preadmission screening (PAS), must be obtained for all elective acute inpatient hospital admissions. The PAS requirements are in addition to any prior authorization (PA) requirements that might apply. PAS (preadmission screening) does not waive or replace any other MassHealth requirements, including PA (prior authorization). A specific procedure or treatment may separately require PA. Therefore, for an elective acute inpatient hospital admission, a member will always need a PAS and may also need an additional PA for a specific treatment or procedure performed during the admission. MassHealth Acute Inpatient Hospital Bulletin 137 addresses both PAS and PA. Related MassHealth regulations may be found in the Provider Library at www.mass.gov/masshealthpubs < http://www.mass.gov/masshealthpubs> as described below.
For MassHealth Regulations related to PAS (Preadmission Screening):
-Click on MassHealth Provider Regulations, then click on the Acute Inpatient Hospital link under the Current MassHealth Regulations header, and locate 130 CMR 415.405 (Utilization Management Program) and 415.414 (Utilization Review).
-Click on MassHealth Provider Regulations, then click on the All Provider link under the Current MassHealth Regulations header, and locate 130 CMR 450.207 (Utilization Management Program for Acute Inpatient Hospitals) and 130 CMR 450.208 (Utilization Management Admission Screening for Acute Inpatient Hospitals).
-PAS regulations can also be accessed from the MassHealth Provider Manual link in the Provider Library.
For MassHealth Regulations related to PA (Prior Authorization):
-Click on MassHealth Provider Regulations, then click on the Physician link under the Current MassHealth Regulations header, and locate 130 CMR 433.408 (Prior Authorization).
-Click on MassHealth Provider Regulations, then click on the All Provider link, under the Current MassHealth Regulations header, and locate 130 CMR 450.303 (Prior Authorization).
-PA regulations can also be accessed from the MassHealth Provider Manual link in the Provider Library. To view related regulations click on Physician Manual. Locate Subchapter 5, Administrative and Billing Instructions, Part 2 Prior Authorization. In addition, Subchapter 6, PHY Service Codes, lists the codes for services that require PA.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
03/09/10
Medicare Crossovers: Nursing Home Ancillary Services Denials for Edit 4801
MassHealth understands that NewMMIS has been denying Medicare crossover claims from nursing facilities for ancillary services. The Agency reviewed this matter and has implemented a change order to address this issue to ensure that future claims will process according to current crossover pricing methods. The specific claims that were affected by this issue are Medicare Part B crossover claims that have been denied for Edit 4801 - Procedure Not Covered By Provider Contract. MassHealth will reprocess previously adjudicated denied claims. Providers will be notified of the reprocess date in a future broadcast message. As a result of this change order, providers may see following new EOB codes on their remittance advice:
1806- Crossover pricing performed (header)
1807- Crossover pricing performed (detail)
1808- Not a MassHealth Covered service (header)
1809- Not a MassHealth Covered service (detail)
Medicare Crossovers: Community Health Center Denials for Edit 4046: Claim type C
MassHealth understands that NewMMIS has been denying Medicare crossover claims from Community Health Centers. The Agency reviewed this matter and has implemented a change order to address this issue to ensure that future claims will process according to current crossover pricing methods. The specific claims that were affected by this issue are Medicare crossover claims that have been denied for Edit 4046 - No rate id for reimbursement rule. MassHealth will reprocess previously adjudicated denied claims. Providers will be notified of the reprocess date in a future broadcast message. As a result of this change order, providers may see following new EOB codes on their remittance advice:
1806- Crossover pricing performed (header)
1807- Crossover pricing performed (detail)
1808- Not a MassHealth Covered service (header)
1809- Not a MassHealth Covered service (detail)
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

Messages from the Week of February 22, 2010
03/04/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 3/7 from 2:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday, 3/7, from 2:00 pm to 10:00 pm due to system maintenance.

Did You Know that Your Primary User Can Help You With:
- Password resets?
- Modifying your access to POSC functionality?
- Linking a "Subordinate User" to a new function?

Your Primary User is responsible for managing security access for your organization. Simply contact your Primary User when you need password-related or access-related assistance. Find out who your organization's Primary User is and contact him for POSC access-related issues. You do not need to contact MassHealth Customer Service for these maintenance tasks. Primary Users who are responsible for managing security access for their organizations should refer to the Primary User Guide at .

Did You Know that You Can Access:
-Explanations of Benefit Plans, EVS Restrictive Messages and a handy comparison of EVS Restrictive Message numbers vs. what they were in REVS? Check out and bookmark MassHealth's Appendix Y - EVS Codes/Messages at http://www.mass.gov/Eeohhs2/docs/masshealth/providermanual/appx-y-all.pdf
-Many resources online? Just click on and bookmark this link: MassHealth Provider Library. Another way to get there is to visit www.mass.gov/masshealth , click on "For Government" tab, click on "Laws, Regulations and Policies" link, click on "MassHealth Regulations and Other Publications" link, then click on "Provider Library" link. You will find helpful downloadable bulletins, manuals and forms as well as "Appendix Y."
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of February 22, 2010
02/26/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 2/28 from 6:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday, 2/28, from 6:00 pm to 10:00 pm due to system maintenance.
To all Providers that Submit Prior Authorization Requests via the POSC
On Monday, March 8, 2010, all Prior Authorization requests with a status of "In Process" that were saved prior to February 8, 2010 and not submitted to NewMMIS will be purged from the system.
To all Providers that Submit Preadmission Screening Requests via the POSC
On Monday, March 8, 2010, all Pre-Admission Screening requests with a status of "In Process" that were saved prior to February 8, 2010 but not submitted to NewMMIS AND with an admission date that has passed will be purged from the system. PAS requests with future admission dates WILL NOT be purged.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
2/25/10
Important Message Regarding Crossover Claims
MassHealth understands that NewMMIS has been denying payments of crossover claims for MassHealth non-covered services provided to Qualified Medicare Beneficiaries (QMB). The Agency has reviewed this matter and developed a change order to address the issue. When implemented, the change order will enable MassHealth to automatically re-process claims for non-MassHealth covered services rendered to QMB members. The change order is expected to be implemented this summer, and additional detailed information will be provided in the months ahead.
The specific claims that are affected by this issue are Medicare Part B crossover claims that have been denied for edit 4801 (procedure not covered by provider contract). These are crossover claims that have been approved and paid by Medicare but are not MassHealth covered services.
The specific members who are affected by this issue will be identified by the following restrictive message on the Eligibility Verification System (EVS):
Member is Qualified Medicare Beneficiary. See 130 CMR 519.010
Providers may seek hardship payment relief if they have a large number of denied claims in this category. To request a hardship, please contact Customer Service at 1-800-841-2900 and indicate that your hardship is related to Medicare Part B crossover claims for QMB members.
MassHealth appreciates your patience as we resolve this issue.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

02/23/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Wednesday 2/24 from 6:00 pm to 9:00 pm
The NewMMIS POSC, including the internal NewMMIS application and online eligibility services will be unavailable Wednesday, 2/24, from 6:00 pm to 9:00 pm due to system maintenance. Please note that EVSpc and the Automatic Voice Response eligibility application WILL be available during this time.
02/22/10
NPI and Paper Claims Submissions (UB-04 Form)
When submitting paper claims on the UB-04 form, please be sure to enter the national provider identifier (NPI) in Field 56 (NPI). It has been brought to the attention of MassHealth that claims are being submitted with the NPI, taxonomy, and other unidentified numbers entered in Field 57A (Other Prv). Entering incorrect or invalid information in Field 57A will cause your claims to be denied. Field 57A is used by atypical providers who do not have an NPI, to enter their provider ID/service location. If applicable, this field is also used to report other provider identifiers assigned by other health plan payer for TPL and paper crossover claims. For more information about how to properly enter your NPI on a UB-04 claim form, please refer to the Billing Guide for the UB-04. The billing guides can be found in the Provider Library at www.mass.gov/masshealthpubs
Submitting Adjustments to Paid Claims on the UB-04 Form
MassHealth would like to remind providers of the proper way to request an adjustment to paid claims on the UB-04 paper claim form. When adjusting an institutional claim the Type of Bill (TOB) frequency code is 7 (Replacement of Prior Claim). The fourth digit of the TOB defines the frequency of the claim. Enter an (A) followed by the 13-character internal control number (ICN) assigned to the paid claim in Field 64A (Document Control Number). The ICN appears on the remittance advice on which the original claim was paid. When submitting an adjustment, include all lines that were on the original claim. Correct the line that needs to be adjusted. Subchapter 5, Part 6 of your MassHealth provider manual gives detailed billing instructions on claim status and correction. For more information about how to complete the UB-04 claim form, refer to the MassHealth Billing Guides for Paper Claim Submitters in the Provider Library at www.mass.gov/masshealthpubs Using these resources will help ensure that your claims process correctly.

NPI and Paper Claims Submissions (CMS-1500 Form)
When submitting paper claims on the 1500 form, please be sure to enter the national provider identifier (NPI) in Field 33a (NPI). It has been brought to the attention of MassHealth that claims are being submitted with the NPI, taxonomy, and other unidentified numbers entered in Field 33b (Other ID No.). Entering your NPI or any incorrect or invalid information in Field 33b will cause your claims to be denied. Field 33b is used by atypical providers who do not have an NPI. You should enter the qualifier ID, followed by the provider ID/service location in Field 33b. If applicable, this field is also used when the provider has an NPI and is providing taxonomy information. In this case, you should enter the qualifier ZZ followed by the taxonomy code in Field 33b. For more information about how to properly enter your NPI on a CMS-1500 claim form, please refer to the Billing Guide for the CMS-1500. The billing guides can be found in the Provider Library at www.mass.gov/masshealthpubs

To Acute Inpatient Hospitals/Physicians:
Acute Inpatient Hospital Elective Admissions Contractor
As MassHealth informed you in earlier remittance advices (RAs), Permedion assumed operations as the MassHealth Acute Hospital Utilization Management Program (UMP) contractor on 11/2/2009. Masspro continues to be the contractor for the chronic/rehab utilization management program. Acute hospital Preadmission Screening Requests (PAS) faxed to Masspro will not be processed. Documentation to support the need for the acute elective inpatient admission must be supplied at the time of the request for PAS. Please submit PAS and documentation to Permedion via the Provider Online Service Center (POSC), phone or fax.
1-877-735-7416 (Permedion Phone)
1-877-735-7415 (Permedion Fax)
Permedion
HMS Government Services
510 Rutherford Ave.
Charlestown, MA 02129
To Acute Inpatient Hospitals/Physicians:
Acute Inpatient Elective Admissions Timeframe for PAS Requests
For Preadmission Screening Requests (PAS) for elective inpatient acute hospital admissions see the All Provider regulations at 130 CMR 450.208(A)(1). This regulation states that providers must submit requests for admission screening at least seven days before a proposed elective admission. It has been brought to the attention of MassHealth that approximately a third of the PAS Requests submitted to Permedion, the MassHealth Acute Hospital Utilization Management Program (UMP) contractor, do not meet the timeframe stated in MassHealth regulations. Although Permedion will try to accommodate PAS exceptions, you may be asked to reschedule the admission if your request does not fall within the required MassHealth timeframe.

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.

Messages from the Week of February 15, 2010
02/16/10
Medicare Part B Physician Crossover Notice
MassHealth has been alerted to a problem affecting Medicare Part B Physician Crossovers. The issue affects claims submitted to Medicare that contain at least two detail lines, where one of the lines is 100% Medicare reimbursable and other lines are for services on which the Medicare Part B deductible is applied or co-insurance is owed. Medicare processes the claim as if the claim was 100% paid and the claim is excluded from the crossover process. The affected claims would have been processed by Medicare between January 4th and February 11th, 2010. Medicare has stated that the affected claims will not be sent in the crossover files. Providers should submit these claims directly to MassHealth. Medicare implemented a fix to correct this issue on February 12th, 2010.

Messages from the Week of January 30, 2010
02/05/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Saturday 2/6 from 8:00 pm to 12:00 Midnight
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Saturday, 2/6, from 8:00 pm to 12:00 Midnight due to system maintenance.
Messages from the Week of January 24, 2010
01/29/10
Slight Change to Some NewMMIS POSC and Virtual Gateway Screens
Effective February 1 ^st you will see that the Virtual Gateway (VG) and NewMMIS POSC screens you use to log in and create new IDs have a slightly different look. The SSN field on both systems' screens will now be called PIN (Personal Identification Number). However, only the title has changed. It's the same field, and the steps to login and access your services will remain the same. You do not need to change any information that you previously elected for this field. The systems will recognize the data that you provided before. Requesting a PIN rather than SSN will provide more choices and more security for our users. We hope you find this change helpful. If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
01/28/10
Slight Change to Some NewMMIS POSC Screens
Effective February 1st you will see that the NewMMIS POSC screens you use to create new IDs have a slightly different look. The SSN field will now be called PIN (Personal Identification Number). However, only the title has changed. It's the same field, and the steps to login and access NewMMIS will remain the same. You do not need to change any information that you previously elected for this field. The system will recognize the data that you provided before. Requesting a PIN rather than SSN will provide more choices and more security for our users. We hope you find this change helpful. If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900.
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 1/31 from 6:00 pm to 11:00 pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday, 1/31, from 6:00 pm to 11:00 pm due to system maintenance.
1099's Mailing Soon
Please be on the lookout for your IRS Form 1099 for calendar year 2009. You should receive a 1099 only if the total amount received in calendar year 2009 from the Commonwealth of Massachusetts was $600 or more. If you are to receive a 1099, it will be postmarked by 1/31/2010 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 .

** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of January 17, 2010
01/23/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Saturday 1/23 from 2:00 pm to 6:00 pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Saturday, 1/23, from 2:00 pm to 6:00 pm due to system maintenance.
Vision Care Materials Order Form (Vis-1)
The VIS-1 form is now available online. Go to www.mass.gov/masshealth and click on the MassHealth Provider Forms link in the Publications panel on the right side of the home page. Forms are listed alphabetically by provider type. This new online format allows providers to enter data into certain fields (including requesting provider contact information) before printing. Providers are urged to use this new feature when making numerous copies of partially completed VIS-1 forms.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
01/20/10
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 in the COB information. The claims can be submitted via 837 batch or DDE - Direct Data Entry. For questions, please contact the MassHealth Customer Service at 1-800-841-2900. Thank you.
To all Providers:
If claims were returned for the following reason: TPL attachment unacceptable (the attachment does not contain detail lines corresponding to service code lines on the claim form), and the attached EOB did contain the detail lines, please submit your claims along with the EOB and a copy of the reject letter and a 90 day waiver form (if applicable) to: CST/TPL 2nd Submission PO Box 9118, Hingham, MA 02043.
If claims were returned for the following reason: TPL attachment unacceptable (submitted with a blanket cover letter of non-covered services/items with your claim form), please submit your claims along with a copy of the reject letter and a 90 day waiver form (if applicable) to, CST/TPL 2nd Submission, PO Box 9118, Hingham, MA 02043.

Messages from the Week of January 3, 2010
1/8/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 1/10 from 9:00 am to 10:00 am
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday, 1/10, from 9:00 am to 10:00 am due to system maintenance
Medicare Crossover Claims
In Legacy MMIS, MassHealth only processed Medicare-paid service lines. In NewMMIS, if Medicare made a payment on the claim, the entire crossover claim is processed including the Medicare-denied service lines. Please review your MassHealth remittance advice before submitting any Medicare-denied service lines to MassHealth. Thank you for your cooperation.
Messages from the Week of December 28, 2009
12/31/09
To all MassHealth Providers - Important Message Concerning this Week's Payments
Due to a processing delay, this week's payments and associated 835's ordinarily made to you by check will be delayed. Checks are scheduled to be placed in the mail this coming Monday, January 4 ^th. If you ordinarily receive EFT payments and associated 835's, you should not experience a delay. We will keep you informed, however, of any change to this situation. We appreciate your continued patience and cooperation.
01/02/10
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 1/3 from 9:00 am to 10:00 am
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday, 1/3, from 9:00 am to 10:00 am due to system maintenance.

Messages from the Week of December 14, 2009
12/17/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 12/20 from 9:00 am to 12:00 Noon
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday, 12/20, from 9:00 am to 12:00 Noon due to system maintenance.
When Attempting to Access Provider Online Service Center (POSC) When it is Down…
You can view, in most cases, information about an outage and how long it is scheduled to last by visiting www.mass.gov/masshealth/newmmisnotices and checking the "NewMMIS Customer Service" section. We hope you find this helpful.
To Home Health Agency & Independent Nurse Providers: Prior Authorization (PA) Numbers No Longer Required On Claims Submissions for Service Codes T1002 - T1003
Providers submitting claims for continuous skilled nursing services, single rate night shift and single rate weekends (T1002 UJ and T1003 UJ) are no longer required to include a PA number, as instructed in a previous remittance advice (RA). Claims containing service codes T1002, T1002 UJ, T1003 and T1003 UJ may now be submitted with or without a PA number and they will be properly processed by the NewMMIS.
To Chronic Disease & Rehabilitation Outpatient Hospital Providers: National Drug Code Requirement on Chronic Disease and Rehabilitation Outpatient Claims
Effective September 15, 2008, MassHealth implemented a change requiring national drug code (NDC) units and appropriate descriptors on all outpatient claims for drugs billed with a Healthcare Common Procedure Coding System (HCPCS) Level II code. This requirement also applies to Medicare crossover claims. MassHealth reviews all outpatient and crossover claims for compliance with this requirement. Claims that do not have this information will be denied, or subject to recoupment. For additional information, please refer to MassHealth Chronic Disease and Rehabilitation Outpatient Hospital Bulletin 4, dated August 2008, in the Provider Library at www.mass.gov/masshealthpubs.
To Pharmacy Providers: Claims for Secondary Payment for Medicare Part B Covered Items
Pharmacy Providers are reminded that, effective July 1, 2009, any claim for a Medicare-B covered drug, durable medical equipment, or medical supply that is payable through the Pharmacy Online Processing System (POPS) for when MassHealth is being billed as the secondary payer and Medicare B is the primary payer, must be processed through POPS. For more information, go to www.mass.gov/masshealth/pharmacy click on the Pharmacy Facts link, then on Pharmacy Facts 2009, then on Pharmacy Facts 50 [05/06/09], or call ACS at 1-866-246-8503.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

Messages from the Week of November 30, 2009
12/05/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 12/6 from 6:00 pm to 8:00 pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday, 12/6, from 6:00 pm to 8:00 pm due to system maintenance.

12/01/09
Taxonomy Code Usage
Taxonomy codes identify the type of services or specialty that a health-care provider offers to patients. Providers should submit claims with a taxonomy code only when MassHealth has specifically directed them to do so. Submission of a taxonomy code when not required or submission of an incorrect taxonomy code could result in claim denials. A taxonomy code is sometimes needed to correctly crosswalk an NPI to a NewMMIS Provider ID/service location (PID/SL) when a provider has one NPI with multiple PID/SL. If a taxonomy code is needed, MassHealth will assign the taxonomy code and notify the provider.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.

Messages from the Week of November 16, 2009
11/19/09
Legacy Electronic Data Interchange (EDI) Web Portal to be Discontinued on 11/27/2009
On November 27, 2009, MassHealth will discontinue use of the former EDI Web Portal that supported legacy MMIS for electronic transactions (files created before implementation of NewMMIS in May 2009). If you need copies of any 835 or 997 transactions that were created before June 2009, you must download the files before November 27, 2009, at MassHealth . Click on Information for MassHealth Providers, then on MassHealth Claims Submission, then on Web-Based MassHealth Transactions, and then on Production Transactions.
After November 27th, only 835 and 997 files created since NewMMIS implementation will be accessible on the Provider Online Service Center (POSC) at www.mass.gov/masshealth/providerservicecenter.
MassHealth Customer Service has contacted any users of the former EDI Web portal that have accessed the site within the last three months to inform them of this change.
For additional information about this transition, please refer to All Provider Bulletin 185 and All Provider Bulletin 187 .
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 11/22 from 7:00 am to 11:00 am and 6:00 pm to 11:00 pm
The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable Sunday 11/22 from 7:00 am to 11:00 am and 6:00 pm to 11:00 pm due to system maintenance. Thank you for your patience during these scheduled maintenance windows and for your continued service to the Mass Health program.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
11/16/09
Masshealth Issues Member Seasonal Flu and H1N1 (Swine) Flu Informational Flyer
MassHealth has prepared an informational flyer to inform MassHealth members about coverage of the seasonal flu and H1N1 (swine) flu vaccines. This informational flyer can be used as a resource to help providers inform their members about their MassHealth seasonal and H1N1 flu vaccine coverage. The flyer addresses vaccine eligibility concerns for both seasonal and H1N1 flu with regard to the member's MassHealth plan requirements. The flyer also communicates some coverage limitations and lists further references for obtaining more flu-related information.
The flyer is being mailed to all households that have MassHealth members. You can download a PDF of the flyer by clicking on the Seasonal and H1N1 Flu Vaccine Coverage for MassHealth Members link under the News & Updates column on the home page of the MassHealth Web site.
For more information about the administration of the H1N1 vaccine, please refer to All Provider Bulletin 197, dated October 2009, available from the Provider Library at www.mass.gov/masshealthpubs.
Adult Day Health Services (ADH) Claims Reprocess
MassHealth initiated scheduled maintenance to ADH service codes on October 2, 2009. The scheduled maintenance inadvertently caused some ADH service claims with dates of service between April 1, 2009 and October 23, 2009 to deny erroneously with Edit code 8121 (Adult Day Health Limit-1 Per Day). In addition, some claims were underpaid as a result of the maintenance.
MassHealth corrected the issue to ADH service codes on October 23, 2009 to ensure that future claims would process according to current billing procedures. MassHealth has systematically reprocessed all erroneously denied claims and adjusted claims that were underpaid. These adjustments will appear on the December 1, 2009 pay cycle. Thank you for your patience.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.

Messages from the Week of November 9, 2009
11/12/09
To all MassHealth Providers
In anticipation of the upcoming holiday season, we wish to inform you that steps have been taken so that payments will not be delayed nor otherwise affected due to the holidays. The normal schedule will apply for posting the provider Remittance Advices and 835 transactions on the NewMMIS Provider Online Service Center.
Planned Session for Provider DDE WebEx: TPL/CST
Training for Nursing Facility Providers- Portal DDE Claim Entry
Date: Wednesday, November 18, 2009
Time: 1:00 - 2:30 pm
MassHealth will be hosting a WebEx educational session to review how to enter TPL and Medicare crossover claims via DDE for Nursing Facility Providers. The sessions will allow providers to follow along as we enter a claim. We will then request providers to enter DDE claims themselves into production and ask questions as they go through the process. To register, please go to http://masshealthnewmmisprovidertraining.ehs.state.ma.us/
Third Party Liability (TPL) Cover Letter Notice
TPL cover letters are no longer required or accepted by MassHealth. NewMMIS functionality allows MassHealth to edit for other insurance by procedure code, modifier, place of service and other claim information. If the service is sometimes covered by the other insurer depending upon the patient's status (for example, home bound skilled level of care) please refer to your provider manual appendix for "Supplemental Instructions for TPL Exceptions." For questions, please contact MassHealth Customer Services at 1-800-841-2900. Thank you.
NewMMIS
Please note: NewMMIS users may experience intermittent connectivity issues due to technical upgrades Wednesday, 11/18, from 7:00 am to 9:00 am
CORRECTION TO MESSAGE ISSUED LAST WEDNESDAY, NOVEMBER 4
Timeframe for Using Legacy PCC Referral Numbers Has Been Extended
All Provider Bulletin 194: Primary Care Clinician (PCC) Referral Process (June 2009) indicated that, effective November 30, 2009, MassHealth would no longer accept the use of legacy-based provider numbers for referrals from PCCs. MassHealth is extending this deadline, and will continue to accept legacy PCC referral numbers for all new and pre-NewMMIS referrals until further notice.
When entering the legacy referral number into the Referral field, you must include two leading zeroes before the legacy PCC provider number.
If you have claims that denied for Edits 3120 (Referral Required on Claim) or 3124 (Rendering Provider Does Not Match Referral Auth) you may resubmit those claims using the legacy PCC referral number in the referral field.
Please continue to check POSC Broadcast Messages for updates to instructions for submitting claims that require referrals. Thank you.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

Messages from the Week of November 02, 2009
11/03/09
To Physicians and Group Practices: Billing for H1N1 Vaccine Administration Before 10/18/09
When billing for H1N1 vaccine administration for dates of service before 10/18/09, when the sole purpose for the visit is vaccine administration, providers should use unlisted CPT Code 90749 and attach an office note indicating H1N1 administration. This code will be priced and paid as indicated in All Provider Bulletin 197.
Effective for dates of service on and after 10/18/09, follow the instructions in All Provider Bulletin 197, dated October 2009. To download a copy of the bulletin from the Provider Library, go to www.mass.gov/masshealthpubs.
Whenever possible, providers should make every effort to administer flu vaccines during regular visits with their members. In such cases, MassHealth will not provide any additional payment for administering the vaccine (s). In instances where providers cannot administer the H1N1 vaccine as part of a regular visit, MassHealth will pay only for the administration of the H1N1 vaccine, and will pay all providers the same fee, regardless of the provider type, in accordance with DHCFP Medicine regulation 114.3 CMR 17.00.
Timeframe for Using Legacy PCC Referral Numbers Has Been Extended
All Provider Bulletin 194: Primary Care Clinician (PCC) Referral Process (June 2009) indicated that, effective November 30, 2009, MassHealth would no longer accept the use of legacy-based provider numbers for referrals from PCCs. MassHealth is extending this deadline, and will continue to accept legacy PCC referral numbers until further notice.
When entering the legacy referral number into the Referral field, you must include two leading zeroes before the legacy PCC provider number.
If you have claims that denied for Edits 3120 (Referral Required on Claim) or 3124 (Rendering Provider Does Not Match Referral Auth) you may resubmit those claims using the legacy PCC referral number in the referral field.
Please continue to check POSC Broadcast Messages for updates to instructions for submitting claims that require referrals. Thank you.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices.
Messages from the Week of October 26, 2009
10/29/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday 11/1 from 6:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable Sunday 11/1 from 6:00 pm to 10:00 pm due to system maintenance. Thank you for your patience during these scheduled maintenance windows and for your continued service to the Mass Health program.
Pre-Admission Screening (PAS) Function Unavailable from Friday, 10/30 at 9:00 pm to Sunday, 11/1 at 10:00 pm
October 30 ^th is the last day that MassPro will process Pre-Admission Screening (PAS) Acute Hospital and Acute with Rehab Hospital requests. Permedion will take over this function starting Monday, November 2 ^nd. In preparation for this change-over, providers will not be able to submit requests via the PAS panel on the Provider Online Service Center (POSC) from Friday, 10/30 at 9:00 pm to Sunday, 11/1 at 10:00 pm.
To Home Health Agencies and Independent Nurses: Prior Authorization Numbers Required on Claims for Procedure Codes T1002 and T1003
MassHealth previously announced the reprocessing of claims for continuous nursing services, single rate night shift and single rate weekends (T1002 UJ and T1003 UJ), that denied erroneously. All affected claims were due to be reprocessed and appear on remittance advice 100020, dated October 13, 2009. However, MassHealth has since discovered that only those claims having a prior authorization (PA) number were reprocessed at that time.
If your T1002 UJ and T1003 UJ claim was not processed on RA 100020, please resubmit it as if it were a new claim. Be sure to include the PA number but do not include the former internal control number (ICN) number.
Going forward, you must include a PA number on all continuous skilled nursing services (T1002 and T1003) claims submissions or your claims will be denied. Thank you for your patience and cooperation.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of October 12, 2009
10/14/09
POSC Password Reset
Providers have indicated that when attempting to change their POSC password once it has expired, selecting the close button prompts the system to return to the same change password page they just completed. Please note that MassHealth is aware of this problem and is working to change it. In the interim, once you receive the message that your password has been successfully changed, please select the appropriate service from the left-hand side of the page to access the POSC.
** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of October 5, 2009
10/8/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 10/11, from 6:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable Sunday, 10/11, from 6:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.
New ICD-9-CM Codes
MassHealth has updated the claims processing system to accept new 2010 ICD-9 Diagnosis and Procedure codes effective 10/1/09. Providers may begin using the new diagnosis and procedure codes for claims with dates of service on or after 10/01/09. Any claim submitted with a date of service on or after 10/1/09 that does not contain valid diagnosis or procedure codes will be denied. Thank you for your cooperation.
WebEx Training Sessions to be Held for Provider DDE: TPL/CST
MassHealth will host several WebEx educational sessions to review how to enter TPL and Medicare crossover claims via DDE. The sessions will allow providers to follow along as we enter the claims. We will then request providers to enter DDE claims for themselves into production and ask questions as they go through the process. To register, please go to http://masshealthnewmmisprovidertraining.ehs.state.ma.us/.
Session 1 - Institutional Claims with Medicare A/B Paid
Date: Wednesday, October 14, 2009
Time: 1:00 - 2:30 pm - Institutional Inpatient
Time: 3:00 - 4:30 pm - Institutional Outpatient or Outpatient Ancillary
Session 2 - Professional Claims with Medicare B Paid
Date: Wednesday, October 21, 2009
Time: 1:00 -2:30 pm
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

10/5/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT, Monday, 10/5, from 9:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable TONIGHT, Monday, 10/5, from 9:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.
Remittance Advice Now Sorted By Member ID
MassHealth has heard your request for changing the PDF Remittance Advice (RA) sort. After thorough review, MassHealth is pleased to announce that starting with RA 100019, dated October 6, 2009, sorting will be by Member Identification Number instead of Internal Control Number (ICN). Thank you for your feedback. If you have questions about this change you can call MassHealth Customer Service at 1-800-841-2900.
Permedion Inc. Begins Acute Hospital Utilization Management Program November 2
Permedion Inc., a subsidiary of Health Management Systems, will assume operations as the MassHealth Acute Utilization Management Program (UMP) contractor on November 2, 2009. Starting on November 2, all Preadmission Screening Requests should be submitted to Permedion via the POSC, phone or fax numbers below. Masspro will continue to process any preadmission calls and requests received through October 30, 2009. Permedion will begin conducting prepayment reviews starting the week of November 2, 2009. Permedion postpayment review sampling will begin in November and Permedion will provide Peer Reviewer representation at hearings.
1-877-735-7416 (Permedion Phone)
1-877-735-7415 (Permedion Fax)
Permedion HMS Government Services
510 Rutherford Ave.
Charlestown, MA 02129
UJ Modifier/Prior Authorization Issue
MassHealth has identified an issue with claims denying erroneously for continuous nursing services, single rate night shift and single rate weekends (T1002 UJ and T1003 UJ). Affected claims will be reprocessed and appear on remittance advice 100020, dated October 13, 2009. No further action is required by providers at this time. MassHealth is addressing the cause of this issue and will communicate updated instructions for submitting UJ claims as a POSC Broadcast Message.
Dental Providers--Nursing Facility Visit
Effective October 1, 2009, MassHealth added dental CDT service code D9410 (Nursing Facility Visit) to the Dental Program Subchapter 6. The service code may be used when making a nursing facility visit. The code D9410 may be billed in addition to the actual service performed and may be billed once per day per member. If you have questions, please contact MassHealth Customer Service at 1-800-207-5019.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices

Messages from the Week of September 28, 2009
10/2/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 10/4, from 6:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable this Sunday, 10/4, from 6:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.
September 30th Was Final Day to Use PIN to Register for NewMMIS Provider Online Service Center (POSC)
Existing Providers that have not yet registered should contact MassHealth Customer Service at 1-800-841-2900 to gain access to the POSC. Thank you for your cooperation.
Update about Medicare Part B Crossover Pricing
MassHealth previously informed providers that NewMMIS supports the repricing of Medicare Part B Crossovers. MassHealth will pay Medicare Part B Crossover claims up to the MassHealth allowable amount less any Medicare payment, or the coinsurance and deductible amount, whichever is less. In calculating the difference between the MassHealth allowable amount and the Medicare payment, NewMMIS will apply the following payment rules:

1) If MassHealth has not adopted the Medicare code and has a comparable code for the service, it will use the comparable code and rate for payment. Please see " Medicare Code to MassHealth Comparable Code Cross Reference" listing.
2) If MassHealth has not adopted the code because it is a non-covered service, MassHealth will not pay the Medicare coinsurance and deductible. Please see attached documents "MassHealth Non-Covered Codes for All Pts" as well as "MassHealth Non-Covered Codes for Spec Prov Types" listings.

If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900. Thank you for your patience and cooperation.
Update on Automated Test Panel (ATP) Service Codes: For Physicians, Nurse Practitioners, Nurse Midwives, Clinical Labs, and Acute Outpatient Hospitals
Please be sure to review the Clinical Laboratory Services Rate regulation (114.3 CMR 20.04) to obtain the list of Service Codes subject to the ATP panel rate payment methodology. This regulation is available online by clicking on the Clinical Laboratory Services Rate regulations.
** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices.
Messages from the Week of September 21, 2009
09/25/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 9/27, from 6:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, all eligibility services, the Voice Response application and EVSpc will be unavailable this Sunday, 9/27, from 6:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.
** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices

09/21/09
NewMMIS Password Expiration Notices to Begin Wednesday, September 23, 2009
In an effort to help ease transition to NewMMIS, MassHealth relaxed the enforcement of the standard security requirement to change passwords every 90 days on the Provider Online Service Center (POSC). Now that it has been almost four months since NewMMIS implementation, MassHealth will reinstate enforcement of this policy beginning this Wednesday, September 23, 2009.
After September 23, providers with passwords that have been in effect for more than 90 days will be prompted to change passwords. In addition, if your password is due to expire within 15 days of the standard 90-day period, you will receive a password expiration prompt and the option to make the change when you log in. Please be sure to follow the instructions on the screens if you receive these prompts. Thank you for your patience and cooperation.
To assist you, we remind you of the NewMMIS Password rules:
Passwords must contain:
Between 8 and 16 characters
One upper case character (i.e., A, B, C)
One lower case character (i.e., a, b, c,)
One number (i.e., 1, 2,3)
Passwords cannot contain:
The words "test", "password" or "pass"
Your first name, your last name, or your full name
Your account ID
Your email address
Any recently used password
** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of September 14, 2009
09/18/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Saturday, 9/19, from 7:00 am to 10:00 am
The NewMMIS POSC, including the Voice Response application, EVSpc, and all eligibility services, will be unavailable this Saturday, 9/19, from 7:00 am to 10:00 am due to system maintenance. We apologize for the inconvenience.
** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices.
Prior Authorizations with Status of "In Process" to be Deleted on September 30, 2009
Please be advised that on September 30, all Prior Authorization (PA) requests created between May 16, 2009 and August 31, 2009 with a status of IN PROCESS will be deleted. PA requests with a status of IN PROCESS represent PAs that were started but never submitted to MassHealth.
** For more information about this notice or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of September 7, 2009
09/11/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 9/13, from 4:00 pm to 10:00pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable this Sunday 9/13, from 4:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.
Update: MassHealth HIPAA Trading Partner Testing Has Resumed
MassHealth resumed HIPAA compliance and comprehensive testing on September 9, 2009. Please call MassHealth Customer Service at 1-800-841-2900 to arrange trading partner testing before submitting any test files. Select Option 1, Option 8, then Option 3 to speak with an Electronic Data Interchange (EDI) unit representative to coordinate testing. You may also email your request to test electronic X12 transactions to hipaasupport@mahealth.net. Any test files submitted without prior knowledge and coordination with the EDI unit will not be monitored for review of results.

If you plan to use an approved billing intermediary or software vendor to submit electronically you do not have to test with MassHealth directly. EDI will still need to obtain certain necessary information however prior to testing with your billing intermediary or software vendor. For more information, please refer to testing instructions at www.mass.gov/masshealth/newmmis.
Utilization Management Program Updates For Acute Hospitals
MassHealth has made some changes to the Utilization Management Program for acute hospitals that will take effect on November 2, 2009. As a result of these updates, the annual volume of claims subject to pre-payment reviews will increase from 15,000 claims to 20,000, inpatient post-payment reviews will increase from 10,000 claims to 15,000 claims, and outpatient post-payment reviews will increase from 5,000 claims to 20,000 claims. Post-payment reviews will be conducted as a combination of mail-in and on-site reviews. Thank you for your continued cooperation.
Update: Medicare Part B Crossover Claim Re-pricing
Some Medicare Part B crossover claims that were previously in suspense status have been processed by MassHealth. Please note that MassHealth will use the comparable MassHealth code for rate derivation when the crossover claim is billed with a code that MassHealth has not adopted. Please refer to the recent NewMMIS notice NewMMIS Functionality Supports Medicare Part B Crossover Claim Repricing at www.mass.gov/masshealth/newmmisnotices for additional information.

Messages from the Week of August 31, 2009
09/04/09
Notice Concerning NewMMIS Claim Edit 800: "HCPCS Requires National Drug Code (NDC)"
MassHealth has identified that 837P electronic claims submitted with National Drug Code (NDC) information for physician-administered drugs are being erroneously denied for Edit 800: "HCPCS Requires NDC." In addition, MassHealth has learned that many of these claims are being submitted without the required NDC information. Please check POSC Broadcast Messages for instructions on resubmitting these claims. Please remember that these claims cannot be billed via direct data entry (DDE) on the Provider Online Service Center (POSC) at this time.
For more information please visit www.mass.gov/masshealth click on Information for MassHealth Providers, then on National Drug Code (NDC) Requirements for Physician-Administered Medications or call MassHealth Customer Service at 1-800-841-2900.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices

09/02/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Wednesday 9/2, from 9:00 pm to 10:00 pm
The NewMMIS POSC, including the internal NewMMIS application, will be unavailable Wednesday 9/2 from 9:00 pm to 10:00 pm due to system maintenance. Eligibility-related services WILL be available, including the Automated Voice Response, EVSpc and HTS. Thank you for your patience and cooperation.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices

08/31/09
To all MassHealth Providers: Availability of 835s
Please be advised that this week's HIPAA 835 files will be available tomorrow, September 1, for download by trading partners on the NewMMIS portal. As a reminder, this is consistent with previous communications to providers that Tuesday is the designated day for 835 availability, although occasionally they have been available earlier. We therefore want to take this opportunity to remind providers once again that they can expect to receive their 835 files each Tuesday. We appreciate your patience and cooperation.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of August 24, 2009
08/28/09
Important Message about Replacement Claims Transactions
Claims adjustments can be done electronically using the HIPAA-compliant 837 or direct data entry (DDE) format as a replacement transaction. Replacement transactions correct previously paid claims and are not meant to be used for resubmitting denied claims. The replacement claim should include all corrections as well as the full amount requested, not the difference between what was paid previously and what you are expecting now. For HIPAA-compliant 837 formats, submit the corrected claim as a replacement Frequency Code 7. For DDE formats, hit the Replace button, correct the claim and click on the Submit button. This procedure can be used to change any field on the claim except for changes to the Member Number, Pay-to Provider Number, Date of Service, or Claim Type. MassHealth recommends that you share this information with your software vendor or electronic billing intermediary. For additional information, consult the applicable MassHealth Companion Guides on the MassHealth Web site at www.mass.gov/masshealth/newmmis. Click on Need Additional Information or Training then on Updated Billing Guides, Companion Guides, and Other Publications.
MassHealth HIPAA Trading Partner Testing To Resume
MassHealth will resume HIPAA Compliance and Comprehensive Testing on September 9, 2009. Please call MassHealth Customer Service at 1-800-841-2900 to arrange Trading Partner testing before submitting any test files. Select Option 1, Option 8, then Option 3 to speak with an Electronic Data Interchange (EDI) unit representative to coordinate testing. You may also e-mail your request to test electronic X12 transactions to hipaasupport@mahealth.net. Any test files submitted without prior knowledge and coordination with the EDI unit will not be monitored for review of results.

If you plan to use an approved billing intermediary or software vendor to submit electronically you do not have to test with MassHealth directly. EDI will still need to obtain certain necessary information, however, prior to testing with your billing intermediary or software vendor. Testing instructions are being updated and will be posted to the Web. Please continue to check POSC Broadcast Messages for more information.

To all Nursing Facility and Rest Home Providers
Nursing facility and rest home providers who bill for Medical Leave-of-Absence (MLOA) and Non-medical Leave-of-Absence (NMLOA) using direct data entry (DDE), must enter the appropriate Occurrence Code and choose "BI" as the Occurrence Type from the Extended Services tab. In addition, please remember to complete the From and To date fields. Claims submitted for these services that do not contain this information will be denied. Thank you for your cooperation.
Update: Medicare Part B Crossover Denials for Error 7740
Some Medicare Part B crossover claims that were previously in suspense status have been processed by MassHealth. Medicare Part B crossover claims submitted to MassHealth for services that are not covered by MassHealth will be denied with Error 7740- FINAL EDIT PROC NOT COVERED BY PROV CONTRACT. Please refer to Broadcast Message dated 08/06/09 "NewMMIS Functionality Supports Medicare Part B Crossover Claim Repricing" for additional information
08/27/09
Third-Party Liability (TPL) Termination Letters from an Insurer
To notify MassHealth of a member's termination of insurance, you must complete a Third-Party Liability (TPL) Indicator Form. The TPL Indicator Form and the insurer letter must be faxed to the TPL unit at 617-357-7604. Please exclude MCO, Medicare and Medicare Advantage plans. You must specify the termination date of the insurance policy on the TPL Indicator Form. The TPL unit will update the member's file within five business days. Prior to submitting your claim to MassHealth, please check EVS to verify that TPL information has been updated. If you are submitting a paper claim to MassHealth, do not attach the TPL Indicator Form or the insurance termination letter to your claim.
The TPL Indicator Form may be downloaded at www.mass.gov/masshealth . Click on MassHealth Regulations and Other Publications, then on Provider Library, and then on MassHealth Provider Forms.
Important Message to all Nursing Home Providers
Nursing home providers submitting TPL claims no longer need to include non-Explanation of Benefits (EOB) attachments. Instead, MassHealth advises that you keep any TPL attachments such as Medicare Advanced Beneficiary Notices, Insurer UR Notices, Medicare Notices of Non-Coverage on file. For TPL purposes, Patient Status code or Condition codes are no longer used. Using these obsolete codes may cause your claims to deny. Providers must now submit electronic or paper TPL claims using the correct Adjust Reason code. Please follow the billing instructions listed in Transmittal letter (TL) NF-54 (April 2009). In addition, paper submissions must bill with a completed TPL Exception Form for Nursing Facilities and All Inpatient Hospitals. The TPL Exception Form is located on the Mass Health Web site at www.mass.gov/masshealth . Click on Mass Health Regulations and Other Publications, then on Provider Library, and then on Mass Health Provider Forms.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
08/26/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 8/30, from 6:00 pm to 10:00pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable Sunday 8/30, from 6:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of August 17, 2009
08/20/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Tonight, 8/20, from 9:00pm to 10:00pm
The NewMMIS POSC, including the internal NewMMIS application, Voice Response application, EVSpc, and all eligibility services, will be unavailable tonight, Thursday, 8/20, from 9:00 pm to 10:00 pm due to system maintenance. We apologize for the inconvenience.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
08/17/09
PIN Registration for New MMIS Provider Online Service Center (POSC) has been extended to September 30, 2009
MassHealth has heard your request for additional time to register to access the Provider Online Service Center (POSC), and has extended the registration period. The last day a provider may register on the POSC using their PIN will be September 30, 2009. After this date, the Primary User for each provider organization will be required to contact MassHealth Customer Service to gain access to the POSC. If you have not yet registered, we strongly urge you to take full advantage of the additional time to complete the POSC registration before September 30, 2009. Thank you for your cooperation.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of August 10, 2009
08/14/09
Nursing Home Providers that Bill for Members in Rest Home Beds Should Resubmit Denied Claims
Claims submitted by nursing homes that bill for members in rest home beds have been denying incorrectly. MassHealth has corrected this issue. Nursing home providers billing for these services should resubmit the denied claims using "Type of Bill" 860 through 865 and "Value Code" 24. Including this information will allow MassHealth to uniquely identify these services and process the claims appropriately. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.
08/13/09
To all Providers of Medical Supplies, Durable Goods, Oxygen and Respiratory Equipment and Pharmacy Providers
MassHealth is researching an issue involving HCPC codes that have been denied for Edit 2505: Member Covered by Medicare. Some of these codes will soon be mapped and set to "pay." In addition, MassHealth will reprocess those claims that denied incorrectly with Edit Code 2505 prior to the change to make them payable. MassHealth will communicate at a future time which HCPC codes were affected and when claims will be reprocessed. No further action is required by providers at this time.
Nursing Home Crossover Denials for Error 4059: Revenue Code Not on File
Crossover claims will no longer encounter denial Error 4059: Revenue Code Not on File, when billed with revenue codes 180, 182, 184, or 189 to report MLOA (Medical Leave of Absence) days. MassHealth will not reprocess previously denied claims. Instead, providers should resubmit the affected claims that denied. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
08/12/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT, 8/12, from 6:00 pm to 8:00 pm
The NewMMIS POSC, including the internal NewMMIS application and all eligibility services, will be unavailable tonight 8/12, from 6:00 pm to 8:00 pm due to system maintenance
NewMMIS Is Currently Experiencing Technical Difficulties:
Please be advised that users of both the NewMMIS Provider Online Service Center (POSC) and the internal NewMMIS application are experiencing difficulty accessing NewMMIS this morning. Technical teams are aware of the problem and working to resolve it. We apologize for the inconvenience and appreciate your patience. We will keep you posted on the status of this issue.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices.
08/11/09
Important Update about NewMMIS and Rest Home Claims
MassHealth has identified that some Rest Home claims were denied inappropriately for Edit 2052: Level of Care/Aid Cat Conflict. Claims that denied erroneously with this edit will be reprocessed and begin to appear on the August 18, 2009 Remittance Advice. No further action is required by providers. We apologize for any inconvenience this may have caused.
Reminder for Providers Submitting Adjusted Claims in NewMMIS
MassHealth recently informed providers that they can resume submitting claims as adjustments with the Legacy MMIS Transaction Control Number (TCN). The issue of some of these claims denying inappropriately was resolved.
However, when submitting adjusted claims using a Legacy TCN, please be sure to include the leading "20" of the TCN. For paper claim adjustments enter an "A" followed by the TCN.
MassHealth thanks you for your patience and cooperation.
** For more information about these notices or any previous notice, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of August 3, 2009
08/07/09
Important Update: Helpful Materials Available for MassHealth Providers:
For MassHealth Providers Who Submit Institutional Claims for MassHealth, MassHealth and Medicare, and MassHealth and Other Insurance:
MassHealth has posted three updated job aids on the e-learning training Web site. The Job Aids outline NewMMIS direct data entry (DDE) requirements for providers submitting Institutional Claims for members with MassHealth only, members with MassHealth and Medicare both and members with both MassHealth and other Insurance. These job aids have been added as: POSC - Submit an Institutional Claim with MassHealth, Submit an Institutional Claim with MassHealth and Medicare , and Submit an Institutional Claim with MassHealth and Other Insurance to the e-learning Web site at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/. The job aids are located in course POSC - Submitting Institutional Claims under the heading Course Materials.
For MassHealth Providers Who Bill Using the Form CMS-1500
MassHealth has posted additional CMS-1500 paper billing support documents to both the NewMMIS and e-learning training Web sites. The documents outline fields that need to be entered when filling out a CMS-1500 form for TPL and provide additional instructions for providers who bill using the paper CMS-1500.
These paper billing support documents have been added as Special Instructions for Submitting Claims on the CMS-1500 for Members with Medicare Coverage and Special Instructions for Submitting Claims on the CMS-1500 for Members with Commercial Insurance to the e-learning Web site at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/. The documents are located in course POSC - Submitting Professional Claims under the heading Course Materials.
The documents have also been added to the NewMMIS Web site, http://www.mass.gov/masshealth/newmmis. Click on Need Additional Information or Training? Then, click on Updated Billing Guides, Companion Guides, and Other Publications. The documents are located under the heading Billing Guides as Special Instructions for Submitting Claims on the CMS-1500 for Members with Medicare Coverage and Special Instructions for Submitting Claims on the CMS-1500 for Members with Commercial Insurance .
For MassHealth Providers Who Submit TPL Exception Claims for Home Health Agencies or for Chronic and Rehabilitation Hospitals:
MassHealth has posted additional job aids on the e-learning training Web site. The Job Aids outline NewMMIS direct data entry (DDE) requirements for providers submitting TPL Exception Claims for Home Health Agencies or for Chronic and Rehabilitation Hospitals.
These job aids have been added as: TPL Exception Claim Submission for Home Health Agencies and TPL Exception Claim Submission for Chronic and Rehabilitation Hospitals to the e-learning Web site at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/. The job aids are located in course POSC - Submitting Institutional Claims under the heading Course Materials .
** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
08/06/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Saturday, 8/8 from 7:00 am to 10:00 am
The NewMMIS POSC, including the internal NewMMIS application and all eligibility services, will be unavailable Saturday 8/8/09 from 7:00 am to 10:00 am due to system maintenance.
New Software Patch Now Available for MassHealth EVSpc Software Users
A new EVSpc patch (version 4.03) has been posted at Information and Software for Electronic Transactions to address a number of provider requests. If you have the new version of the EVSpc software for NewMMIS you simply need to download that patch and not the entire version of the software. Information and Software for Electronic Transactions also has a link for release notes detailing the nine updates that were applied to the software which include the software now highlighting changes to member eligibility from a previous eligibility inquiry on the EVSpc software for the same member. Please call MassHealth Customer Service at 1-800-841-2900 with any questions.
NewMMIS Functionality Now Supports Medicare Part B Crossover Claim Repricing
As outlined in All Provider Bulletin 114, ( See www.mass.gov/Eeohhs2/docs/masshealth/bull_2002/all-114.pdf ), MassHealth will pay Medicare Part B crossover claims up to the MassHealth allowable amount less any Medicare payment, or the coinsurance and deductible amount, whichever is less.
In calculating the difference between the MassHealth allowable amount and the Medicare payment, NewMMIS will look to see if MassHealth has adopted the Medicare code or has a comparable code for the service and look at the rate for the applicable code. MassHealth will not pay for non-covered services.
However, MassHealth will pay co-insurance and deductibles for services that are covered by Medicare and would not otherwise be covered by Medicaid when the service is provided to a MassHealth member who is eligible for coverage of Medicare coinsurance and deductibles.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
08/05/09
NewMMIS "Zero Paid Claims" Issue Has Been Resolved
Beginning in July 2009, some claims began paying zero inappropriately with EOB code 9928: COB-TPL Cost Savings. MassHealth is pleased to inform you that it has resolved the issue. Affected claims are being reprocessed. No further action is required by providers at this time. If you have questions, contact MassHealth Customer Service at 1-800-841-2900.
** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
08/04/09
Claims Adjustment Issue in NewMMIS Has Been Resolved:
In July, MassHealth advised providers that certain claims submitted as adjustments with the Legacy MMIS Transaction Control Number (TCN) were denying inappropriately and that providers should hold such submissions pending further notice.
MassHealth is pleased to inform providers that this issue has been resolved and that providers can now submit claims as adjustments with the Legacy MMIS TCN
MassHealth thanks you for your patience and cooperation.
Messages from the Week of July 27, 2009
07/30/09
Notice of POSC Technical Issues:
Please be advised that the POSC has experienced a few 15-30 minute periods of technical issues since Tuesday 7/28/09. Until the issue is resolved, you might experience short periods where POSC is not accessible or responsive. When this happens, you may not be able to complete the current action you are performing. Should you experience an outage or slow response, please wait 15 minutes and try your transaction again. We apologize for any inconvenience this causes.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
07/28/09
Notice Concerning Acute Outpatient NewMMIS Claims Filed with an Institutional Form or Transmission:
Some providers are receiving the following message in error in response to acute outpatient claims filed on an institutional UB-04 claim form or via an 837 I claim transmission: "520 INVALID REVENUE CODE/PROCEDURE CODE COMBINATION." MassHealth is aware of this issue and its cause, and is actively working to add the revenue code/procedure code combinations that are accepted. We will keep you posted as to our progress. Thank you for your patience and cooperation.
EVS Health Safety Net (HSN) Secondary Messaging Issue Has Been Resolved:
Previously, EVS incorrectly displayed the following restrictive message when a patient was eligible for Health Safety Net or Partial Health Safety Net and there was no other health insurance on file on the date of service searched:

"Member is HSN Secondary. Bill member's private health insurance. See 114.6 CMR 13.00 for info on TPL REQs."

This restrictive message now only appears when the member has other insurance that is known to MassHealth. This issue has now been resolved. If you have any questions, please contact the Health Safety Net Helpdesk at 1-877-910-2100.
Update Regarding NewMMIS Claims Denied for Error Code 1945:
Claims processed in NewMMIS for week ending July 24 that denied in error for edit "1945-MULT SAK PROV LOCS FOR BILLING PROV SPEC" may now be rebilled to MassHealth. The error, caused by a change to the MassHealth NPI crosswalk that resulted in denials for providers that bill with a single NPI but who have multiple service locations, has been resolved. We apologize for the inconvenience. Providers who receive this error message appropriately should contact MassHealth Customer Service at 1-800-841-2900 to discuss claim submission options.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
7/27/2009
Important Announcement about Claims Submitted on NewMMIS
Beginning July 20, 2009 some claims in NewMMIS began denying inappropriately for error code 1945-MULT SAK PROV LOCS FOR BILLING PROV SPEC. A change was made to the MassHealth NPI crosswalk on July 19 that resulted in denials for providers that bill with a single NPI but have multiple service locations. MassHealth is working to correct this issue as quickly as possible and will provide an update soon. Thank you for your patience.
Messages from the Week of July 20, 2009
7/21/09
NewMMIS E-Fax Issue Has Been Resolved
Previously, MassHealth indicated that we were experiencing problems viewing some of the attachments submitted by providers using e-fax. This problem has been resolved. All attachments generated via e-fax will be created in PDF format. Please ensure that you download the free Acrobat Reader 7.0 or newer to open and read documents in PDF format. If you have any questions, please contact MassHealth Customer Service at 1-800-841-2900.

To MassHealth Providers Who Bill Using Form UB-04
MassHealth has posted an additional UB-04 TPL paper billing support document to both the NewMMIS and e-learning training Web sites. The document outlines fields that need to be entered when filling out a UB-04 form for TPL and provides additional instructions for providers who bill using the paper UB-04.
This paper billing support document has been added as the UBO4 Claim Form_TPL Required Information job aid to the e-learning Web site at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/. The job aid is located in course POSC - Submitting Institutional Claims under the heading Course Materials.
This document has also been added to the NewMMIS Web site as Special Instructions for Submitting Claims on the UB-04 for Members with Other Health Insurance. It can be found at http://www.mass.gov/masshealth/newmmis under Need Additional Information or Training? Click on Updated Billing Guides, Companion Guides, and Other Publications. The document is located under the heading Billing Guides.
Thank you for your cooperation.
TPL Denials for Error Codes 2502 and 2505 for Personal Care Agencies and Independent Living Providers
MassHealth will reprocess claims that denied for error codes 2502, Member Covered by Other Insurance, or 2505, Member Covered by Medicare for Billed Procedure Codes S5160 and S5161, on a future RA. Please do not resubmit these claims. No further action is required by providers. New third party liability (TPL) claims submitted to MassHealth for these services will not receive error 2502 or 2505. If you have questions, please call MassHealth Customer Service at 1-800-841-2900.
** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
URGENT: Message for Users Experiencing Login Issues on NewMMIS this Morning
Please be advised that some NewMMIS users are experiencing login issues this morning. A feature requiring users to reset their passwords after 90 days is not working properly. Consequently, when some users reset their password, they receive an unexpected error message. Technical teams are aware of the problem and are currently working to resolve the issue. We apologize for any inconvenience. We will provide updates on this issue as more information becomes available. Thank you for your patience.
Messages from the Week of July 13, 2009
7/17/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 7/19 from 6:00 pm to 8:00 pm:
The NewMMIS POSC, including the internal NewMMIS application and all eligibility services, will be unavailable from 6:00 pm to 8:00 pm due to system maintenance.
7/16/09
Update from MassHealth About NewMMIS and Prior Approvals:
MassHealth has identified some issues in the Prior Approval (PA) area that are expected to be corrected over the next few weeks. These changes will enable the MassHealth PA Unit to process requests more quickly and eliminate any backlog. Please be assured that MassHealth is committed to resolving these issues expeditiously, and to working with providers to ensure that services to members are not interrupted, and that members newly requesting services receive timely access to those services. To that end, we've determined that additional training would help providers during this time to work through the issues and to enhance their overall understanding of the new system and processes. The next training addressing PA/PAS issues is scheduled for August 15. You may register for a session through the MassHealth e-Learning system at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/default.asp. Once logged in, open the Course Catalog and select NewMMIS Question and Answer Sessions by Topic for Providers. Click on View Course Details and Enroll. To register for a session, click on Session Schedule tab and select the applicable Action button.
While we address these issues, here is some information that will be helpful to you:

Please be aware that Personal Care Attendant (PCA) PAs are being extended to eliminate a break in service. When the new PA is adjudicated the extension will be end-dated and the new PA will start the next day. To further assist PCA providers, MassHealth is updating the job aids regarding prior authorization to make those job aids specific to the PCA program.

Durable Medical Equipment (DME) providers should e-mail Tania.Gray@state.ma.us and "cc:" cemilia.ceme@state.ma.us if they have specific PAs that are about to expire in order for the PAs to be adjudicated immediately. To help MassHealth concentrate on PAs whose expiration date is imminent, DME providers are asked not to contact MassHealth about PAs that are not due to expire until August.

All providers: Be sure to check EVS before submitting PA's to determine if the member is eligible. Please note a warning message will also display if you attempt to submit a PA via the POSC for a member that is not eligible.

Voiding PAs: If you previously encountered difficulty voiding PAs, please be advised that this issue has been resolved and you should now be able to void a PA if you have changed your mind and no longer want to submit the PA to MassHealth. Once the PA has been submitted to MassHealth you will need to contact the PA Unit if you want to void the PA.

Searching using an old provider number: You can search for PAs using your old provider number but please be advised that two zeros must be inserted in front of your "legacy" provider number.

Duplicate Errors: In certain circumstances providers get a "duplication" error when they attempt to submit a PA. To avoid this error, change the service date by one day (so it does not duplicate against the previous PA). This allows the PA to go through. You should indicate the correct service dates in the comment section and MassHealth will update the dates on the PA.

E-fax issue: MassHealth is experiencing problems viewing some of the attachments that come in via e-fax. Please note that the PA Unit will contact you if there is a problem viewing your attachments. Work is underway to resolve this issue. We will keep you posted as to resolution progress. Please do not stop using e-fax service as, absent the ability to upload scanned documents, this is the most expeditious way to submit your attachments with your electronic PA submission.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
7/15/09
Direct Data Entry Cannot Be Used For Billing National Drug Codes (NDC) For Physician-Administered Drugs:
Please be advised that claims for physician-administered drugs that require NDC information cannot be received as direct data entry (DDE) claims in the Provider Online Service Center. These claims must be submitted on paper using the CMS-1500 claim form or electronically using an 837 transaction.
For general information about billing these claims, please see the appropriate billing or companion guide or go to www.mass.gov/masshealth and click on MassHealth and HIPAA, then on Electronic Data Interchange (EDI) and HIPAA Information for Providers, then on the MassHealth Companion Guides link, and choose the 837P/837I Companion Guide or UB-04 or CMS-1500 Billing Guide.
Third Party Liability (TPL) Paper Claims Notice:
Some providers may have experienced a delay in the processing of their TPL paper claims (Commercial and Medicare) due to a lack of submitting required information on the claim form. MassHealth has addressed the issue for the majority of the affected claims. Providers should begin to see their TPL claims process on future remittance advices. As a reminder, it is important that you enter the carrier code on your claim form. If there are multiple payers, indicate the carrier code on each explanation of benefits (EOB). Please refer to Appendix C of your MassHealth provider manual for a list of MassHealth carrier codes. The provider manuals can be found in the Provider Library at www.mass.gov/masshealth/masshealthpubs. If you have questions, please call Customer Service at 1-800-841-2900.
Atypical Providers Billing with the NewMMIS Provider ID Service Location (PID SL):
MassHealth identified a system issue for atypical providers submitting 837I and 837P transactions using their PID SL. The system is dropping the service location (SL) from the PID SL, causing claims to deny for EOB code 254-Billing Provider Location Missing. This issue is being corrected by Thursday, July 16, 2009. Please note that paper claims and direct data entry (DDE) claims have not been affected. The claims that were denied erroneously as a result of this issue will be reprocessed at a future date. Providers can wait for the reprocess of these claims or resubmit them through EDI after July 16 or through direct data entry (DDE) or on paper. If you have questions please call MassHealth Customer Service at 1-800-841-2900.
Please Hold Claims Adjustments:
Certain claims submitted as adjustments with the Legacy MMIS Transaction Control Number (TCN) have denied inappropriately with EOB codes 550-Adjustment Failed and 1101-Invalid Adjustment Former TCN. Claims that denied erroneously with these edits will be reprocessed on a future date. No further action is required by providers. Due to this problem, MassHealth recommends that providers hold all adjustments that would be submitted with a former Legacy MMIS TCN until further notice. We apologize for the inconvenience.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT, 7/15 from 6:00 pm to 9:00 pm:
The NewMMIS POSC, including the internal NewMMIS applications, will be unavailable TONIGHT, 7/15, from 6:00 pm to 9:00 pm due to system maintenance. However, from 8 pm to 9 pm, the following WILL BE AVAILABLE: EVSpc, HTS and the Automated Voice Response (AVR).
7/14/09
Webex Provider training sessions:
MassHealth is holding several NewMMIS Webex training sessions for the provider community throughout July and August. Each session will focus on a different functional area of the system. Some of the topics include third-party liability, referrals, prior authorizations, and professional and institutional claims.
You may register for a session through the MassHealth e-Learning system at http://masshealthnewmmisprovidertraining.ehs.state.ma.us/default.asp. Once logged in, you should open the Course Catalog and then select NewMMIS Question and Answer Sessions by Topic for Providers. To identify specific learning opportunities, click on View Course Details and Enroll. To register for a session, click on the Session Schedule tab and select the applicable Action button. Failure to follow these registration steps exactly will result in an incomplete registration and you will not receive the needed course materials.
MassHealth will e-mail downloadable software and course access instructions to all registered providers upon successful enrollment into a course. If you have questions contact MassHealth Customer Service at 1-800-841-2900.
Topic
Month of July
1PM - 3PM
Month of August
1PM - 3PM
TPL & Crossovers
7/7/09
8/3/09
PA/PAS
7/15/09
8/13/09
Professional Claims
7/20/09
8/17/09
Referrals
7/23/09 - new date
8/10/09
Institutional Claims
7/30/09
8/25/09

Please Remember to Check View Broadcast Messages in the Provider Online Service Center (POSC):
It is important that you make it a part of your routine to check Broadcast Messages daily for any critical information or communications that MassHealth has posted. POSC Broadcast Messages are one of the primary methods MassHealth uses to communicate timely updates to providers. To access Broadcast Messages, sign on to the POSC, click on Manage Correspondence and Reporting, and then click on View Broadcast Messages.
Medicare Benefits Exhausted Claims Notice:
MassHealth has identified an issue where the Medicare Part B ancillary payments are not being deducted from Medicare Benefits Exhausted claims. MassHealth is actively working on a resolution and will reprocess all affected claims. In the interim, providers should continue to bill these claims to MassHealth. Please check future messages for updates. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.
Nursing Home Crossover Claims Notice:
MassHealth has identified an issue where a patient paid amount is deducted when there is no patient paid amount on file for the member. No action is required by the provider. Masshealth is actively working on a resolution and will reprocess all affected claims. Please check future messages for updates. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.
TPL CLAIM SUBMISSIONS FOR MEDICARE NONCERTIFIED CLINICIANS (Community Health Centers, Therapists, Mental Health Centers):
Please be advised that previously-used third-party liability (TPL) billing instructions for Medicare noncertified clinician services are no longer valid. For now, providers should submit any claims for Medicare noncertified services directly to MassHealth. These claims will not be denied due to the Medicare coverage of the member at this time. MassHealth is revising billing instructions for how to bill for services provided by Medicare noncertified clinicians and will begin editing for Medicare coverage when the new billing instructions are published. If you have questions, please contact MassHealth Customer Service at 1-800-841-2900.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
Messages from the Week of July 6, 2009
7/10/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, 7/12 from 6:00 pm to 9:00 pm:
The NewMMIS POSC will be unavailable Sunday from 6:00 pm to 9:00 pm due to system maintenance. However, during this time the following WILL BE AVAILABLE: EVS, EVSpc, HTS, the Automated Voice Response (AVR), and the internal NewMMIS application. Thank you.
07/07/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance TONIGHT Tuesday, 7/7 from 9:00 pm to 10:00 pm:
Tonight, July 7, NewMMIS POSC will be unavailable from 9:00 pm to 10:00 pm due to system maintenance. During this time, EVS, EVSpc, HTS, the Automated Voice Response (AVR), and the internal NewMMIS application will all be unavailable.
Messages from the Week of June 29th
07/02/09
Lost Permissions Problem Corrected:
Previously, defects in subordinate ID creation and maintenance panels prevented some providers from modifying permissions, and/or permissions were not being accepted after modifications were made to user profiles. These defects have been fixed. Users should no longer receive error messages indicating that a user is already linked when they attempt to assign permissions. Additionally, role modifications made to existing user profiles should be accepted and now stay applied.
PIN Registration at the POSC Ending August 25, 2009 :
August 25, 2009 is the last day that Providers may register on the POSC using their PIN. After this date, the Primary User for each provider organization will be required to contact the CST to gain access to the POSC. If you have not yet registered, we strongly urge you to complete the POSC registration before August 25, 2009.
View the status of electronic batch claims - a general rule of thumb to check for claim status :
Viewing the status of electronic claims through the POSC varies based upon the media type used and the time that the claim is submitted. If your claim is submitted at the POSC via Direct Data entry (DDE) the status of that claim will appear immediately upon submission of the claim. If you utilize the 837 batch claim submission option, and submit a batch of claims in the morning, you will be able to view the status of the claims that same afternoon. However, if you submit the 837 batch claims in the afternoon, you should not expect to be able to view the status of those claims until the next business day. This allows sufficient time to process the claims in that batch.
Notice to PCAs regarding FI Information on Prior Authorizations:
The FI information that is being automatically populated for PAs in the 'FI' field in the 'Basic Medical Detail' section on the 'Line Items' tab may be incorrect. This incorrect information will not have any impact on the systems ability to accurately process your PA request. If you encounter incorrect information that is automatically populated in the FI field, please disregard it. You will be informed when this issue has been corrected.
07/01/09
To all MassHealth Providers
The 835 files for the June 19th financial cycle are now available for download.
Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Tonight
NewMMIS and the POSC will be unavailable tonight, Wednesday, July 1 from 8:00 pm to 9:00 pm for system maintenance. In addition, the HTS service will be unavailable from 8:45 pm to 9:00 pm. This will not impact the other services with NewMMIS. Thank you for your continued support.
Notice to all NewMMIS and Provider Online Service Center (POSC) Users
Users of NewMMIS and the POSC may experience intermittent unavailability between 5:00 am and 5:30 am each day while system maintenance occurs. This will not impact the other services with NewMMIS. Thank you for your continued support.
Messages from the Week of June 22nd
6/30/09
To all MassHealth Providers:
The 835 payment files for the June 19th financial cycle are delayed. We will keep providers updated as to when the 835 files are available to download from the NewMMIS Provider Online Service Center (POSC). Thank you for your patience and cooperation.
To all NewMMIS Provider Online Service Center (POSC) Users Who Use the Firefox Web Browser:
POSC users who use the Firefox web browser are advised to refrain from using the Firefox browser "Back" button while working in the POSC application, as this may have unexpected results. Instead, please use the POSC navigation buttons labeled "Back" or "Go Back to Search Results." Thank you for your cooperation.
06/26/09
Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, June 28:
NewMMIS and the POSC, including the internal NewMMIS application, will be unavailable Sunday, June 28 from 8:00 pm to 9:00 pm for system maintenance. During this time, the following access methods for eligibility verification will remain available:
EVSpc
HTS
Automated Voice Response at 1.800.540.0042
Update on MassHealth Payments for the Remainder of Fiscal 2009
MassHealth executed its regularly scheduled pay cycle on Friday, June 19 and will do so again on Friday, June 26. Each pay cycle results in remittance advices being available on the following Tuesday, with checks issued three days later and EFTs accessible six days later.
The June 19 pay cycle included all types of providers; the pay cycle included payments for clean claims received on or before May 27.
The pay cycle on June 26 will include all types of providers, and will include payments for clean claims received on or before June 3.
MassHealth intends to resume normal processing of payrolls in July. Additional information regarding those payrolls will be communicated through the MassHealth website, the Provider Online Service Center (POSC) and other channels.
MassHealth continues to evaluate hardship payment requests and is actively approving such requests subject to the availability of MassHealth resources. Providers who have been approved for a hardship payment are being contacted directly regarding such payments. If you are considering submitting a hardship request, please do so in light of the claims that you expect will be paid in the payroll that will run on June 26.
Requesting a Hardship Payment
Providers who are facing significant financial distress resulting from payment delays may call Customer Service at 1-800-841-2900 to request a hardship payment per the guidelines below.
When calling Customer Service to request a hardship payment, providers will be asked to demonstrate urgent need and should be prepared with the following information:
The name and contact information for a single individual within the organization who is knowledgeable about financial matters and authorized to make financial decisions;
The immediate impact of the financial hardship;
The number of days of operating cash on hand;
The proportion of MassHealth MMIS payments within the provider's overall payer mix;
Date and amount of the last MassHealth payment received; and
The minimum payment necessary to alleviate the financial hardship through the end of June.
When calling, providers should clearly indicate that they are requesting a hardship payment. Customer service representatives are prepared to respond to these calls and will request the information outlined above and convey it to MassHealth for evaluation in light of the severity of the need and the availability of resources. MassHealth is mindful of the difficulties imposed by fiscal management decisions and appreciates your patience and understanding as we manage through the end of the fiscal year.
Important Follow-up Message to MassHealth Providers About Claims and Payments:
MassHealth recently announced that some claims that were approved to pay in the last pay cycle are being held in a "fiscal pend" status to enable the agency to manage cash flow within available resources at fiscal year end. MassHealth is actively developing a plan for disbursement of funds for the remainder of the fiscal year and anticipates making some limited payments between now and the end of the month. Details regarding the schedule of such payments and their distribution among provider types will be communicated as soon they are available. Normal pay cycles are expected to resume in July.
MassHealth will consider hardship payment requests fromindividual providers who are facing significant financial distress resulting from payment delays. When calling Customer Service (1-800-841-2900)to request a hardship payment, providers will be asked to demonstrate urgent need andshould be prepared with the following information:
The name and contact information for a single individual within the organization who is knowledgeable about financial matters and authorized to make financial decisions;
The root cause of the financial hardship, i.e., claims submission difficulties, NewMMIS system defects, MassHealth payment delay, etc.;
The number of days of operating cash on hand;
The proportion of MassHealth MMIS payments within the provider's overall payer mix;
Date and amount of the last MassHealth payment received; and
The minimum payment necessary to alleviate the financial hardship through the end of June.
When calling, providers should clearly indicate that they are requesting a hardship payment. Customer service representatives are prepared to respond to these calls and will request the information outlined above and convey it to MassHealth for evaluation in light of the severity of the need and the availability of resources. MassHealth is mindful of the difficulties imposed by fiscal management decisions and appreciates your patience and understanding as we manage through the end of the fiscal year.
Important Update:
New MMIS POSC Primary Users Modifying Permissions for Subordinate Users
Recently, we notified NewMMIS POSC users of a resolution to an issue in which POSC Primary Users attempting to modify permissions for their subordinates were losing permissions of users in other accounts, and modifications made to subordinate accounts appeared to save successfully, but actually did not.
While most providers are not reporting any difficulties, a small number of providers are reporting they are still encountering problems. MassHealth is researching these reports and will update users shortly.
In the meantime, we reiterate our previous update regarding this issue:
You still you may begin to modify accounts again. If you do experience a problem again, please do not create additional ID's for users. This only populates the system with a significant number of unused accounts. Please contact NewMMIS Customer Service at 1-800-841-2900.
Thank you for your patience and cooperation.
** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
FYI: Change in Claims/Payment Processing Cycles Due to July 4th Holiday
In order to accommodate early processing in advance of the July 4th holiday, the NewMMIS weekly claims and financial payment processing cycles will be run on Thursday, July 2 rather than Friday, July 3.
For more information about the relationship between claims submittal, adjudication and RA reporting, please see the notice entitled "NewMMIS Payment Cycle", dated June 2, 2009, found under the "Manage Claims and Payment" heading on the www.mass.gov/masshealth/newmmisnotices web page. Also, feel free to refer once again to the two communications shown at the top of that web page, entitled "Important Follow-up Message to MassHealth Providers about Claims and Payments" and "To all MassHealth Providers."
Thank you for your patience and cooperation.
** For more information about these notices or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
06/22/09
Update: New MMIS Provider Online Service Center (POSC) Primary Users Modifying Permissions for Subordinate Users
Providers were notified in late May that POSC Primary Users who attempted to modify permissions for their subordinates were losing permissions of users in other accounts. Subsequently, modifications made to other subordinate accounts appeared to save successfully, but the accounts were not actually modified.
At that time MassHealth informed providers that they should assign permissions at the time the subordinate accounts were created, and NOT to modify accounts after they were created.
MassHealth has fixed this problem in the application. You may begin to modify accounts again. We apologize for any inconvenience this may have caused.
If you experience a similar incident again, please do not create additional ID's for users. This only populates the system with a significant number of unused accounts. Please contact NewMMIS Customer Service at 1-800-841-2900.
Thank you for your patience and cooperation.
Messages from the Week of June 15th
06/17/09
NewMMIS and Provider Online Service Center (POSC) System Maintenance Thursday, 6/18:
On Thursday, June 18, there will be two NewMMIS and POSC system maintenance outages affecting NewMMIS, the POSC, EVS, EVSpc, HTS, the Automated Voice Response (AVR), and the internal NewMMIS application. During these times will be no access to these services, nor access to eligibility verification services. The outage times are:
5:00 am to 5:30 am
8:00 pm to 2:00 am
Important Follow-up Message to MassHealth Providers About Claims and Payments:
MassHealth recently announced that some claims that were approved to pay in the last pay cycle are being held in a "fiscal pend" status to enable the agency to manage cash flow within available resources at fiscal year end. MassHealth is actively developing a plan for disbursement of funds for the remainder of the fiscal year and anticipates making some limited payments between now and the end of the month. Details regarding the schedule of such payments and their distribution among provider types will be communicated as soon they are available. Normal pay cycles are expected to resume in July.
MassHealth will consider hardship payment requests fromindividual providers who are facing significant financial distress resulting from payment delays. When calling Customer Service (1-800-841-2900)to request a hardship payment, providers will be asked to demonstrate urgent need andshould be prepared with the following information:
The name and contact information for a single individual within the organization who is knowledgeable about financial matters and authorized to make financial decisions;
The root cause of the financial hardship, i.e., claims submission difficulties, NewMMIS system defects, MassHealth payment delay, etc.;
The number of days of operating cash on hand;
The proportion of MassHealth MMIS payments within the provider's overall payer mix;
Date and amount of the last MassHealth payment received; and
The minimum payment necessary to alleviate the financial hardship through the end of June.
When calling, providers should clearly indicate that they are requesting a hardship payment. Customer service representatives are prepared to respond to these calls and will request the information outlined above and convey it to MassHealth for evaluation in light of the severity of the need and the availability of resources. MassHealth is mindful of the difficulties imposed by fiscal management decisions and appreciates your patience and understanding as we manage through the end of the fiscal year.
06/16/09
NewMMIS System Maintenance TONIGHT 6/16:
Tonight, Tuesday June 16, portions of NewMMIS will be unavailable from 9:00 pm to 9:30 pm for system maintenance.
EVS (from POSC) and POSC will be AVAILABLE.
HTS services, EVS pc, and AVR (Auto Voice Response) will be UNAVAILABLE.
All other Virtual Gateway Services will be available. We apologize for the inconvenience.
TO ALL MASSHEALTH PROVIDERS:
As the end of the fiscal year approaches, MassHealth will need to delay some Fiscal Year 2009 payments until Fiscal Year 2010. In the past, such claims would have appeared on the legacy remittance advice (RA) in a status of "fiscal pend." Additional systems work is required in NewMMIS before RAs produced by NewMMIS are able to display that same status message. As such, you may receive RAs that do not contain any information about claims that are approved to pay in this fiscal year but are being held for payment until next fiscal year. We apologize for the inconvenience and are mindful of the financial strains that payment delays cause for providers.

If you experience a significant financial hardship related to unpaid MassHealth claims, please call MassHealth Customer Service at 800-841-2900 to request relief. We will evaluate such requests based on the severity of the need and in light of available MassHealth resources. Please note that this situation is temporary and payments will resume on schedule with approval of the FY2010 budget.

Thank you for your cooperation during this difficult period.
06/15/09
Notice of NewMMIS System Maintenance TONIGHT, 6/15:
Tonight, Monday June 15, portions of NewMMIS will be unavailable from 9:00 pm to 10:00 pm for system maintenance. The following lists what will be available and unavailable tonight during this time:
HTS services: Unavailable
EVS pc: Unavailable
AVR (Auto Voice Reponse): Unavailable
EVS (from POSC): Available
POSC: Available
Messages from the Week of June 8th
06/13/09
IMPORTANT NewMMIS UPDATE AS OF SATURDAY JUNE 13, 1:30PM: System Maintenance for NewMMIS and Provider Online Service Center (POSC) extended beyond 11:00AM:
Please note that system maintenance originally scheduled to be completed at 11:00 am today, Saturday June 13, for NewMMIS, the POSC, EVS, EVSpc, HTS, the Automated Voice Response (AVR) and the internal NewMMIS application needs to be extended beyond that time. All of these functions are currently unavailable. During this time, there is no access to eligibility verification services. Work is currently underway to have all services available as soon as possible. Please check for a message on the web site https://gateway.hhs.state.ma.us/authn/index.jsp?throughout the day Saturday for status updates. If you see no messages on that page, this means all services mentioned above are available. Thank you for your patience and cooperation.
06/12/09
System Maintenance June 13 for NewMMIS and Provider Online Service Center (POSC):
Please note that NewMMIS, the POSC, EVS, EVSpc, HTS, the Automated Voice Response (AVR) and the internal NewMMIS application will all be unavailable Saturday, June 13, from 6:00 am 11:00 am for system maintenance. During this time, there will be noaccess to eligibility verification services. Thank you for your patience and cooperation.
Notice about Certain Transportation Claims:
MassHealth has identified that certain claims for transportation providers are erroneously denying for "Edit 251 - 1st Modifier Invalid." MassHealth is reviewing the denied claims and will reprocess these claims once the problem is resolved. No further action is required by providers at this time.
Explanation of Benefit Codes List:
A list of the explanation of benefit (EOB) codes that appear on the remittance advice is posted on the MassHealth Web site. This list was previously published as Part 6 of Subchapter 5 of every MassHealth provider manual. It is now a freestanding list. You can find the list from the MassHealth home page by clicking on:
"Information for MassHealth Providers", then on
"MassHealth Claims Submission"
You will see "List of Explanation of Benefit Codes Appearing on the Remittance Advice." The link is not called Error Codes, as stated in Part 6 of Subchapter 5. That incorrect navigation will be corrected in an upcoming transmittal letter.
Notice to PCM Providers:
Some PCM providers who attempt to adjust existing Prior Authorizations (PAs) that were converted from APAS do not have the NewMMIS issued Prior Authorization number for that PA. In order to acquire the appropriate NewMMIS PA number, providers should search for the PA on the "Search for Prior Authorizations" panel by entering certain information (i.e. select the correct Provider ID Service Location, member name, status, etc.) into the PA search panels in NewMMIS. Please refer to the "Inquire on PA" job aid located on www.mass.gov/masshealth/newmmis to review how to use the search function.
Important Information about HIPAA Batch Claims:
Recently, a number of HIPAA batch claims have denied for edit 1945, as we are not able to match the claim to the correct unique provider service location. This may occur when a provider has enumerated with one NPI for multiple NewMMIS provider IDs. Providers who have enumerated with one NPI for multiple NewMMIS provider IDs and that are "required" to bill MassHealth using a taxonomy code, must enter the Provider Type Qualifier of BI in PRV01 of the 2000A loop in 837 HIPAA batch claims. The HIPAA Companion Guides are being updated to reflect this information. Providers will need to resubmit these claims and should contact Customer Service at 1-800-841-2900 if they have questions.
06/09/09
Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance this week - June 9 - 12
Between 5:00 am and 5:30 am each day this week users of POSC may experience intermittent unavailability. This is a temporary problem and will be corrected shortly.
Between 12:00 Midnight and 12:30 am daily this week Member and Claims operations on POSC, IVR, HTS and EVSpc will be unavailable
This Thursday, June 11, NewMMIS and the POSC will be unavailable from 9:00 pm to 10:00 pm for system maintenance.
Advisory about Primary Users Modifying Permissions for Subordinate Users
Currently, some NewMMIS POSC Primary Users are not able to grant or modify permissions for some Subordinate Users. We are aware of this issue and it is currently being evaluated. In the interim, if you encounter problems granting or modifying Subordinate User permissions, please stop making any modifications to your subordinate profiles. You do not need to call Customer Service or take any other action at this time. A fix to this issue will be announced soon and distributed to users and posted on
http://www.mass.gov/masshealth/newmmisnotices .
Thank you for your patience and cooperation.
** For more information about these notices or any previous notices, please visit
http://www.mass.gov/masshealth/newmmisnotices
Attention HIPAA 835 Transactions Users
The HIPAA 835 transactions that were planned to be available for download on the evening of June 8 will not be available until June 11, 2009 at the earliest. This postponement is to allow additional validation of the payment information received from the Comptroller's office.
Accessing Eligibility Inquiry History on NewMMIS
To view eligibility inquiry history on NewMMIS, please be sure to do the following from the Provider Online Service Center (POSC) home page:
Select the "Manage Members" option from the POSC home page
Select "Inquire Eligibility Request"
Enter the Tracking Number or Member ID and Date of Service. You will then see all applicable eligibility inquiry requests.
Reminder - How to Access Copies of PA Letters
If you wish to review PA notices, please be sure to go to the POSC home page and select "Manage Correspondence and Reporting", then select "View Notifications."
Reminder - About Service Authorization Numbers
Please note that Service Authorization Numbers may contain alpha characters in addition to the first character, which identifies the type of service authorization.
06/08/09
Recommended Times to Contact MassHealth Customer Service about NewMMIS Issues:
Since NewMMIS was implemented on May 26, MassHealth Customer Service has been experiencing higher call volumes and occasionally longer wait times than during the period prior to implementation. If you are able, please consider contacting us when call volume is lowest: 8:30 - 9:30 AM, 12:00 - 2:00 PM or 5:00 - 6:00 PM. We hope this is helpful to you. Thank you for your patience and cooperation.
To Providers Attempting to Verify Eligibility using Member Name:
It has been reported that some providers attempting to verify eligibility using member name are receiving the following message:

Multiple Members found matching criteria-call 800-833-7582 for assistance

First,the phone number in this error message is incorrect and will be updated shortly in NewMMIS. The correct telephone number for providers to call is 800-841-2900.

Second, providers who receive multiple search results when attempting to verify eligibility by member name should refine their search results by performing eligibility verification using:
The member's 12-digit Medicaid ID, OR
Social Security Number, OR
For DYS and DCF Members only: Other Agency ID beginning with X or Y.
Eligibility verification performed using the above search criteria will always return search results for a single member, thus eliminating multiple search results.
Messages from the Week of May 31st
06/05/09
Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Sunday, June 7:
NewMMIS and the POSC will be unavailable Sunday, June 7 from 6:00 pm to 12:00 midnight for system maintenance. In addition, the EVS eligibility system will be unavailable from 6:00 pm to 7:00 pm Sunday night. From 7:00 pm to 12:00 midnight, the following access methods for eligibility verification will remain available:
EVSpc - available for download at www.mass.gov/masshealth/newmmis
TS - any vendor or provider that connects to NewMMIS in a system-to-system approach or web service
Automated Voice Response at 1.800.540.0042
06/04/09
Important Notice about Medicare Part C Claims
Masshealth is conducting additional validation of Medicare Part C claims. While this validation is in process, certain Part C crossover claims will suspend for Edit 1036: RENDERING PROVIDER NOT ELIGIBLE TO BILL THIS CLAIM TYPE. The issue is expected to be resolved shortly. Therefore no actionis necessary for providers. Thank you for your patience
Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Tonight:
NewMMIS and the POSC will be unavailable tonight, Thursday, June 4 from 9:00 pm to 10:00 pm for system maintenance.
O6/04/09
To all specialists / servicing providers billing for services that required a PCC Plan referral before implementation of NewMMIS on May 26, 2009:
When submitting claims for such services you must place two leading zeros in front of the old PCC referral number. For example, if the PCC referral number under legacy MMIS was 9712345, you must now use 009712345 when submitting the claim in NewMMIS.

** For more information about this notice or any previous notices, please visit www.mass.gov/masshealth/newmmisnotices
06/03/09
Notice of NewMMIS and Provider Online Service Center (POSC) System Maintenance Tonight
NewMMIS and the POSC will be unavailable tonight, Wednesday, June 3 from 9:00 pm to 10:00 pm for system maintenance.

Messages from the Week of May 24th
06/02/09
Notice of NewMMIS Provider Online Service Center (POSC) System Maintenance Tonight:
The NewMMIS POSC will be unavailable tonight, Tuesday, June 2 from 9:00 pm to 10:00 pm for system maintenance.
NewMMIS Payment Cycle
NewMMIS adjudicates claims more quickly than the former system, offering providers more timely insight into the status of their claims submissions. Soon after claims are submitted, providers are able to check their status via the POSC to see if claims are approved to pay, are denied or are suspended. However, the actual payment cycles for NewMMIS are the same as they were under the old system, with MassHealth typically releasing funds for paid claims to most providers within three weeks after the claim has been approved to pay. When interpreting your remittance advice, it is important to understand that claims in a denied or suspended status will appear on the very next remittance advice after they are adjudicated, while claims in a paid status will not appear until payment is released. This means that paid claims will appear on the remittance advice 1-3 weeks after denied or suspended claims from the same batch submission. To reiterate, actual payment cycles for NewMMIS are the same as under the old system; they have not changed. The adjudication of claims is more rapid and the status of adjudicated claims is made available to providers sooner. Please ensure that your billing and operations staff are aware of this information
Messages from the Week of May 24th
05/29/09
Notice of NewMMIS Provider Online Service Center (POSC) System Maintenance 5/31
The NewMMIS POSC will be unavailable Sunday, May 31 from 8:00 am to 12 noon for system maintenance.During this time, the following access methods for eligibility verification will remain available:
EVSpc - available for download at www.mass.gov/masshealth/newmmis
HTS - any vendor or provider that connects to NewMMIS in a system-to-system approach or web service
Automated Voice Response at 1.800.540.0042
Temporary Eligibility Operator Support at 1.800.833.7582
Temporary hours of additional support over the weekend of May 30th and 31st for providers who do not yet have a user ID and password for the POSC
MassHealth has noted that some providers have not yet registered for a user ID and password to access the MassHealth Provider Online Service Center (POSC). You need this access in order to verify member eligibilit
For providers who do not yet have a user ID and password, MassHealth is providing additional temporary support staff over the weekend of May 30th and 31st to assist with eligibility verification. If you already have your user ID and password for the POSC, please do not call these numbers for eligibility verification. These numbers are for use ONLY by providers who do not have a user ID and password AND who have a MassHealth member in the office or facility over the weekend for whom they need to verify eligibility.
The temporary hours of additional support are as follows:
For eligibility verification questions and general POSC questions:
Saturday, May 30
8:00 AM - 12:00 PM
1-800-841-2900
For eligibility verification questions only:
Saturday, May 30
12:00 PM - 9:30 PM
1-800-833-7582

Sunday, May 31
7:00 AM - 9:30 PM
1-800-833-7582
Claims from nursing facilities that provide level four service
MassHealth is aware that claims from nursing facilities that provide level four services may process erroneously. We have diagnosed the problem and expect it to be resolved in June. We apologize for any inconvenience this may cause.
Checking member eligibility status on the Provider Online Service Center (POSC)
Some users may encounter an error when checking for member eligibility status on the POSC. The error causes the screen to be filled with a long technical message that begins "javax.portlet. PortletException: Cannot get value for expression". If you receive this message, please log out, wait 30 minutes, and log back in.

Technical teams are in the process of resolving this issue. In the meantime, please do not call the CST help desk as the issue is known and the fix is underway. We will update you shortly and apologize for any inconvenience this may cause.
05/26/09
Notice of NewMMIS Issues
NewMMIS is experiencing intermittent issues and may continue to experience these issues throughout the day. If you are encountering difficulties, please wait an hour and try again. Technical teams are working to address the issue and we apologize for any inconvenience this may cause.
05/24/09
Lost Permissions
Some Users are experiencing the loss of access to certain functions on the Provider Online Service Center (POSC). If you are a Subordinate User and experience the loss of this functionality please check with the Primary User within your organization. If you are a Primary User and have lost access to certain functions please contact Customer Services at 1-800-841-2900 immediately. While this issue is being fixed, please do not modify permissions after they have been added. We will notify you once the issue has been resolved.
Messages from the Week of May 17th
05/23/09
Providers should resubmit claims from the 2088 RA Run that denied for code 095
Please note that any claim that denied on the 2088 remittance advice for code 095 (dated 5/26/09), Claim Cannot be Processed/Resubmit to NewMMIS, should be resubmitted to NewMMIS. Providers must use their National Provider Identifier (NPI) for all claims submissions. "Atypical Providers" should bill using their 10-digit Provider ID/Service Location (pid sl) number, which was sent in the MassHealth provider PIN registration letter in March. If you have questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
Providers entering data during Prior Authorizations
MassHealth has received reports that providers are intermittently receiving error codes and/or error messages indicating that the web service is not available upon data entry of Prior Authorizations (PAs). This problem has been diagnosed and MassHealth is actively developing a solution for this issue. If you receive this message during data entry, please save your PA request, record your tracking number, and return to complete your PA later. We apologize for any inconvenience this may cause.
Be advised of crossover denials for edit 503
MassHealth has become aware that Medicare is sending erroneous Coordination of Benefits (COB) payer information that is resulting in crossover denials for edit 503. Medicare will not be correcting these claims. Providers should submit their claims directly to MassHealth for payment consideration. You can submit your claims either electronically through the Provider Online Service Center (POSC) or on paper. Claims processed in NewMMIS will ignore the erroneous payer information and adjudicate appropriately. Providers must use their National Provider Identifier (NPI) for all claims submissions. "Atypical Providers" should bill using their 10-digit Provider ID/Service Location (pid sl) number, which was sent to providers in the MassHealth provider PIN registration letter in March. For questions, contact MassHealth Customer Service at 1-800-841-2900.
To Providers Submitting Electronic 837I and 837P Claims to NewMMIS:
Providers are reminded that when submitting 837 Institutional and 837 Professional claims to NewMMIS to enter theNewMMIS Trading Partner ID in the ISA06. We are seeing a high incidence of files being rejected because trading partners are continuing to use the current legacy seven-digit MassHealth ID.

Thank you in advance for your cooperation. If you have questions about any of these messages, please call 1-800-841-2900.
05/20/09
Providers submitting 837I and 837P claims to NewMMIS
Providers are reminded that when submitting 837 Institutional and 837 Professional claims to NewMMIS to enter the NewMMIS Trading Partner ID in the ISA06. All claims submitted to NewMMIS must have the new Provider ID / Service Location and/or member ID and other necessary data elements identified in the MassHealth Companion Guides and Billing Guides. We are seeing a high incidence where files are being rejected because trading partners are continuing to use the current legacy seven-digit MassHealth ID.
To Providers Who Have Registered for the NewMMIS Provider Online Service Center (POSC) as a "Primary User":
Providers who have registered at the POSC as a "Primary User" should not give anyone access to the "Manage Subordinates" function other than the individual in your organization whom you have selected as your primary back-up. It is your responsibility and obligation to protect the data that you enter and manage. If the "Manage Subordinates" function is granted to anyone other than your primary back-up, the "granted to" user is able to view a list of all subordinate users you have created, their personal information (i.e. Last 4 of SSN, DOB, etc.), and they will be able to modify access to those user accounts. This is a serious privacy concern. Primary Users are instructed not to assign this access to anyone other than their back-ups in the NewMMIS POSC Primary User guide. This is noted as well in the security set-up examples noted on Mass.gov.
Advisory About Modifying Permissions After They Have Been Added:
MassHealth has been informed that some providers have noticed that their access to certain functions on the POSC appear to have been removed in error. This seems to happen when the provider modifies permissions for another user (user from provider location A ("A") allows user from provider location B ("B") access to view their information or perform services on behalf of A and then decides to modify B's given permissions) or when the Primary User modifies the access for their subordinates at the primary site. While this issue is being evaluated, please do not modify permissions after they have been added. Once this issue is fully reviewed, we will advise you of next steps.
Notice about Prior Authorization (PA) Messages You May See on the POSC:
Please be advised that currently, a "PA not required" message is displayed on the POSC when entering a Prior Authorization request for services that sometimes require a PA. This is a so-called "soft edit" and will not prevent you from entering the PA. MassHealth is aware of this issue and will correct it after NewMMIS implementation. In the interim, please refer to Sub-chapter 6 of your provider manual to determine if PA is required. If you are a DME provider you should refer to the DME/Oxygen tool to determine if PA is required. Both the provider manuals and the DME/Oxygen tool can be found on www.mass.gov/masshealth - Click on "MassHealth Regulations and Other Publications", then click on "Provider Library."
Messages from the Week of May 10th
05/15/09
Important Note About Trading Partner Testing
On May 16, providers may begin to submit electronic claims via the POSC. However, the 837 test feature available on the POSC will not be fully operational until June 8th. Providers are encouraged to submit HIPAA compliance tests through May 18th via the EDI Web site https://masshealth2.ehs.state.ma.us/transactions/test/logon.do. MassHealth will temporarily stop trading partner testing at the end of business on May 18th. Please do not submit any test files via the POSC until trading partner testing resumes on June 8th. Any test files submitted via the POSC will not be processed until June. Additionally, any corresponding tracking numbers issued by the POSC will not be valid until the test claims are processed in June.

Topic	Month of July 1PM - 3PM	Month of August 1PM - 3PM
TPL & Crossovers	7/7/09	8/3/09
PA/PAS	7/15/09	8/13/09
Professional Claims	7/20/09	8/17/09
Referrals	7/23/09 - new date	8/10/09
Institutional Claims	7/30/09	8/25/09

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Important. Please Read MMIS Notices - Chronological Archive

Messages from the Week of June 17, 2013

Messages from the Week of June 10, 2013

June 10, 2013

Webinar Notice to Providers

Messages from the Week of June 3, 2013

June 3, 2013

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

Provider Profile Maintenance for Group Practices

New MassHealth Publications Posted on the Web

Messages from the Week of May 27, 2013

May 28, 2013

Chronic Disease and Rehabilitation Outpatient Crossover Denials

Non-Group Providers Billing With a Rendering NPI

Messages from the Week of May 20, 2013

May 23, 2013

System Maintenance

May 20, 2013

MassHealth Timeframes for Bill Paying for Nursing Facility Providers

Messages from the Week of May 20, 2013

Webinar Notice to Providers

Reminder to Enroll all Provider Service Locations

Messages from the Week of May 6, 2013

May 6, 2013

Adult Day Health Retroactive Rate Increase

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

Transportation Providers – Billing with Invalid Modifiers

New MassHealth Publications Posted on the Web

Messages from the Week of April 29, 2013

April 29, 2013

Hospice Election Form Reminder

Hospice Providers – Eligibility Verification System (EVS)

Independent Nurses – Billing Weekend Nursing Services

Messages from the Week of April 22, 2013

April 23, 2013

Messages from the Week of April 15, 2013

April 17, 2013

System Maintenance

Deadline Extended on Health Safety Net Billing Waiver Extension

Attention Masshealth Providers

Messages from the Week of April 8, 2013

April 8, 2013

Edit 4038 - Claims Adjustments

Messages from the Week of April 1, 2013

April 1, 2013

New MassHealth Publications Posted on the Web

Health Safety Net Billing Waiver Extension

Attention Dental Providers

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

Messages from the Week of March 25, 2013

March 29, 2013

Messages from the Week of March 18, 2013

March 20, 2013

March 18, 2013

ACA Section 1202 Rates for Physicians Who Provide Primary Care Services

Early Intervention Service Code T1024 Denials for Edit 8155

Updated Hospice Rates

New MassHealth Publication Posted on the Web

Messages from the Week of February 25, 2013

February 25, 2013

Health Safety Net Billing Waiver Extension

Notification of Change Requirements

Provider Online Service Center (POSC) Security

Messages from the Week of February 18, 2013

February 20, 2013

Messages from the Week of February 11, 2013

February 13, 2013

Messages from the Week of January 28, 2013

February 1, 2013

Messages from the Week of January 14, 2013

January 18, 2012

System Maintenance

January 14, 2013

Substance Abuse Service Code H0020 Denials for Edit 5930

Chronic Disease and Rehabilitation Hospital UMP Post-Payment Reviews

New MassHealth Publications Posted on the Web

Messages from the Week of January 7, 2013

January 11, 2013