MMIS Customer Service

Date

Title

Comments

February 1, 2016Group Practitioner Application Redesign

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

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

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  If any outdated applications are received after 4/1/2016 they will be rejected and applicants will be required to reapply using form PE-GPO.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

February 1, 2016Update – Get Ready for the MMIS/Provider Online Service Center (POSC) Technical Upgrade

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

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

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

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

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

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

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

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

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

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

February 1, 2016Pharmacy, DME and Oxygen – Updated Payment and Coverage Guidelines Tool Now Online

REVISED

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

 To confirm that you are using the most recent version of the applicable Tool (V.25), go to www.mass.gov/masshealthpubs.  Click on Provider Library, then on MassHealth Payment and Coverage Guideline Tool.

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

January 25, 2016To Home Health Agency Providers

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

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

G0154 will be replaced with:

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

and

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

G0154 TT will be replaced with:

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

and

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

G0154 UD will be replaced with:

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

and

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

G0154 TT, UD will be replaced with:

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

and

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

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

January 25, 2016Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374

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

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

January 19, 2016Update – MMIS/Provider Online Service Center (POSC) Technical Upgrade – Effective February 22, 2016

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

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

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

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

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

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

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

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

January 19, 2016Revalidation Process Changes

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

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

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

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

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

January 19, 2016MassHealth Seeks Testing Partners for Its New Connectivity Method Option

REVISED

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

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

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

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

January 19, 2016To Hospice Providers

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

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

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

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

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

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

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

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

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

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

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

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

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

January 11, 2016MassHealth Updates the CARC’S & RARC’S List Effective January 1, 2016

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

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

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

January 11, 2016Timely Filing Regulations for Claims with Other Health Insurance

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

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

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

December 31, 2015835 and Payment DelayDue to the Christmas and New Year’s Day holidays, payments and 835s will be delayed by one business day.  For questions, please contact the MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
December 28, 2015Personal Care Attendant (PCA) Overtime and Intra-Day Travel Time Pay

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

The service code for billing the PCA Overtime is:

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

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

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

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

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

December 28, 2015New POS 19 Implementation

Revised

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

December 21, 2015Provider Online Service Center (POSC) Technical Upgrade

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

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

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

December 21, 2015To Home Health Agency Providers

REVISED

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

G0154 will be replaced with:

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

G0154 TT will be replaced with:

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

G0154 UD will be replaced with:

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

G0154 TT, UD will be replaced with:

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

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

December 14, 2015Rate Adjustments for Mental Health Codes

Please note the phone number correction

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

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

December 14, 2015

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

REMINDER – Pharmacy, DME and Oxygen providers be advised that the MassHealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web. To confirm that you are using the most recent version of the applicable Tool, go to http://WWW.MASS.GOV/MASSHEALTHPUBS, click on Provider Library and then click on MassHealth Payment and Coverage Guideline Tool.

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

December 14, 2015To Home Health Agency Providers

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

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

December 14, 2015Correct Coding 2016 Ventilators

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

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

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

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

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

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

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

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

December 7, 2015Inpatient Hospital Grouper IssueMassHealth has identified an issue with the industry standard 3M APR/DRG grouper that is affecting in-patient hospital claims.  Specifically, for services involving a normal delivery that include a repair of a laceration, the grouper cross--walks to DRG #952 when it should cross-walk to DRG #560.  This has resulted in a number of potential overpayments to acute hospitals since October 1, 2015.  MassHealth is currently evaluating the issue and will notify providers within the next several weeks about its approach to address the issue with 3M and recoup overpayments as applicable.   If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900.
November 30, 2015Medical Practitioner Application Redesign - Update

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

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

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

November 30, 2015To Hospice Providers

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

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

November 30, 2015To Home Health Agency Providers

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

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

November 16, 2015Important Reminder – Diagnosis Indicator Field

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

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

November 16, 2015Rate Adjustments for Mental Health Codes

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

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

November 9, 2015Important Reminder – V5010 Requirements

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

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

November 2, 2015Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374MassHealth is aware of an issue affecting Medicare crossover claims for dual eligible members (MassHealth and Medicare coverage) who were enrolled in a MassHealth CarePlus benefit plan. The crossover claims for these members may have erroneously denied for Edit 4371 - Benefit plan claim type restriction on procedure and/or Edit 4374 - Benefit plan claim type restriction on revenue code.   MassHealth is in the process of revising the benefit plan information for these members, and will systematically reprocess affected crossovers claims on future remittance advices.
October 26, 2015ICD Error Code Resolution

Please note the phone number correction.

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

Please reference the MassHealth ICD-10 transition bulletin at www.mass.gov/masshealth/ICD-10 to view important transition & billing information.   If you have any questions please contact MassHealth Customer Service Center at 1-800-842-2900 or providersupport@MAHealth.net.

October 13, 2015Important Reminder-Submit Valid ICD-10 Codes on Claims

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

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

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

October 13, 2015Reminder – ICD-10 Claim Submission

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

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

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

October 5, 2015MassHealth Implements ICD-10

MassHealth implemented ICD-10 on October 1, 2015.  

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

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

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

October 5, 2015Acute Inpatient Hospitals Preadmission Screening Requests Must Be Processed Through the POSC

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

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

October 5, 2015Clarification Regarding Pre-Admission Screening (PAS) SubmissionsMassHealth will continue to accept CPT codes on PAS requests for prospective admissions with dates of service on or after 10/01/2015. Providers should enter the ICD-10 diagnosis code in the appropriate field and enter the CPT code in the “notes” field. If you submit a CPT code in the notes field you must leave the ICD procedure field blank. If available, providers may choose to enter the ICD-10 PCS code in the appropriate ICD procedure field in lieu of the CPT code(s).
October 5, 2015ICD-10 Implementation Monitoring

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

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

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

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

September 28, 2015MMQ Terminates October 1st – You Must Transition Now!

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

One of the following MMQ submission methods must be used:

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

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

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

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

September 28, 2015October 1st ICD-10 Implementation is Just Days Away – Please Be Ready!

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

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

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

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

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

September 28, 2015September ICD-10 Webinar Training Sessions Still Available - Please Sign Up Now!

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

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

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

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

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

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

September 28, 2015New Medical Practitioner Application Webinar

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

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

September 28, 2015Medical Practitioner Application Redesign

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

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

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

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

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

September 28, 2015Deadline for Hospitals to Submit Adjustments for Section 1202 Payments Extended to October 15, 2015MassHealth has extended the submission deadline for Section 1202 claims adjustments for Acute Inpatient hospitals and Acute Outpatient hospitals to October 15, 2015.  Acute Inpatient hospitals and Acute Outpatient hospitals are eligible to receive Section 1202 payments for Section 1202-eligible services rendered by Section 1202-eligible physicians for dates of service in calendar years 2013 and 2014. All adjusted claims must be submitted according to the instructions in Acute Inpatient Hospital Bulletin 151 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aih-151.pdf, and Acute Outpatient Hospital Bulletin 31 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aoh-31.pdf and received by MassHealth no later than October 15, 2015. For questions, contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.
September 25, 2015RITE Way TransportationRITE Way Transportation is no longer providing transportation services.  If you have questions or need assistance, please call MassHealth Customer Service at the dedicated telephone number that has been set up to address this matter: 1-844-748-3928.
September 25, 2015September ICD-10 Training Sessions Still Available – Please Sign Up Now!

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

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

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

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

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

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

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

September 25, 2015October 1st ICD-10 Implementation is Just Days Away – Please be Ready!

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

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

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

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

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

September 14, 2015October 1st ICD-10 Implementation is Just Days Away  – Are You Ready?

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

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

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

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

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

September 8, 2015ICD-10 Implementation Q&A Web Conferences – Your Questions Answered

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

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

Conference Line Information:

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

Web Conference Schedule:

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

September 8, 2015Corrections for Edit 4037 Claims Denials

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

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

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

September 8, 2015Missed ACA Section 1202 Payments for Providers

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

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

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

September 8, 2015Professional Part B Crossover Claims: Edit 560 - M-CARE Coinsurance AMT Greater than the Amount Paid

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

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

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

August 31, 2015

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

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

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

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

August 31, 2015EVSpc and EVScall Have Terminated – Effective September 1st

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

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

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

August 31, 2015Important Reminder: MassHealth’s Proprietary MMQ Software Terminates October 1st – You Must Transition Now!

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

One of the following MMQ submission methods must be used:

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

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

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

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

August 31, 2015ICD-10 Update For Early Intervention Specialty Services

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

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

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

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

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

August 31, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – August 2015:

  • All Provider Bulletin 252: Improving Access for MassHealth Members with Disabilities
  • All Provider Bulletin 251: Enhancements to the Claiming Process and New Certification Process for MassHealth Limited Program
  • All Provider Bulletin 250: Enhancements to the Provider Revalidation Process

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

August 31, 2015

September ICD-10 Training Session Dates – Please Sign Up Now!

ICD-10 implementation is just days away! You must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. Please sign up for one of our information sessions to get an important overview of ICD-10 and the operational impacts to the POSC:

Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 10:30-Noon
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 1:30-3:00
Burlington Public Library, 22 Sears St., Burlington, Monday, September 14th, 11:00-12:30
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 10:30-Noon
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 1:30-3:00
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 10:30-Noon
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 1:30-3:00
Boston Public Library-Hyde Park Branch, 35 Harvard Ave., Hyde Park, Thursday, September 24th, 1:30-3:00      

To register for a training session, visit www.masshealthtraining.com and, under the Events tab, select the session for the date you wish to attend.

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

Tuesday September 8th 10:00-Noon
Tuesday September 22nd 10:00-Noon

To register for a Webinar session, visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the month of October will be forthcoming.

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

August 25, 2015Masshealth Claims Denied For Edit 2548 – Non-Covered Amount is Not Equal to Billed Amount

MassHealth has identified claims adjudicated from 6/23/15 through 8/14/15 which paid erroneously.  

The affected claims contained an amount in the non-covered amount field which was not equal to the claim billed amount.  These claims have been reprocessed and will deny for Edit 2548 NON-COVERED AMT IS NOT EQUAL TO THE BILLED AMT on future remittance advices. Providers should refer to Appendix “Supplemental Instructions for Claims with Other Insurance” in the Provider Manual for instructions on billing claims using the non-covered amount field for TPL exception billing.

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

August 17, 2015Reminder: September 1st Deadline for Hospitals to Submit Adjustments for Section 1202 Payment

This is a reminder to Acute Inpatient hospitals and Acute Outpatient hospitals that, in order to receive Section 1202 payments for Section 1202-eligible services rendered by Section 1202-eligible physicians for dates of service in calendar years 2013 and 2014, all adjusted claims must be submitted to and received by MassHealth by September 1, 2015.

Please refer to Acute Inpatient Hospital Bulletin 151 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aih-151.pdf pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                 , and Acute Outpatient Hospital Bulletin 31 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aoh-31.pdf pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                for additional guidance.

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

August 17, 2015Important Reminder - V5010 Requirements

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

Please ensure that you have fully complied with this 2012 requirement. Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

August 17, 2015Augmentative and Alternative Communication (AAC) Device Coverage

Coverage for electronic tablets already in effect for children under EPSDT:

Under its DME program, MassHealth covers medically necessary dedicated AAC tablets and AAC software and applications for children under age 21. A dedicated tablet is one that is configured to limit the primary use to a medical purpose, such as for use as an AAC (for example, as a speech generating device).

An evaluation by a healthcare practitioner (physician, physician assistant or nurse practitioner) and a speech therapist are required to confirm the medical need for an AAC and then the medical appropriateness of a particular device, such as a tablet. The speech therapist will then recommend a DME provider that could provide the AAC device or tablet. The DME provider should follow the existing prior authorization process to request authorization to provide the tablet to the child. New and existing DME providers should contact MassHealth customer service (1-800-841-2900) for enrollment and prior authorization information.

MassHealth is in the process of updating its regulations to (1) explicitly add, to the definition of DME, electronic devices used as for medical purposes as AAC, such as tablets dedicated to the functional speaking needs of the member and locked or configured to prevent use not related to communication and (2) include coverage of AAC software and applications.

Once the regulations have been updated, MassHealth will cover medically necessary dedicated tablets as AAC through a prior authorization process available for members of all ages.

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

August 13, 2015MassHealth Member Eligibility Verification Processing Issue (HIPAA 270)

MassHealth has identified an issue when processing HIPAA 270 eligibility transactions. The issue occurred when a provider submits a HIPAA 270 request spanning multiple dates: for example the request was for member eligibility from 7/1/2015 to 7/10/2015 but MassHealth was only returning a response for 7/1/15. This issue starting occurring after 10PM on Sunday August 9th (after a code promotion) and impacted all HIPAA 270 requests submitted with spanning dates up to 5PM on Wednesday, August 12th. Requests with single dates of eligibility were not impacted. The issue is now corrected. We ask that any providers with HIPAA 270 inquiries that were impacted to please resubmit the requests to us if applicable.

We apologize for any inconvenience caused by this error and thank you for your continued commitment to the MassHealth Program.

Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

August 10, 2015ICD-10 Trading Partner Testing Q&A Web Conferences in August – Please Sign Up!

The October 1st ICD-10 implementation date is fast approaching. The last day to submit your first file is August 31st!  

To ensure that all MassHealth trading partners that submit transactions to MassHealth and/or develop software for MassHealth providers are tested prior to implementation, we invite you to join us for a series of web conferences to discuss any questions that you may have regarding testing or any obstacles that could prevent or delay your testing activities. This is the perfect opportunity to have your concerns addressed and questions answered. Listed below is the schedule, conference line and web conference information:  

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

10:00 AM Thursday August 13th:
Web Conference Information: https://cc.readytalk.com/r/7eu0m3ju7zeg&eom

10:00 AM Thursday August 20th:
Web Conference Information: https://cc.readytalk.com/r/hw2kv0r0f3ur&eom

10:00 AM Thursday August 27th:
Web Conference Information: https://cc.readytalk.com/r/iiv5xdduuxww&eom

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

August 10, 2015ICD-10 Training Session Dates in August and September – Please Sign Up Now!

The October 1st ICD-10 implementation date is fast approaching. The last day to submit your first file is August 31st!  

To ensure that all MassHealth trading partners that submit transactions to MassHealth and/or develop software for MassHealth providers are tested prior to implementation, we invite you to join us for a series of web conferences to discuss any questions that you may have regarding testing or any obstacles that could prevent or delay your testing activities. This is the perfect opportunity to have your concerns addressed and questions answered. Listed below is the schedule, conference line and web conference information:  

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

10:00 AM Thursday August 13th:
Web Conference Information: https://cc.readytalk.com/r/7eu0m3ju7zeg&eom

10:00 AM Thursday August 20th:
Web Conference Information: https://cc.readytalk.com/r/hw2kv0r0f3ur&eom

10:00 AM Thursday August 27th:
Web Conference Information: https://cc.readytalk.com/r/iiv5xdduuxww&eom

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

ICD-10 Training Session Dates in August and September – Please Sign Up Now!

All MassHealth providers are again reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. MassHealth is offering information sessions that provide you an overview of ICD-10 and the operational impacts to the POSC system. Please sign up for one of the August or September training dates below:

Milford Public Library 80 Spruce St, Milford, Thursday August 20th 10:30-12:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 1:30-3:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 10:30-12:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 1:30-3:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 10:30-12:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 1:30-3:00
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 10:30-Noon
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 1:30-3:00
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 10:30-Noon
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 1:30-3:00
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 10:30-Noon

Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 1:30-3:00
Burlington Public Library, 22 Sears St., Burlington, Wednesday, September 23rd, 10:30-Noon
Burlington Public Library, 22 Sears St., Burlington, Wednesday, September 23rd, 1:30-3:00
Boston Public Library-Hyde Park Branch, 35 Harvard Ave., Hyde Park, Thursday, September 24th, 1:30-3:00

To register for a training session, visit www.masshealthtraining.com and, under the Events tab, select the information session for the date you wish to attend.

In addition to the live trainings, we offer the following Webinars:

Tuesday August 11th 10:00-Noon
Tuesday September 8th 10:00-Noon
Tuesday September 22nd 10:00-Noon

To register for the Webinar session, visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of September and October will be forthcoming.

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

August 10, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – July 2015

  • Acute Inpatient Hospital Bulletin 152: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
  • All Provider Bulletin 249: ICD-10 Implementation Readiness
  • Community Health Center Bulletin 83: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
  • School-Based Medicaid Bulletin 28: School-Based Medicaid Program Guidance on Indirect Cost Rates

TRANSMITTAL LETTERS – July 2015:

  • LAB-44: Subchapter 6 Revisions
  • AOH-35: Revised Service Codes 

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

August 3, 2015Thank You for Completing the ICD-10 Readiness Survey

MassHealth wants to thank the many providers who took the time to complete our brief online survey on ICD-10 readiness.

With the October 1, 2015 implementation date fast approaching, your survey answers will help MassHealth better understand the current status of provider preparation, e.g., deploying new software and testing transactions.  MassHealth can provide assistance, guidance and materials to all providers, vendors, billing intermediaries and clearinghouses.

All providers are urged to stay current with MassHealth’s latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids. Go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

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

July 27, 2015EVSpc  and EVScall Terminate September 1st – You Must Transition Now!

All MassHealth providers are again reminded: EVSpc and EVScall will terminate on September 1, 2015. All functionality will cease as MassHealth cannot provide software support after that date.

You must stop using the software immediately and transition to other eligibility verification methods outlined at http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/ and click on “Information and Software for Electronic Transactions.”

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits even if EOHHS has been advised of the possibility of such damages.

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

July 27, 2015Important Reminder to All Providers: Please Complete the ICD-10 Readiness Survey by this Friday, July 31st

ICD-10 implementation is only two months away – October 1st, 2015.  As a MassHealth provider or vendor, you must be ready for this implementation.

Please take MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 31st by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?id=416.  How are you preparing for ICD-10? Have you deployed new software?  Do you need any assistance, guidance or materials?

Your survey answers will help MassHealth to a.) better understand the status of your implementation effort and b.) provide assistance and/or guidance to providers, vendors, billing intermediaries and clearinghouses as October 1st approaches.

Please stay current with MassHealth’s latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

July 20, 2015Revamped Revalidation Webinar Now Available For Providers

All MassHealth providers are invited to join the revamped Revalidation Tutorial Webinar for guidance on how to complete the Revalidation process. 

The webinar will provide you step-by-step instructions on how to access your information on the POSC, change/update your profile information and download and complete any original signature documents that may be required.

Webinars are held every 2nd Thursday and 4th Tuesday of the month.  The next Webinar will be held: 

Tuesday, July 28, 2015
1:00 – 2:00 PM

To join the Webinar, go to:

Audio Login -
Toll-Free (US & Canada): 866.740.1260
Toll: 303.248.0285
Access Code: 4725660

Web Login -
Meeting URL: http://www.readytalk.com/?ac=4725660
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800.843.9166 or help@readytalk.com
Access Code: 4725660

We also offer more information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid.  Please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment and click on Provider Revalidation. For questions, please contact MassHealth Customer Service at revalidation@mahealth.net or call 1-800-841-2900.

July 20, 2015Deadline Extended to July 31st! Please Complete the ICD-10 Readiness Survey

Are you ready FOR ICD-10 implementation on October 1, 2015? How is your organization preparing for ICD-10? Do you need any materials, guidance or assistance from MassHealth?  Have you deployed new software? Are you ready to test transactions?

Please complete MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 31st by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?id=416

Your answers will help MassHealth better understand the status of your implementation effort and provide assistance and/or guidance to providers, vendors, billing intermediaries and clearinghouses as the implementation date approaches.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

July 20, 2015ICD-10 Training Session Dates Available in August – Please Sign Up Now!

All MassHealth providers are reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. To help you prepare for ICD-10 implementation, MassHealth is offering information sessions that provide an overview of ICD-10 and the operational impacts to the POSC system. Please view the list of August training dates below:

South Yarmouth Public Library 312 Old Main St, S. Yarmouth, Tuesday August 4th 1:30-3:00
Medford School of Nursing 107 Governors Ave, Medford, Thursday August 6th, 10:30-12:00
Medford School of Nursing 107 Governors Ave, Medford, Thursday August 6th, 1:30-3:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 10:30-12:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 1:30-3:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 10:30-12:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 1:30-3:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 10:30-12:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 1:30-3:00                    

To register for a training session, please visit www.masshealthtraining.com and, under the Events tab, select the information session for the date you wish to attend.

In addition to the live trainings, we offer the following Webinar:
Tuesday August 11th 10:00-12:00

To register for the Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of September and October will be forthcoming.

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

July 13, 2015Claims to Deny or Suspend for Duplicative Services

Effective dates of service July 1, 2015, MassHealth has implemented changes to prevent payment of duplicative services for the following providers/programs: Personal Care Attendant (PCA) program, Adult Foster Care (AFC) and Group Adult Foster Care (GAFC), Home Health Agencies (HHA) and Independent Nurses.  Audits will deny or suspend claims if there is a conflict. Examples:

  • Provider submits PCA program claim; claim will deny if member is already in AFC/GAFC
  • Provider submits AFC/GAFC claim; claim will deny if member is already in the PCA program
  • Member is in an inpatient/institutional setting (chronic, acute, SNF); claim should suspend if member is already in PCA, AFC/GAFC or HHA/Continuous Skilled Nursing

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

July 13, 2015Claims Edits to Identify Potential Duplicative Services for Assessments/Evaluations/Re-Evaluations

Effective dates of service July 1, 2015, MassHealth has implemented changes to identify potential duplicative services for the following providers: Personal Care Management (PCM) Agencies and Adult Foster Care (AFC).  Audits will be posted on the Remittance Advice (RA) if there is a conflict. Examples:

  • Provider submits PCA program evaluation or reevaluation; claim will pay with the edit that indicates that the member is already in AFC/GAFC
  • Provider submits an AFC assessment; claim will pay with the edit that indicates that the member is already in the PCA program

PCM and AFC providers receiving this edit will need to work with the member to resolve any conflicts in service before proceeding to enroll the member into the PCA or AFC program to prevent fraud and denials.

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

July 13, 2015Claims Submitted for Therapy Services Provided by Assistants Will Not be Paid

Therapy providers are reminded that MassHealth does not currently pay for therapy services provided by physical, occupational or speech therapy assistants as per MassHealth regulation 432.412 in the Therapy Provider Manual:

432.412: Nonpayable Services
The MassHealth agency does not pay a therapist for any of the following services:

(A) Services provided by any person under the therapist's supervision;

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

July 7, 2015Important Reminder on V5010 Requirement to Include Attending Provider NPI on Claims

REMINDER: As previously communicated in March, 2015, providers and other trading partners that submit claims transactions to MassHealth must adhere to the HIPAA V5010 requirements as mandated on January 1, 2012. This includes ensuring that the attending provider’s NPI is submitted on any/all institutional claims except for claims that only include non-scheduled transportation. 

Please note that effective August 9, 2015 MassHealth will begin to reject institutional claims that do not contain the Attending Provider’s NPI. The only exception will be for claims containing non-scheduled transportation services.

Please ensure that you have fully complied with this 2012 requirement.   Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

July 7, 2015Important Reminder: MMQ Software Terminates in Three Months – Have You Transitioned Yet?

All nursing facility providers are again reminded: As of October 1, 2015, MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software. By September 30, 2015, you must transition to another method of submitting MMQs, such as:

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

Do you need help in transitioning? MassHealth has posted a Job Aid online at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf.

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

For questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

July 7, 2015EVSpc AND EVScall Terminate in Two Months – You Must Transition Now

All MassHealth providers are again reminded: EVSpc and EVScall will terminate on September 1, 2015. All functionality will cease as MassHealth cannot provide software support after that date. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)
    • You must coordinate with MassHealth Customer Service to test batch and HTS files before you will be allowed to submit and receive HIPAA transactions in an electronic batch file format through the POSC or HTS methods.
    • If you already use a vendor that submits “270” requests for you from a system that does NOT use the EVSpc/EVScall software, you should not be impacted by the EVS termination. Confer with your software vendor if you have any questions regarding its submission methods.

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits even if EOHHS has been advised of the possibility of such damages.

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

July 7, 2015ICD-10 is Just 90 Days Away – You Must Test Transactions Now!

All MassHealth providers are reminded: ICD-10 will be implemented on October 1, 2015. Both providers and vendors that submit transactions on behalf of providers must test ICD-10 transactions with MassHealth prior to implementation. If you or your vendor do not test with MassHealth, there is a risk that your claims may deny in “production,” which may negatively impact financials.

  • Please contact the MassHealth EDI team immediately at 1-855-295-4047 or at edi@mahealth.net to schedule a test date.
  • If you do not plan to test, please contact the EDI team to confirm why you are not testing.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at  www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

July 7, 2015Changes to the Personal Care Attendant (PCA) Orientation Service Code

Effective July 1, 2015 dates of service, the service code that Fiscal Intermediaries use to bill for PCA Orientation will be changing.

The new service code is:

  • 99509 U3 - Home Visit Day Life Activity (Personal Care Services) (Use to bill for PCA New Hire Orientation, per diem, per eligible PCA)

Fiscal Intermediaries should use the payroll claiming number when billing this code to MassHealth. Updates to subchapter 6 of the Provider Manual are forthcoming.

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

July 7, 2015Personal Care Attendant (PCA) Earned Sick Leave Pay

Effective July 1, 2015 dates of service, Fiscal Intermediaries will be able to submit claims to MassHealth for PCAs who have earned PCA Sick Leave pay.

The service code for billing the PCA Sick Leave is:

  • 99509 U1 - Home Visit Day Life Activity (Personal Care Services per 15 minutes) (Use to bill for PCA Earned Sick Leave pay) (Current PA for PCA Services required for each member)

Fiscal Intermediaries should use the payroll number when billing this code to MassHealth. Updates to subchapter 6 of the Provider Manual are forthcoming.

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

June 29, 2015ICD-10 Training Session Dates Available in July – Please Sign Up Now!

REMINDER: All MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. To help you prepare for ICD-10 implementation, MassHealth is providing information sessions to guide you on how to implement ICD-10 with MassHealth. Please view the list of July training dates below:

-Tuesday July 14: 10:00 AM-Noon, Baystate Medical Center, 101 Wassen Ave., Springfield MA
-Tuesday July 14: 1:00-3:00 PM, Baystate Medical Center, 101 Wassen Ave., Springfield MA
-Wednesday July 15: 10:00 AM-Noon, Worcester Library, 3 Salem Street, Worcester MA
-Wednesday July 15: 1:00 PM - 3:00 PM, Worcester Library, 3 Salem Street, Worcester MA

To register for a training session, please visit www.masshealthtraining.com and under the Webinar tab select the LIVE ICD-10 Training for the date you wish to attend.

In addition to the live trainings, we offer the following Webinar:

Monday July 13, 2015 10:00 AM – 12:00 PM

To register for the Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of August through October will be forthcoming.

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

June 22, 2015Please Complete the ICD-10 Readiness Survey

ICD-10 must be implemented on October 1st, 2015. As a MassHealth provider or vendor, are you ready? How is your organization preparing for ICD-10? Do you need any materials, guidance or assistance from MassHealth?  Have you deployed new software? Are you ready to test transactions?

Please take MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 17th by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?preview=show&id=416.

Your answers will help MassHealth to better understand the status of your implementation effort and provide assistance and/or guidance to providers and vendors, billing intermediaries and clearinghouses as the implementation date approaches.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at

www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

June 22, 2015ICD-10 Training Session Dates Now Available June and July – Please sign Up!

REMINDER: MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015.  To help you prepare for ICD-10 implementation, MassHealth is providing training sessions to guide you on how to implement ICD-10 with MassHealth. Please view the list of June and July training dates below:

-Wednesday, June 24, 10:30 am–12:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Wednesday, June 24, 1:30 pm–3:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Thursday, June 25, 10:30 am–12:00 pm, Brightwood Library, 359 Plainfield St. Springfield MA
-Thursday, June 25 1:30 pm–3:00 pm, Brightwood Library, 359 Plainfield St. Springfield, MA
-Tuesday, June 30, 10:30 am–12:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday, June 30, 1:30 pm–3:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday July 14: 10:00 am-Noon, Baystate Medical Center, 101 Watson Ave., Springfield MA
-Tuesday July 14: 1:00-3:00 pm, Baystate Medical Center, 101 Watson Ave., Springfield MA
-Wednesday July 15: 10:00 am-Noon, Worcester Library, 3 Salem Street, Worcester MA
-Wednesday July 15: 1:00 PM - 3:00 pm, Worcester Library, 3 Salem Street, Worcester MA

To register for a training session, please visit www.masshealthtraining.com and under the Webinar tab select LIVE ICD-10 Training for the date you wish to attend.

In addition to the live trainings, we offer the following Webinars:

Monday June 29, 2015 10:00 AM – 12:00 PM
Monday July 13, 2015 10:00 AM – 12:00 PM

To register for a Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then the date you wish to attend. Additional training session dates, times and locations for the months of August through October will be forthcoming.

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

June 22, 2015Attention All Providers: Important New Changes to Revalidation Process

All MassHealth providers are advised that there are two new changes that affect how you complete revalidation and enrollment, as explained below.

  1. An original “wet” signature is no longer required on the FRDF (Federally Required Disclosures Form). You may now submit a FRDF to MassHealth by uploading it onto the POSC, by e-mail or by fax (1-617-988-8974). Please provide a fax cover sheet requesting that the document be scanned to your PID/SL or ATN.
  2. There are now revalidation-specific document type labels in the drop-down menu on the POSC (Provider Online Service Center). Please select document types that begin with “REV” when you submit documents in response to a Revalidation Notification and follow these steps:
    1. Go to the Steps panel and click Attachments.
    2. Under List of Attachments, click New Item.
    3. Under Attach and Send Files:
      1. From the Document Type drop-down menu, click the applicable document type.
      2. Click Browse and then select your document to upload.
      3. Click Add/Upload to add the document to the provider file.

If you need assistance, MassHealth offers revalidation tutorial webinars on the 2nd Thursday and 4th Tuesday of every month. To register for the webinar, please go to: http://www.masshealthtraining.com/lms/_portal/account/?2.

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

June 9, 2015ICD-10 Training Sessions Now Available – Have You signed Up Yet?

REMINDER: MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015.

To help you prepare for ICD-10 implementation, MassHealth is providing training sessions to guide providers on how to implement ICD-10 with MassHealth.  The sessions will be conducted from June 24, 2015 to October 8, 2015.  Please view the list of June training dates below:

-Wednesday, June 24, 10:30 am–12:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Wednesday, June 24, 1:30 pm–3:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Thursday, June 25, 10:30 am–12:00 pm, Brightwood Library, 359 Plainfield St. Springfield MA
-Thursday, June 25 1:30 pm–3:00 pm, Brightwood Library, 359 Plainfield St. Springfield, MA
-Tuesday, June 30, 10:30 am–12:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday, June 30, 1:30 pm–3:00 pm, Old Colony Library, 2 Main St. Randolph, MA

To register for one of these training sessions, please visit www.masshealthtraining.com.  Additional training session dates, times and locations for the months of July through October will be forthcoming.

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

June 9, 2015ICD-10 Starts October 1st – Time is Running Out For Transaction Testing

REMINDER:  The ICD-10 implementation is just four months away. If you are a vendor that submits transactions to MassHealth on behalf of providers, you must test transactions with MassHealth before implementation. Please contact the MassHealth EDI team immediately at 1-855-295-4047 or at edi@mahealth.net to schedule a test date.  If you do not plan to test, please contact the EDI team to confirm why you are not testing.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

June 1, 2015MassHealth Prior Authorization Requirements

Reminder: MassHealth requires providers to obtain prior authorization (PA) for certain services.

Please review your MassHealth program regulations for a proposed service to determine when PA is required.

Please note that PA requests for certain services require additional forms that must accompany your request. In addition to program regulations that apply to your provider type, and the all provider regulations at130 CMR 450.303, PA requirements may appear in Subchapter 6 of certain provider manuals, in provider bulletins or in other written issuances from MassHealth. You can access the MassHealth provider manuals and provider bulletins from the MassHealth online Provider Library at www.mass.gov/masshealthpubs. 

Durable Medical Equipment, Oxygen, Orthotics and Prosthetics should also refer to coverage guideline tools for PA requirements. These providers can access the coverage guideline tools by clicking on Provider Library and then on MassHealth Payment and Coverage Guideline Tool.

Providers must follow these PA guidelines to avoid such claim denials as Edit Code 3003 (Procedure code requires PA).  For any PA questions, please contact the Prior Authorization Unit (PAU) at PriorAuthorization@umassmed.edu or 1-800-862-8341.

June 1, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – May 2015:

  • DEN-93: Revised Service Codes
  • FPA-52: 2015 HCPCS
  • PHY-144: 2015 HCPCS
  • ROC-3: 2015 HCPCS

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

May 26, 2015

To DME Providers and Hospice Providers

This is a reminder that the hospice provider is responsible for all durable medical equipment (DME) and medical supplies for the management of terminal illness for the member receiving hospice services.

Claims from DME providers for DME and medical supplies for members receiving hospice services will be automatically denied. DME providers are required to re-submit their claims with documentation showing that the services provided are not related to the terminal illness. Providers should resubmit these claims with the supporting documentation on the POSC according to All Provider Bulletin 225, using Delay Reason Code 11. Program managers will review these claims. In certain cases where the member has been receiving supplies before initiation of hospice services, and/or if supplies are not related to the terminal illness, claims will be paid.

Hospice Provider Manual: 437.423: Covered Services
(G) Drugs and Durable Medical Equipment and Medical Supplies. The hospice must provide and be responsible for all drugs and durable medical equipment and medical supplies needed for the palliation and management of the terminal illness and related conditions, according to the member's plan of care.

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

May 18, 2015MassHealth Timeframes for Bill Paying for Nursing Facility Providers

MassHealth will be modifying the timeframes for paying Nursing Facility claims for May dates of service received by MassHealth in May or June. The payment schedule will be modified by approximately 3 weeks.  Please see the modified payment schedule outlined below.

RA DATE: 07/07/2015
PAYMENT DATE CHECKS: 07/10/2015
PAYMENT DATE EFT: 07/13/2015

Claims for June dates of service will go back to the regular schedule. (Remittance Advice (RA) dated the third Tuesday of the month)

RA DATE: 07/21/2015
PAYMENT DATE CHECKS: 07/24/2015
PAYMENT DATE EFT: 07/27/2015

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

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

May 18, 2015

Attention Dental Providers: Important Information Regarding Adult Dentures

Effective May 15, 2015 MassHealth will cover dentures for adult members.

The affected service codes covered are:

D5110, D5120, D5211, D5212, D5510, D5520, D5610, D5620, D5630, D5640, D5650, D5660, D5710, D5711, D5730, D5731, D5750, D5751

Prior Authorization is not required; however, other limitations may apply. Please check the Office Reference Manual at www.masshealth-dental.net for complete coverage information.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

May 14, 2015MassHealth Provider Online Service Center (POSC)

The MassHealth Provider Online Service Center (POSC) is currently experiencing intermittent issues with processing of Direct Data Entry (DDE) Claims.  If you get a message when submitting a DDE claim that “Your transaction has not been processed please try again later”  we ask that you wait for 30 minutes and check if the claim was received before resubmitting the claim.  In some cases, this message is posting despite the claim being processed in the MassHealth system. Other portal functions are not impacted. We are working to resolve this issue and we apologize for any inconvenience that this may cause.

Providers who have questions should contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.

May 11, 2015

Member Eligibility Submission Limit in Effect as of May 8th

Effective Friday, May 08, 2015, MassHealth began placing a limit on member eligibility batch transactions. Any single transaction including more than 3,000 members will be rejected. This limit allows for more efficient and timely processing of all eligibility transactions.

OF IMPORTANCE: Due to technical issues, this submission limit went into effect two days prior to the original effective date communicated (May 10, 2015). If you were not able to support this change until the original implementation date of May 10th and you experienced validation issues due to the 3,000 limit on either May 8th or May 9th, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

To ensure the efficient processing of your eligibility request, please adhere to these submission guidelines:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. ALWAYS INCLUDE the member’s Medicaid ID number on the eligibility request if known.
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received.
May 11, 2015ICD-10 Implementation – Urgent Reminder – Vendor-PHASE II Testing Ends on May 29, 2015

An urgent reminder from MassHealth: Vendor Phase II testing will end on May 29, 2015.

To date there has been limited vendor participation in the MassHealth ICD-10 testing phase.

If you are a vendor that submits transactions to MassHealth on behalf of providers you must test that transaction with MassHealth before implementation.

MassHealth strongly urges vendors that are ready for testing to arrange a test date immediately. Contact the EDI team directly at 1-855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

May 4, 2015New XML Gateway Hardware and IP Address

Effective Tuesday April 28th,  MassIT has put new XML Gateway hardware into operation and the IP address of the XML gateway DNS name has changed.  If you are using the fully qualified domain name (wsgw.mass.gov) for the XML gateway, then this change will be transparent to you.  For those partners who are connecting via an IP address or have hard coded the IP address of the XML Gateway, you will want to change to use the Fully Qualified Domain name and/or new IP.  As we transition to the new gateway, we will monitor traffic and attempt to notify any customers that are required to make changes, but a proactive check is recommended to prevent any unplanned service disruptions.  Partners who may have hardcoded old IP addresses are advised to replace them as soon as possible with the new IP addresses and  update firewall rules as needed to assure connectivity. Please also check to ensure the retired gateway IPs are not cached anywhere (interchange agent) as well. The old hardware will be retired in the coming weeks.

Retiring Hardware Enterprise XML Gateway IPs:

Host NameVIP (target)Physical (source)
wsgw.mass.gov (Prod)170.63.98.114170.63.98.115 and 170.63.98.116

 

New Enterprise XML Gateway IPs:

Host NameVIP (target)Physical (source)
wsgw.mass.gov (Prod)170.63.70.72170.63.70.73 and 170.63.70.74
May 4, 2015Important Information for Chronic Disease and Rehabilitation Hospitals: Billing for Administrative Days (ADs)

For inpatient admissions on or after April 17, 2015, MassHealth will limit payment for Administrative Day (AD) coverage.  MassHealth will no longer pay for the first approved 45 administrative days of a member’s inpatient hospital stay. For any approved administrative day stay beyond 45 days, MassHealth will pay the hospital at its current AD rate.

For this matter, hospitals will be required to split their claims when billing for a continued inpatient stay that includes both hospital level of care and administrative day level of care in addition to entering an Occurrence Span Code on their claims.  The following are revised billing instructions that hospitals must follow when billing for administrative days:

  1. For hospital level of care days, hospitals should continue to bill as they currently do.
  2. For administrative day level of care stay, up to the first 45 days, hospitals should bill with an Occurrence Span Code of 22 along with the Occurrence Span Dates for the member’s stay.
  3. For administrative days that exceed 45 days (i.e., day 46 and beyond), hospitals should bill with an Occurrence Span Code of 21 with the Occurrence Span Dates for the member’s stay.

MassHealth policy regarding pre-admission screening, conversion and continued stay reviews has not changed.  Claims will continue to require a Preadmission Screening (PAS) number when billing any inpatient hospital stay.

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

May 4, 2015EVSpc and  EVScall Terminate September 1st – Do you need Assistance in Transitioning?

MassHealth continues to remind all providers that EVSpc and EVScall will terminate on September 1, 2015. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)

To help you choose another verification method, MassHealth has posted a detailed Job Aid online. Go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

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

May 4, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – April 2015:

  • AFC-14: Alternative Placement Days
  • CDR-30: Elimination of Payment for Administrative Days

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

April 27, 2015Important Information to Dental Providers: DentaQuest Provider Web Portal Availability

Due to a DentaQuest system update, there was an interruption in the loading of updated MassHealth member eligibility information to the provider web portal over the weekend of April 24th 2015. Please note:

  • The member eligibility data that will be available will be current as of 2:00 PM, Thursday April 23rd, and will likely not be updated until Tuesday April 28. DentaQuest will update the message on the provider portal if the files are not updated by this date.
  • During this time, while you can print copies of the member’s eligibility screen for appeals purposes, please be aware that MassHealth will NOT pay claims for members who have lost eligibility during this time.
  • Claims entered via the portal during the migration will experience a delay in processing.
  • Remittance Advices will not be posted until Tuesday April 28th.

The DentaQuest system update is essential to the improvement of their systems. Thank you for your patience while DentaQuest completes these enhancements.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

April 21, 2015MMQ Software Terminates on October 1, 2015 – PLEASE TRANSITION NOW

All nursing facility providers are again reminded that MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software as of October 1, 2015.

By September 30, 2015, you must transition to an alternative method of submitting MMQs, such as:

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

To assist you in transitioning, MassHealth has posted a Job Aid online at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf.

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

For questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

April 13, 2015MassHealth Hospice Provider Training Webinar on May 6th

To all Hospice Providers - Admitting Nurses, Billing Staff and Quality Managers: MassHealth invites you to attend a Provider Training Webinar on May 6th from 1:30 – 3:00 pm.

Information will include updates to regulations, review of current regulations that impact payment, information on the hospice election form, nursing facility guidelines, program eligibility, and claims and payment information. To join the webinar:

Conference Call Login:

Toll-Free (US & Canada): 866-740-1260
Access Code: 4725653

Web Login:

Meeting URL: http://www.readytalk.com/?ac=4725653
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800.843.9166 or help@readytalk.com
Access Code: 4725653

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

April 13, 2015Update – Customer Service Center Experiencing Unusual High Call Volume

As the MassHealth Customer Service Center continues to experience unusually high call volume, providers are advised to avoid long wait times on the telephone by using the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please include your full name, MassHealth provider name, PIDSL (Provider Identification Service Location Number) and/or NPI, phone number and the details of the inquiry. The MassHealth Customer Service Center will direct your question(s) to the appropriate customer service specialist to assist you as quickly as possible.

OF IMPORTANCE: Please do not send member PHI (protected health information) in your email.  Instead, please notify MassHealth by email that you have a question that requires transmission of PHI and we will respond by initiating a secure email discussion with you.

April 13, 2015ICD-10 Trading Partner Testing – Have You Signed Up Yet?

MassHealth reminds all providers: you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2015, as required by federal law. To help you prepare for ICD-10 implementation, MassHealth is currently testing with trading partners. Full Trading Partner Testing began April 1, 2015 and will continue through September 30, 2015.

If you submit batch claims transactions to MassHealth, it is imperative that you schedule a test date immediately.  The MassHealth EDI testing team has been outreaching to providers to schedule test dates.  Please ensure that your organization responds to all outreach attempts made by MassHealth.

If you are not certain that your organization has scheduled a test date, please contact the MassHealth EDI testing team directly at 855-295-4047 (toll free) or at edi@mahealth.net.

To stay current with the latest ICD-10 updates, including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, Provider Bulletins and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

April 6, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

BULLETINS – March 2015:

  • Long-Term Care Facility Bulletin 109: Annual Review of Personal Needs Allowance Account

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

April 6, 2015Important Message for Acute Inpatient Hospitals – Information on Claims Adjustments and Billing Instructions for Admissions Spanning 10/1/14 are now Available Online

In-state and out-of-state acute inpatient hospitals are advised that information on claim adjustments and additional billing instructions for hospital stays that span October 1, 2014, and that exceed 20 days are now available online.

Inpatient acute hospitals are now being paid using the new FFY15 (Federal Fiscal Year 2015) APAD (Adjudicated Payment Amount per Discharge) methodology and, for qualifying discharges as applicable, the FFY15 Outlier Payment methodology. These replace the prior FFY14 SPAD (Standard Payment Amount per Discharge) and outlier per diem methodologies. The web page clarifies payment and details claims adjustments and billing instructions for admissions that occurred before and extended beyond October 1, 2014, with a length of stay of greater than 20 acute days.

MassHealth will be voiding and correctly paying certain claims for these admissions.

Hospitals must now follow the new billing instructions outlined on the web.

Please go to: www.mass.gov/eohhs/provider/insurance/masshealth/claims/customer-services/billing/ and then click on Billing Tips.

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

March 30, 2015Important Reminder: EVSpc and EVScall Terminate September 1st

All providers who are still using EVSpc and EVScall to verify member eligibility are again reminded: EVSpc and EVScall will terminate on September 1, 2015. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)

To help you with these suggested transition methods, MassHealth has posted a detailed Job Aid online. Go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

Please do not delay! EVSpc/EVScall has already stopped displaying current key eligibility messages regarding MassHealth member coverage.

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

March 30, 2015Important Reminder to Dental Providers: All TPL Claims Must Be Sent Electronically Effective May 1, 2015

Dental providers are reminded: all TPL claims must be sent electronically, effective May 1, 2015.

Paper TPL claims sent on or after this date will be denied.  Please see the Dental Provider web portal for more information: www.masshealth-dental.net.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

March 30, 2015Attention All Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

All MassHealth Dental Providers billing CDT service codes are again reminded: please disregard any past RA message texts that advised of MassHealth mail forwarding ending on 12/31/14.

This message does not affect MassHealth Dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Please send all Dental Claims to the following address only:

DentaQuest – MassHealth Dental Claims
12121 North Corporate Parkway
Mequon, WI 53092

Dental providers should continue to refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, prior authorizations, claims, electronic claims, provider complaints and fraud, and provider enrollment.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

March 25, 2015MassHealth Remittance Advices (RA) and HIPAA 835 Payment FilesMassHealth Remittance Advices (RA) and HIPAA 835 Payment files are now available for download. We apologize for the delay.  If you have questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.
March 23, 2015Clarification Regarding Submission of Hospital-Based Nonbilling Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

The Hospital-Based Nonbilling Provider Enrollment Form must be submitted to MassHealth on or before April 1, 2015 for services of hospital-based physicians working in hospital-licensed health centers, acute inpatient hospitals or acute outpatient hospitals to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.             

Physicians can obtain Hospital-Based Nonbilling Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) can be found  in MassHealth Provider Bulletins issued in February 2015 at: www.mass.gov/eohhs/provider/insurance/masshealth/section-1202-rates-for-physicians-who-provide-pcs.html

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

March 23, 2015V5010 – Reminder to Providers

REMINDER: Providers and other trading partners that submit claims transactions to MassHealth must adhere to the HIPAA V5010 requirements as mandated on January 1, 2012. This includes ensuring that the attending provider’s NPI is submitted on any/all institutional claims except for claims that only include non-scheduled transportation.

Please ensure that you fully comply with this 2012 requirement as MassHealth will fully enforce it to ensure HIPAA compliance. Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

March 23, 2015Remittance Advices (RA) and HIPAA 835 Payment Files

Due to extended MMIS weekend processing, MassHealth anticipates a one day delay in the generation of provider Remittance Advices (RA) and HIPAA 835 Payment files. As soon as the RA and 835 Payment files are available for download, we will post a message here.

If you have questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.

March 18, 2015POSC

Providers and Trading Partners who receive a weekly 835 Payment file on the POSC are advised that a duplicate file was created in error this week. You may notice that the same file is appearing twice. Please just ignore the second file. We apologize for any confusion or inconvenience that this may cause.

If you have any questions, please contact the EHS Customer Support Center at SystemsSupporthelpdesk@state.ma.us.  For provider questions regarding this issue, please contact the Virtual Gateway customer service line at 1-800-421-0938.

March 16, 2015

Customer Service Center Experiencing Unusual High Call Volume

MassHealth Customer Service Center is currently experiencing unusually high call volume. We apologize for this inconvenience.

To avoid long wait times on the telephone, please be aware that providers can make use of the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please make sure to include the caller's full name, MassHealth provider name, Provider Identification Service Location (PIDSL) Number and/or National Provider Identifier (NPI), telephone number and the details of the inquiry or question(s). The MassHealth Customer Service Center will direct your inquiry to the appropriate customer service specialist to assist you as quickly as possible.

March 16, 2015ICD-10 Trading Partner Testing Update

REMINDER: All MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2015, as required by federal law.

MassHealth is continuing to prepare for ICD-10 implementation and is currently testing with trading partners. Vendor Phase II testing continues through March 31, 2015. Full Trading Partner Testing begins April 1, 2015, continuing through August 31, 2015. The MassHealth EDI testing team will be outreaching over the next several months to help you prepare for testing.

If you have questions or you are ready to schedule a test date, please contact the MassHealth EDI testing team directly at 855-295-4047 (toll free) or at edi@mahealth.net.

To stay current with the latest ICD-10 updates, including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, Provider Bulletins and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

March 16, 2015Important Notification:  MMQ Software Will Terminate on October 1, 2015

Effective October 1, 2015, MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software currently used by nursing facility providers. By September 30, 2015, all providers using this software must transition to an alternative method of submitting MMQs. Other methods include:

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

MassHealth will provide support for the proprietary MMQ software only until September 30, 2015, when all nursing facility providers must have transitioned to alternate methods.

To facilitate the transition, MassHealth has already removed the MMQ software from the web site and has made available updated MMQ file specifications. POSC users may refer to the MMQ Job Aid available at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf. Batch submitters may view the MassHealth MMQ file specifications available at www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf. Both of these documents were modified for ICD-10.

If you have questions or need assistance in transitioning off the MassHealth MMQ software tool, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.

March 9, 2015Customer Service Center Experiencing Unusual High Call Volume

MassHealth Customer Service Center is currently experiencing unusually high call volume. We apologize for this inconvenience.

To avoid long wait times on the telephone, please be aware that providers can make use of the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please make sure to include the caller’s full name, MassHealth provider name, Provider Identification Service Location (PIDSL) Number and/or National Provider Identifier (NPI), telephone number and the details of the inquiry or question(s). The MassHealth Customer Service Center will direct your inquiry to the appropriate customer service specialist to assist you as quickly as possible.

March 9, 2015Section 1202 Notice of Overpayment Letters Mailed

During the week of March 9, 2015 MassHealth will begin to mail Notice of Overpayment letters to group practices that did not respond to the Final Notice of Lack of Section 1202 Eligibility dated December 9, 2014.

The Notice of Overpayment contains the amount of Section 1202 overpayments made to the group practice for identified claims for certain dates of service submitted in connection with Section 1202 of the Affordable Care Act, which should not have been paid Section 1202 rates. As a result, MassHealth is taking steps to recover any Section 1202 payments that have been made to the group practice since January 1, 2013. Details can be seen on remittance advices at the end of March and throughout April.  Remittance Advice Code 9985 will appear on affected claims.

If the group practice seeks to dispute the amount of the identified overpayments indicated in the Notice of Overpayment letter, it must respond timely to the Notice of Overpayment as noted in the letter; otherwise, it will forfeit any rights to an adjudicatory hearing or to appeal the agency decision.

All communications to MassHealth concerning this matter, including any reply, should be sent to the MassHealth Customer Service Center (CSC) by e-mail at providersupport@mahealth.net, by fax at 617-988-8974 or by mail to the following address:

MassHealth Customer Service Center
Attn: Provider Enrollment, Section 1202 Reply to Notice of Overpayment
P.O. Box 9162
Canton MA 02021

March 6, 2015EDI Transactions

MassHealth is currently experiencing delays in processing EDI transactions (this includes claims submission, claims status transactions as well as eligibility transactions).  As a result providers may be experiencing a delay in receiving 999 acknowledgements or seeing the transactions processed.  Direct Data Entry (DDE) claims are not impacted. Providers do not need to resubmit these EDI files as they will be processed. We are working to resolve the issue and we plan to complete processing this weekend. We apologize for any inconvenience.

We apologize for any inconvenience this may cause. If you have any questions, please contact the EHS Customer Support Center at SystemsSupporthelpdesk@state.ma.us  

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

March 2, 2015Reminder: Member Eligibility Inquiry Submission Guideline Now Expanded from 1,000 to 3,000 Per Transaction

Providers and vendors are reminded: MassHealth has adjusted its member eligibility submission guideline to accommodate up to 3,000 members in an eligibility transaction.

MassHealth strongly encourages providers to modify their eligibility submission practices immediately as, effective May 10, 2015, the agency will begin to reject transactions that exceed 3,000 members. The 270/271 HIPAA Implementation Guide requires that the 270 transaction contain no more than ninety-nine patient requests when using the transaction in batch mode but allows for other patient request limits to be set. MassHealth agrees to the reasonable limit of up to 3,000 member request per transaction and reserves the right to modify this limit as required in accordance with the HIPAA standard.

To ensure the timely and efficient processing of your eligibility files, please adhere to these submission guidelines:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. YOU MUST INCLUDE the member’s Medicaid ID number on the eligibility request if known
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received.

Please begin immediately to adhere to these batch file submission guidelines as non-conformance will impact the timely response to your file submission. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

March 2, 2015

Update: Crossover Claims Denied Erroneously for Edits 853 AND 855

Providers are advised: crossover claims that were denied erroneously for Edit 853 and Edit 855 on claims processed from 10/26/2014 through 12/18/2014 have been reprocessed and will appear on a future remittance advice.  

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

March 2, 2015

Crossover Claims Denied Erroneously for Modifier Edits

As indicated by a message text published in December 2014, MassHealth has resolved an issue that resulted in erroneous denials of crossover claims that processed from 10/26/2014 through 12/18/2014 for the following edits:

EDIT 4010 - MODIFIER REQUIRES MEDICAL REVIEW
EDIT 4033 - INVALID PROC MOD COMBINATION
EDIT 4203 - MODIFIER IS NOT COVERED

The crossover claims adjudicated after 12/18/2014 will no longer deny for these edits. Providers may resubmit denied crossover claims as MassHealth will NOT be reprocessing these claims.  No changes are necessary to the modifiers on the crossover claim when resubmitting these claims.

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

March 2, 2015

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

BULLETINS – February 2015:

  • Acute Inpatient Hospital Bulletin 151: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services
  • Acute Inpatient Hospital Bulletin 150: New Fax Number for MassHealth Applications and Documents
  • Acute Outpatient Hospital Bulletin 31: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services
  • Community Health Center Bulletin 82: New Fax Number for MassHealth Applications and Documents
  • Physician Bulletin 98: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services

TRANSMITTAL LETTERS – February 2015:

  • DME-33: 2014 HCPCS
  • ORT-24: 2014 HCPCS
  • OXY-31: 2014 HCPCS
  • PRT-25: 2014 HCPCS

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

February 23, 2015

Pharmacy, DME and Oxygen – Updated Payment and Coverage Guidelines, PA Operating Standards Now Online

Pharmacy, DME and Oxygen providers are advised: The MassHealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web.

To confirm that you are using the most recent version of the applicable Tool (v.23), go to www.mass.gov/masshealthpubs.  Click on Provider Library and then on MassHealth Payment and Coverage Guideline Tool.

You will also find the newly-updated Operating Standards for the Prior Authorization process on the Payment and Coverage Guideline page.  Click on the “Click Here” box on the upper right corner of the page.  This will bring you to the Quick Links page. Please note: this must be open in POSC to view deferral reasons. If you have any PA questions, please contact the PAU at PriorAuthorization@umassmed.edu or 1-800-862-8341.

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

February 23, 2015ICD-10 Implementation – Vendor-Phase II Testing Underway – Have You Signed Up Yet?

A reminder from MassHealth: With the implementation of ICD-10 scheduled for October 1, 2015, MassHealth is continuing to test with trading partners. Vendor Phase II testing is underway from February 2 – March 31, 2015. MassHealth strongly urges vendors that are ready for testing to arrange a test date immediately.

Testing involves submitting test claims, receiving test results, submitting corrected test claims and getting approved for production. Please schedule your testing immediately if you have not done so already. Contact the EDI team directly at 855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

February 23, 2015Deadline Extended to April 1, 2015 to Submit Hospital-Based Non-Billing Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

The Hospital-Based Non-Billing Provider Enrollment Form must be submitted to MassHealth on or before April 1, 2015 for services of a hospital-based physician to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.

Physicians can obtain Hospital-Based Non-billing Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) will be forthcoming in a MassHealth Provider Bulletin.

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

February 3, 2015ICD-10 Implementation – Vendor-Phase II Testing is Underway

A reminder from MassHealth: With the implementation of ICD-10 scheduled for October 1, 2015, MassHealth is continuing to test with trading partners. Vendor Phase II testing is underway from February 2 – March 31, 2015. Full Trading Partner Testing – Phase II is scheduled for April 1 – August 31, 2015. However, any trading partner that is currently ready to test should contact MassHealth immediately to arrange a test date.  

Testing involves submitting test claims, receiving test results, submitting corrected test claims and getting approved for production. MassHealth strongly urges you to schedule testing immediately if you have not done so already. Please contact the EDI team directly at 855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

February 3, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – January 2015:

-ABR-16: Revisions to Abortion Services Regulations
-AIH-52: Gender Dysphoria, Sterilization, and Hysterectomy Policies
-ALL-212: Revised Payment Methodology for Out-of-state Chronic Disease and Rehabilitation Hospitals
-AOH-34: Revisions to Abortion Services Regulations
-AOH-33: Updated Gender Dysphoria and Sterilization Policies; Out-of-State Chronic Disease and Rehabilitation Hospitals
-AUD-17: Addition of Cochlear Implant External Components and Subchapter 6 Updates
-CHC-102: Gender Dysphoria, Sterilization, Hysterectomy, and Laboratory Services Policy
-COH-9: Updated Gender Dysphoria and Sterilization Policies; Out-of-State Chronic Disease and Rehabilitation Hospitals
-FAS-28: Updated Gender Dysphoria and Sterilization Policies, and Provider Eligibility Requirements
-FPA-51: Updated Sterilization Provisions and Subchapter 6
-HIS-25: Regulation and Subchapter 6 Updates
-PHM-61: Updated Gender Dysphoria Policy
-PHY-142: Updated Gender Dysphoria and Sterilization Policies
-POD-71: Updated Gender Dysphoria Policy
-STR-18: Updated Sterilization Clinic Regulations

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

January 20, 2015

Member Eligibility Inquiry Submission Guideline Now Expanded from 1,000 TO 3,000 Per Batch File

Providers and vendors are advised: MassHealth has adjusted its member eligibility submission guideline to accommodate up to 3,000 members in a single eligibility batch file request.

MassHealth strongly encourages providers to modify their eligibility submission practices immediately as the agency will begin this spring (mid-late March) to reject submissions that exceed 3,000 members.

REMINDER: To ensure the timely and efficient processing of your transactions, please adhere to these submission guidelines which conform to Phase I CORE 155: Eligibility and Benefits Batch Response Time Rules, HIPAA ASC X12 and MassHealth policy:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. YOU MUST INCLUDE the member’s Medicaid ID number on the eligibility request if known.
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received from MassHealth on the prior eligibility response (where applicable).

It is important that you adhere to these batch file submission guidelines as non-conformance will impact the timely response to your file submission. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

January 20, 2015

Job Aid Now Posted Online For Help in Transitioning From EVSpc and EVScall

MassHealth has now posted a Job Aid online for all providers who are still using EVSpc and EVScall and need to transition to another method of member eligibility verification and claim status inquiry.

Please go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf for a list of EVS transition options, access methods, set-up processes, resources and helpful links.

MassHealth has extended the termination date for EVSpc and EVScall software to September 1st, 2015. Please note that MassHealth will reject any/all transactions that are generated from this tool on or after the termination date.  However, providers should not delay! Please make this transition as soon as possible, as the software tool no longer displays key eligibility messages regarding MassHealth member coverage.

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

January 20, 2015

Important MassHealth Disclaimer Regarding EVSpc and EVScall Software Termination

All MassHealth Providers were notified on August 18, 2014, to stop using EVSpc to verify member eligibility as the software tool does not provide eligibility notifications, warnings, and other important messages about MassHealth Members that are provided by other MassHealth eligibility access methods noted below. Pursuant to that August notification, you must transition to one of the eligibility verification methods available on the POSC or via MassHealth Automated Voice Response (AVR).

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits, even if EOHHS has been advised of the possibility of such damages. To the maximum extent permitted by applicable law, EOHHS disclaims all warranties, conditions, representations or guaranties of any kind, either express, implied, statutory or otherwise including, but not limited to, any implied warranties or conditions of satisfactory quality or fitness for a particular purpose.

MassHealth has extended the termination date for EVSpc and EVScall software to September 1st, 2015. MassHealth will reject any/all transactions generated from the tool after this date. To choose a new eligibility verification method, please refer immediately to the EVSpc/EVScall Job Aid page now online: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

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

January 20, 2015

Response Deadline Approaching: Letter Regarding 1202 Rate Eligibility

This is a reminder to all providers who received a letter from MassHealth, dated December 9, 2014 regarding ACA Section 1202 Physician Eligibility:

If you believe that a physician is eligible for Section 1202, you must submit the Physician Certification and Attestation Form by February 1, 2015 in order to reinstate a physician’s 1202 eligibility and receive any missed 1202 payments.

If you do not respond to the notice dated December 9, 2014, MassHealth will calculate and recover any Section 1202 payments that have been made to group practices since January 1, 2013 for services provided by physicians who did not attest to 1202 eligibility and did not return a completed Certification and Attestation form by the deadline

The Form is available at: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf and should be returned to MassHealth PEC, P.O. Box 9162, Canton MA 02021 or by FAX to 1-617-988-8974.

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

January 12, 2015Deadline to Submit Hospital-Based Non-Billing Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

This is a reminder that the Hospital-Based Non-Billing Provider Enrollment Form must be submitted to MassHealth on or before March 1, 2015 for services of a hospital-based physician to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.

Physicians can obtain Hospital-Based Non-billing Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) will be forthcoming in a MassHealth Provider Bulletin.

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

January 5, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – December 2014:

-Acute Inpatient Hospital Bulletin 149: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
-All Provider Bulletin 248: Information about ICD-10
-Community Health Center Bulletin 81: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
-Nursing Facility Bulletin 138: Increase in Medical Leave-of-Absence (MLOA) Days

TRANSMITTAL LETTERS - December 2014:

-CHC-101: 2014 HCPCS and Vaccine Codes

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

January 5, 2015Important Date Change:  EVSpc and EVScall Software Termination Extended to September 1, 2015

IMPORTANT INFORMATION – All MassHealth Providers were notified on August 18, 2014, to stop using EVSpc to verify member eligibility as the software tool does not provide eligibility notifications, warnings, and other important messages about MassHealth Members that are provided by other MassHealth eligibility access methods noted below. Pursuant to that August notification, you must transition to one of the eligibility verification methods available on the POSC or via Automated Voice Response (AVR). If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits, even if EOHHS has been advised of the possibility of such damages. To the maximum extent permitted by applicable law, EOHHS disclaims all warranties, conditions, representations or guaranties of any kind, either express, implied, statutory or otherwise including, but not limited to, any implied warranties or conditions of satisfactory quality or fitness for a particular purpose.

MassHealth has extended the termination date for EVSpc and EVScall software from February 28th to September 1st, 2015. All functionality will end and there will be no support for the software after that date. Please refer to: www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/evspc.html.

EVSpc/EVScall has already stopped displaying current key eligibility messages regarding MassHealth member coverage. Therefore, you must immediately stop using EVSpc and EVScall and transition to one of the following POSC or other access methods:

-Use DDE (Direct Data Entry)

-Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files

-Check eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042 or

-Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions in accordance with MassHealth specifications:

-Upload 270 batches through the POSC or

-Submit and receive batched transactions directly (system-to-system) via HTS (Healthcare Transaction Services)

OF IMPORTANCE: To submit and receive HIPAA transactions in an electronic batch file through the POSC or through the HTS method, you must first coordinate with MassHealth Customer Service. For questions or assistance, contact the MassHealth Customer Service Center immediately at 1-800-841-2900 or providersupport@mahealth.net.

January 5, 2015Important Reminder: 1202 Enhanced Payments Have Ended Effective 12/31/2014

Physicians and group practices that have been receiving enhanced rates under ACA Section 1202 are advised: the enhanced rates have expired effective 12/31/14.

For dates of service January 1, 2015 and forward, your remittance advices will reflect standard, unenhanced MassHealth physician rates.

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

January 5, 2015Medicare Crossover Claims Denied for Edit 519 – Admit Date is After Statement Period “From” Date

MassHealth has resolved an issue that resulted in erroneous denials of Inpatient Part A crossover claims for Edit 519 with process dates from 9/11/2014 through 12/23/2014. 

Crossover claims adjudicated after 12/23/2014 will no longer deny for Edit 519. MassHealth has reprocessed the previously denied crossover claims which will appear on a future remittance advice.

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

January 5, 2015MassHealth Mail Forwarding Has Ended Effective 12/31/14

All providers are reminded that mail forwarding - from the old MassHealth Hingham address to the current Canton address – has ended as of December 31, 2014. Please make sure you use the correct address or your mail will be returned to you as undeliverable.

PROVIDER ENROLLMENT AND CREDENTIALING – Use this mailing address to submit new enrollment applications, provider file updates or correspondence:

MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton MA 02021

PAPER CLAIMS - If you are authorized to submit paper claims, the P.O. Box is:

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

PAPER PRIOR AUTHORIZATIONS - Send PA-1 request forms to:

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

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

January 5, 2015Dental Providers: Please Use Correct DentaQuest Address For Claims

All MassHealth Dental Providers billing CDT service codes should disregard the message text “MassHealth Mail Forwarding Has Ended Effective 12/31/14.” This message does not affect dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Please send all Dental Claims to:

DentaQuest – MassHealth Dental Claims
12121 North Corporate Parkway
Mequon, WI 53092

Please refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, provider enrollment, prior authorizations, claims, electronic claims, provider complaints and fraud.

For questions, contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

December 29, 2014Updated Approved Vendor List Now Available on Web

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

To access this new list and a helpful list of “Questions You Should Ask Your

Vendor/Clearinghouse/Billing Intermediary,” please go to:  www.mass.gov/eohhs/gov/laws-regs/privacy-security/masshealth/edi/vendor-list.html.

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

December 29, 2014Reminder: 1202 Enhanced Payments End 12/31/2014

All physicians and group practices that have been receiving enhanced rates under ACA Section 1202 are advised: the enhanced rates expire effective 12/31/14.

Please note that for dates of service January 1, 2015 and forward, your remittance advices reflect standard, unenhanced MassHealth physician rates.

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

December 29, 2014

New Modifiers to Bypass PTP Editing

Please note that there are four new HCPCS modifiers, listed below, that will be effective for use for dates of service on or after January 1, 2015. These modifiers should be used to bypass PTP (procedure-to-procedure) editing only when the code pair is designated by CMS as eligible for a modifier and when the second service is a distinct procedural service:

XE - Separate encounter: a service that is distinct because it occurred during a separate encounter
XP - Separate practitioner: a service that is distinct because it was performed by a different practitioner
XS - Separate structure: a service that is distinct because it was performed on a separate organ/structure
XU - Unusual non-overlapping service: the use of a service that is distinct because it does not overlap usual components of the main service

These modifiers describe clinical situations that currently are indicated by appending Modifier 59 – “Distinct Procedural Service”. However, CMS has identified that Modifier 59 is often misused to bypass PTP edits, partly because it is so non-specific. The new modifiers were established so that providers can specify more clearly the situations in which PTP edits, designated by CMS as eligible for a modifier, are eligible to be bypassed.

Modifier 59 remains a valid PTP-associated modifier. However, the coding instructions for Modifier 59 specify that it should be used “only if no more descriptive modifier is available.” Therefore, providers should use one of the new modifiers instead if the clinical situation described by one of the new modifiers is present.

Providers should consult the CPT code book for additional information about how to appropriately use modifiers. Please also refer to All Provider Bulletin 227 for more information on the appropriate use of PTP Modifiers. For questions, contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

December 22, 2014Support for Older Browser Connections Ends in January — Please Upgrade

Effective January 26, 2015, the MassHealth POSC (Provider Online Service Center) will no longer support browser connections using the SSL protocol. These are browser connections coming from older browsers such as Internet Explorer 6 or 7 that explicitly disable the TLS 1.0 protocol. If you are running Internet Explorer 6 or 7, we ask that you install Mozilla Firefox.

If you wish to use Internet Explorer, we recommend that you update to Internet Explorer 11. If you are running Internet Explorer 8, please validate that you have the TLS 1.0 Protocol enabled. This can be done within Internet Explorer under the Menu item Tools > Internet Options > Advanced Tab. Scroll down to the security section and make sure that TLS 1.0 is enabled. If not, add a check mark next to it to enable. Stop and restart your browser.

For other browsers such as Google Chrome and Mozilla Firefox, our testing has confirmed that TLS 1.0 has been enabled by default.  We recommend that you share this information with your IT department.

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

December 22, 2014Crossover Claims Denied Erroneously

MassHealth has resolved an issue that resulted in erroneous denials of crossover claims that processed from 10/26/2014 through 12/18/2014 for the following edits:

EDIT 853 FINAL DEADLINE EXCEEDED - DETAIL
EDIT 855 FINAL DEADLINE EXCEEDED - HEADER
EDIT 4010 MODIFIER REQUIRES MEDICAL REVIEW
EDIT 4033 INVALID PROC MOD COMBINATION
EDIT 4203 MODIFIER IS NOT COVERED

The crossover claims adjudicated after 12/18/2014 will no longer deny for these edit. MassHealth plans to reprocess the previously denied crossover claims on a future remittance advice. However, providers may resubmit denied crossover claims at this time.

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

December 15, 2014Letters Regarding Physician Eligibility For Section 1202 Rates

This is a reminder to all physicians who received a letter from MassHealth, dated December 9, 2014 regarding ACA Section 1202 Physician Eligibility:

If you believe that a physician is eligible for Section 1202, you must submit the Physician Certification and Attestation Form by February 1, 2015 in order to reinstate a physician’s 1202 eligibility and receive any missed 1202 payments.

If you do not respond to the notice dated December 9, 2014, MassHealth will calculate and recover any Section 1202 payments that have been made to group practices since January 1, 2013 for services provided by physicians who did not attest to 1202 eligibility and did not return a completed Certification and Attestation form by the deadline.

The form is available at: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf and should be returned to MassHealth PEC, P.O. Box 9162, Canton MA 02021 or by FAX to 1-617-988-8974.

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

December 8, 2014Reminder – MassHealth Mail Forwarding Ends December 31, 2014

MassHealth alerted all providers of new mailing addresses that became effective January 2, 2014. As part of the transition, MassHealth allowed mail still being sent to the old addresses to be forwarded.  However, all mail forwarding will cease on December 31, 2014. Please make sure you use the correct address or your mail will be returned to you as undeliverable.

PROVIDER ENROLLMENT AND CREDENTIALING – Use this mailing address to submit new enrollment applications, provider file updates or correspondence:

MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton MA 02021

PAPER CLAIMS - If you are authorized to submit paper claims, the P.O. Box is:

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

PAPER PRIOR AUTHORIZATIONS - Send PA-1 request forms to:

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

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

December 8, 2014Attention All Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

All MassHealth Dental Providers billing CDT service codes should disregard the message text “Reminder – MassHealth Mail Forwarding Ends December 31, 2014.” This message does not affect MassHealth dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Please send all Dental Claims to the following address:

DentaQuest – MassHealth Dental Claims
12121 North Corporate ParkwayMequon, WI 53092

Dental providers should continue to refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, prior authorizations, claims, electronic claims, provider complaints and fraud, and provider enrollment.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

December 8, 2014Crossover Claims Denied for Edit 4033 – Invalid PROC MOD Combination

MassHealth has resolved an issue that resulted in erroneous denials of crossover claims that processed from 10/26/2014 through 11/26/2014 for Edit 4033-INVALID PROC MOD COMBINATION.

The crossover claims adjudicated after 11/26/2014 will no longer deny for this edit. MassHealth plans to reprocess the previously denied crossover claims on a future remittance advice. However, providers may resubmit denied crossover claims at this time.

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

December 1, 2014Urgent Reminder to Stop Using EVSpc and EVScall Software Immediately

All providers still using EVSpc and EVScall Software are again reminded: MassHealth will terminate use of this software on February 28, 2015. All functionality will be terminated and there will be no support for the software after that date. EVSpc/EVScall has already ceased displaying current key eligibility messages regarding MassHealth member coverage. MassHealth will not accept any files with “.snd” suffix after February 28, 2015.

Please stop using EVSpc and EVScall immediately and transition to one of the following POSC or other access methods:

  • Use POSC DDE (Direct Data Entry)
  • Submit a Health Care Benefit Inquiry & Response (270/271) or Health Care Claims Status Inquiry & Response (276/277) batch file transaction in accordance with MassHealth specifications. You must coordinate with MassHealth Customer Service for this.
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive batched transactions directly (system-to-system) via HTS (Healthcare Transaction System).You must coordinate with MassHealth Customer Service for this.

Please note: you must coordinate with MassHealth Customer Service to test batch and HTS files before you can submit and receive HIPAA transactions in an electronic batch file format through the POSC or the HTS method. If you already use a vendor that submits your “270” requests from a system that does NOT use the EVSpc/EVScall software, you should not be impacted by this upcoming EVS termination. Please check with your vendor regarding its submission methods.

For more information, go to www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/. Click on Information and Software for Electronic Transactions.

With the February 28, 2015 date to terminate EVSpc/EVScall approaching, you must take time now to make this very important transition. If you have questions or need assistance in transitioning to one of the access methods, please contact the MassHealth Customer Service Center immediately at 1-800-841-2900 or providersupport@mahealth.net.

December 1, 2014HCPCS Code G0463 – Outpatient Medicare Crossover Claim Denials

MassHealth has resolved an issue that resulted in erroneous denials of outpatient crossover claims for Edit 4021-PROCEDURE NOT COVERED FOR BENEFIT PLAN when billed with HCPCS G0463-HOSPITAL OUTPT CLINIC VISIT.

Outpatient crossover claims adjudicated after 08/15/2014 containing HCPCS G0463 will no longer deny for Edit 4021. MassHealth will not reprocess outpatient crossovers that previously denied for Edit 4021. Providers should resubmit their previously denied crossovers at this time.

All MassHealth providers are reminded to bill with MassHealth-covered Evaluation and Management CPT Codes for all other outpatient non-crossover claims.

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

December 1, 2014Third Party Liability (TPL) Claims Denied for Referral

MassHealth has identified TPL claims processed from 05/26/2009 through 10/02/2013 that were erroneously denied for Edit 3120-REFERRAL REQUIRED ON CLAIM. The affected claims have been reprocessed. The reprocessed claims will appear on future remittance advices.

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

December 1, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS - November 2014:

ALL-211: Revised Regulations about Electronic Health Records

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

November 24, 2014

Important Reminder – Please Adhere to File Submission Guidelines

Providers and vendors have been submitting excessively large HIPAA Eligibility Inquiry and Response transactions (270/271) to MassHealth for processing. In order to ensure the timely, efficient processing of transactions submitted by MassHealth providers and vendors in conformance with Phase I CORE 155: Eligibility and Benefits Batch Response Time Rules and in accordance with HIPAA ASC X12 and MassHealth policy, providers and vendors must adhere to the following submission guidelines:

1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.

2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.

3. DO NOT include more than 1,000 members in any single eligibility request.

4. YOU MUST INCLUDE the member’s Medicaid ID number on the eligibility request if known.

5. ALWAYS POPULATE all subsequent eligibility requests with the member information received from MassHealth on the prior eligibility response (where applicable).

It is important that you adhere to these file submission guidelines as non-conformance will impact the timely response to your file submission. For questions, please contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net.

November 10, 2014New PCC Application Available

All PCC (Primary Care Clinician) Providers and providers wishing to become PCCs are advised: MassHealth is now introducing a new, updated PCC Application for those providers eligible as stated in the MassHealth all provider regulation 450.118.

We ask that you immediately begin using this new PCC application to enroll in the PCC Plan (Primary Care Clinician Plan). The application is not available online and you must contact the MassHealth Customer Services Center to receive the new form. Please discard any blank copies of the old PCC application you may have. The older version of the application will no longer be accepted after December 31, 2014.

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

November 3, 2014IMPORTANT: EVSpc AND EVScall WILL BE TERMINATED ON FEBRUARY 28, 2015 – PLEASE TRANSITION NOW

MassHealth has now moved the termination date of EVSpc/EVScall Eligibility Verification Software to February 28, 2015. All EVSpc/EVScall functionality will cease after that date as MassHealth cannot provide support for the software after that date. All transactions submitted via EVSpc/EVScall will be rejected. EVSpc/EVScall already cannot display current key eligibility messages regarding MassHealth member coverage.

Providers must stop using EVSpc and EVScall immediately! Please transition to one of the following POSC or other access methods:

-Use POSC DDE (Direct Data Entry).
-Submit a Health Care Benefit Inquiry & Response (270/271) or Health Care Claims Status Inquiry & Response (276/277) batch file transaction in accordance with MassHealth specifications. You must coordinate with MassHealth Customer Service for this.
-Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
-Check eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042.
-Submit and receive batched transactions directly (system-to-system) via HTS (Healthcare Transaction System).You must coordinate with MassHealth Customer Service for this.

Please note: you must coordinate with MassHealth Customer Service to test batch and HTS files before you will be allowed to submit and receive HIPAA transactions in an electronic batch file format through the POSC or the HTS method. If you already use a vendor that submits “270” requests for you from a system that does NOT use the EVSpc/EVScall software, you should not be impacted by this upcoming EVS termination. Please confer with your vendor if you have any questions regarding its submission methods.

For additional information please go to: www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/ and click on Information and Software for Electronic Transactions.

The February 28, 2015 date to terminate use and support of EVSpc/EVScall is fast approaching! Please take time now to make this very important transition. For questions or assistance with transitioning to one of the access methods, contact the MassHealth Customer Service Center immediately at 1-800-841-2900 or providersupport@mahealth.net.

October 23, 2014Updates to POSCIt is important to note that due to the recent updates to the POSC, only connections from workstations using Internet Explorer version 8 or higher will be accepted.  Users with Internet Explorer version 7 or lower will need to update their browsers.  For provider questions regarding this upgrade, please contact the Virtual Gateway customer service line at 1-800-421-0938.
October 20, 2014

New EVS Message For Individuals with Temporary MassHealth Coverage and Commonwealth Care

Temporary coverage is ending soon for individuals with temporary MassHealth coverage and those currently covered through Commonwealth Care. Beginning in November 2014, and continuing through December, MassHealth and the Massachusetts Health Connector will be sending these individuals call-to-action notices asking them to submit new applications for 2015 coverage. These notices will provide the information needed to ensure these members re-apply and enroll in appropriate coverage before temporary MassHealth or Commonwealth Care coverage ends. We have posted messages on EVS for these impacted populations in order to help you identify and assist individuals who need to submit new applications.

Individuals with temporary MassHealth will receive notices between November 15th and December 15th. These members will have 60 days from the date of the notice they receive to take action before temporary coverage ends. Current Commonwealth Care members will receive notices on November 13th, 2014 and in order to avoid any gaps in coverage must submit a new application and enroll in new coverage by January 31, 2015.

Starting on October 20 2014, MassHealth will be posting the following EVS messages to help you identify those impacted by these changes:

  • EVS message for individuals with temporary MassHealth coverage: “This member’s temporary benefits are ending soon! They need to submit a new application on or after November 15, 2014 at MAhealthconnector.org”
  • EVS message for Commonwealth Care members: “This member’s Commonwealth Care coverage is ending soon! They need to submit a new application on or after November 15, 2014 at MAhealthconnector.org”

If this EVS message is displayed, please encourage and, if able, assist the individual to submit a new application at MAhealthconnector.org on or after November 15, 2014. These members do not have to wait to get a letter from MassHealth or the Health Connector to take action.

If an assistor, such as a Navigator or Certified Application Counselor, is available at your facility, please coordinate with them to schedule an appointment for these individuals to submit an application. If an assistor is not available, please direct the individuals to visit http://bettermahealthconnector.org/get-help/ for a complete list of assistors who can provide free help with submitting an application.

October 20, 2014Update to Homebound Assessment Form

Home Health Agency providers are advised that updates to the Homebound Assessment Form have been posted as of 09/30/2014.

Please note the change in the title for Section V: “Provider of DME Attestation, Signature and Date” has been changed to “Provider Attestation, Signature and Date.” This change was made because the signature must be from the Home Health Provider and not the DME Provider.

To access the updated form, please go to: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/hba.pdf. For questions, please contact the MassHealth Customer Services Center at providersupport@mahealth.net or 1-800-841-2900.

October 14, 2014MassHealth Reprocessing Physician Claims to Adjust for Rate Changes

MMIS files for rates effective July 1, 2012 were updated on August 23, 2012. Recent audits identified incorrectly paid claims.

MassHealth will be reprocessing claims for dates of service July 1, 2012 through August 23, 2012 to correct this. The adjusted claims will appear over the next several pay cycles. We apologize for the inconvenience.

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

October 14, 2014ICD-10 Trading Partner Testing Update

MassHealth would like to extend a thank you to all of the providers who participated in the ICD-10 Trading Partner Testing activities to date. Please note that Beta testing ended on May 30, 2014 and Vendor testing ended on August 29, 2014. To see the results of the Vendor Testing, please visit the MassHealth ICD-10 web page on www.mass.gov.

We also thank all of the providers who scheduled a test date for 2014 or 2015, and who are currently testing ICD-10 transactions with MassHealth. If you missed your test date and need to reschedule, please contact MassHealth’s EDI Department directly at 855-295-4047 or edi@mahealth.net. The ICD-10 Testing Team will be happy to assist you.

MassHealth strongly encourages you to begin testing preparations now even though you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 2015, as required by federal law. To stay current with the latest ICD-10 updates, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/.  Click on ICD Implementation.

If you are interested in testing ICD-10 transactions with MassHealth, or you have been notified that you are required to test ICD-10 transactions with MassHealth, please contact the ICD-10 Testing Team directly at 855-295-4047 or edi@mahealth.net for more information.

October 14, 2014DME & Oxygen Claim Denials for Dual Eligible Members

DME and Oxygen services that have been rendered in a nursing facility (place of service 31 or 32) may be billed to MassHealth as the primary insurance only when the member’s Medicare Part A coverage has been exhausted.

MassHealth plans to reprocess claims with adjudication dates from 9/20/2013 through 9/26/2014 that denied for: Edit 2505- MEMBER COVERED BY MEDICARE or Edit 2593-DETAIL/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE when HIPAA group code PR and claim adjustment reason code 5 were reported on the claim. The reprocessed claims will appear on future remittance advices.

Please continue to refer to the online MassHealth DME & Oxygen Payment and Coverage Guideline Tool regarding Prior Authorization requirements for service codes covered by MassHealth.

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

October 14, 2014DME/OXY Payment and Coverage Guideline Tool  - Updated

Pharmacy, DME and Oxygen providers are advised: the Masshealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web.

To confirm that you are using the most recent version of the applicable tool, please go to www.mass.gov/masshealthpubs. Click on Provider Library and then on Masshealth Payment and Coverage Guideline Tool.

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

October 6, 2014Independent Nurses: No Payment for Services in Institutional Settings

Independent nurses are reminded that MassHealth will not pay for nursing services provided in institutional settings per MassHealth regulation 414.409:

414.409: Conditions of Payment

(A) Place of Service. The MassHealth agency pays for nursing services to a member who meets the clinical criteria in 130 CMR 414.408 and resides in a non-institutional setting which may include, without limitation, a homeless shelter or other temporary residence or a community setting. In accordance with 42 CFR 440.70(c), the MassHealth agency does not pay for nursing services provided in a hospital, nursing facility, intermediate care facility for the mentally retarded or any other institutional setting providing medical, nursing, rehabilitative or related care.

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

October 6, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS - September 2014:

-All Provider Bulletin 247: Free Enhanced Text Messaging Service to Support Pregnant Women and New Mothers

-Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 88: Revised Screening Process for Chronic Disease and Rehabilitation Hospitals

TRANSMITTAL LETTERS - September 2014:

-ALL-210: Revised Appendix A

-AIH-51: Elimination of 20-day coverage limitation for acute inpatient hospital stays of members aged 21 or older

-ALL-209: Revised payment methodology for out-of-state acute hospitals

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

September 29, 2014Mental Health Center Crossover Adjustments for E&M Procedure Codes

MassHealth has systematically adjusted professional crossover claims with E&M (evaluation and management) procedure codes billed by Mental Health Centers. Claims with dates of service on or after January 1, 2014 were adjusted due to a change in the reimbursement rate. These adjusted claims will appear on a future remittance advice.

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

September 22, 2014MassHealth Provider Revalidation Continues

MassHealth is continuing its Provider Revalidation effort, as required by the federal Affordable Care Act. The process requires that you revalidate your enrollment information for MassHealth under new screening criteria.  You are receiving this remittance advice message because you/your entity may have received a Revalidation Request letter in August or September.

This Revalidation initiative:

-Is being conducted by Provider Type.

-Is currently focusing only on MassHealth providers enrolled on or before March 25, 2011 and will be completed by March 24, 2016. If you enrolled as a provider after March 25, 2011, you will be revalidated on or before five years from the date of your initial enrollment.

-Must be completed within 45 days of the date on the request letter.

OF IMPORTANCE: With certain higher-volume provider types, the revalidation will be conducted over several months, e.g., only a portion of pharmacies or nurse practitioners will be called to revalidate per month. Therefore, you may not necessarily have been called to revalidate yet, although all in your provider type have been sent this message.

To verify whether you have been mailed a Revalidation Request letter, contact the MassHealth Customer Service Center at 1-800-841-2900 or email providersupport@mahealth.net.

For more information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation.

September 22, 2014COB Claims Submitted with Invalid HIPAA Claim Adjustment Reason Codes

Providers are reminded that claims involving COB (Coordination of Benefits) information must be submitted to MassHealth with a valid HIPAA CARC (Claim Adjustment Reason Code). Beginning September 16, 2014, claims submitted with invalid CARCs may result in denials for the following edits:

2558 - OTHER PAYER DENIAL ARC IS NOT ON TABLE – HEADER
2559 - OTHER PAYER DENIAL ARC IS NOT ON TABLE – DETAIL

Providers should refer to the Washington Publishing Company website http://www.wpc-edi.com/reference for a complete list of valid HIPAA Claim Adjustment Reason Codes.

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

September 22, 2014How to Check your Revalidation Status

Many MassHealth providers have been asking about the current Revalidation initiative, as required by the federal Affordable Care Act:

1. When will it be my turn to revalidate?

If you and/or your entity were enrolled on or before March 25, 2011 and you have not yet received a Revalidation request letter from MassHealth, you will eventually be notified by U.S. mail at your DBA address to revalidate between now and March 25, 2016. MassHealth selects a limited number of provider types each month for revalidation. Those providers have 45 days from the date on the letter to complete the online revalidation process.

To check whether you were mailed a letter, contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net.

2. I completed the online revalidation process and mailed in required documents. How do I know my revalidation is complete?

If you successfully completed the online revalidation process on the POSC (Provider Online Service Center) and your submitted documents are complete, MassHealth will mail you a confirmation letter to your DBA address. Otherwise, a revalidation specialist will call you/your entity directly to assist you in completing the process correctly. Because of high volume, the review and response time to providers is slightly delayed at this point.

To check your revalidation status, please contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net. 

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

September 15, 2014Claims Adjustments for Procedure Codes 99495 AND 99496

MassHealth has systematically adjusted professional crossover claims for physicians and group practice providers who billed with procedure codes 99495 or 99496 for dates of service on or after 1/1/2013.  These services were paid the ACA Section 1202 reimbursement rates in error. These adjusted claims will appear on a future remittance advice.

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

September 8, 2014Confirmation: Bed Hold Days Increased to Twenty Days

To all Nursing Facility Providers: A message was sent on July 29, 2014 stating that the number of allowable MLOA (Medical Leave of Absence) days, also known as Bed Hold days, will be increased to up to 20 days, effective September 1, 2014. This message confirms the increase.

Effective September 1, 2014, MassHealth now allows up to 20 MLOA days. Any existing MLOA events that commenced prior to that date will fall under the previous policy of ten (10) MLOA days. MLOA applies to admissions to Acute, Chronic Disease, Psychiatric and Rehabilitation hospitals.

All other policy provisions consistent with regulation 130 CMR 456.000 will remain in effect. The payment rate for MLOA days will remain at $80.10 per day. A provider bulletin on this change in allowed MLOA days will be issued at a later date.

For questions about this policy change, please contact Program Manager Ron Pawelski at 617-222-7546 or by email at Ronald.Pawelski@state.ma.us.

September 2, 2014Reprocessing of T1020 – Fiscal Intermediary Administrative Fees

MassHealth has identified an issue that resulted in claims for the Fiscal Intermediary administrative fees (Service Code T1020) being paid at the incorrect rate. MassHealth is reprocessing these claims and the adjustments will begin to appear on this and future remittance advices.

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

September 2, 2014Letters Regarding Physician Eligibility for Section 1202 Rates

This is a message to all physicians in group practices who have not responded to a letter from MassHealth, dated August 1, 2014, regarding ACA Section 1202 eligibility for physicians that have not returned the Physician Certification and Attestation Form:

The letter included a deadline of August 30, 2014 to return completed attestation forms.  This message is a notification that MassHealth is extending the deadline to submit the form to September 12, 2014.

Physicians who received the August 1, 2014 letter and are eligible under Section 1202 should complete the Physician Certification and Attestation Form available at http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf by September 12, 2014. Physicians who do not return their attestation form by this deadline will no longer be paid Section 1202 rates, as of October 1, 2014.

As explained in the letter, MassHealth will calculate and recover any Section 1202 payments that have been made to group practices since January 1, 2013 for services provided by physicians who do not attest to 1202 eligibility and did not return a completed Physician Certification and Attestation Form by the September 12, 2014 deadline.

Completed forms should be returned to MassHealth PEC, P.O. Box 9162, Canton MA 02021 OR by FAX to 1-617-988-8974.

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

September 2, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS - August 2014:

-Hospice Bulletin 11: Change in Fax Number for MassHealth Hospice Election Forms

TRANSMITTAL LETTERS - August 2014:

-LAB-43: Subchapter 6 Revisions
-ALL-208: Site Visits
-HCBS-3: Home and Community-Based Services (HCBS) Waiver Manual (HCBS Service Codes, Descriptions and Modifiers)

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

August 18, 2014New Fax Number for MassHealth Hospice Election Forms

Effective immediately, all Hospice providers must use a new fax number to submit Hospice Election Forms on behalf of MassHealth members who seek to elect hospice services, revoke or terminate hospice services or change hospice providers.

The new fax number is: 617-886-8402.

You may also mail Hospice Election forms to:

MassHealth Hospice Unit
UMMS-CHCF
529 Main St., Ste. 320
Charlestown MA 02129

Hospice Election forms must be completed fully and submitted under separate cover for each member.

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

August 18, 2014Important Notification: EVSpc Will Terminate in December 2014

MassHealth will terminate the use of EVSpc on December 31, 2014 and will no longer provide support for the software tool after that date. The software is no longer compatible with the EVS functionality on the POSC (Provider Online Service Center). Providers that use the EVSpc software will not receive key eligibility messages related to MassHealth members’ coverage. Providers are strongly encouraged to stop using the EVSpc immediately and transition to one of the following POSC or telephone access methods:

-DDE (Direct Data Entry)
- Submit a Health Care Benefit Inquiry & response (270/271) batch file transaction in accordance with MassHealth specifications
-Engage a vendor to generate your Health Care Benefit Inquiry batch files
-Check eligibility by calling the Provider AVR (Automated Voice Response) system at 1-800-554-0042

The tool will no longer be available for download. The December 31, 2014 termination date will provide ample time for providers to transition to one of the POSC access methods.

July 21, 2014Provider Billing Reminder: MassHealth DME and Oxygen Payment and Coverage Guidelines Tool

Pharmacy, DME and Oxygen providers are reminded that the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool has been updated and posted on the Web. To confirm that you are using the most recent version of the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool, go to WWW.MASS.GOV/MASSHEALTHPUBS click on Provider Library and then click on Masshealth Payment and Coverage Guideline Tools.

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

July 15, 2014MassHealth Provider Revalidation Continues for Chain Pharmacies

As required by the Affordable Care Act, MassHealth is continuing its Provider Revalidation effort. This process requires that you revalidate your enrollment information for MassHealth under new enrollment screening criteria. You may also be required to submit original signature documentation to support your Revalidation, including a Federally Required Disclosures Form.

Revalidation is a.) being conducted by Provider Type and b.) currently focusing on providers enrolled on or before March 25, 2011. These revalidations will be completed by March 24, 2016.  If you enrolled as a provider after March 25, 2011, you will be revalidated on or before five years from the date of your initial enrollment. Failure to complete the Revalidation will affect your enrollment status and may result in sanctions.

Chain Pharmacies are the next group of provider type that have been mailed Revalidation letters and must complete the Revalidation process on the POSC (Provider Online Service Center) within 45 days of the date on the revalidation letter. If you need access to the POSC, you will need to complete a Data Collection Form (DCF) or request access from the primary user at your practice. Please note: Independent pharmacies will be among the next waves of provider types to be revalidated.

For additional information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation.

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

July 15, 2014Community Health Center – Type of Bill 77X – Outpatient Crossover Claim Denials

MassHealth has systematically reprocessed CHC outpatient crossover claims with adjudication dates on 05/26/2009 through 05/06/2014 that denied in error for Edit 4036-PROV CONTRACT POS RESTRICTION ON PROCEDURE. These reprocessed claims will appear on a future remittance advice. 

Please Note: If the claims denied for other valid reasons, providers are responsible to correct the denial and resubmit their claims to MassHealth accordingly. For questions, please contact MassHealth Customer Services Center at 1-800-841-2900 or providersupport@masshealth.net.

July 7, 2014Header-Related Remark Codes in the MIA Segment of the HIPAA 835

Effective July 1, 2014, MassHealth will be reporting header-related remark codes in the MIA segment of the HIPAA 835. This will be provided when a claim is priced and reported at the header and there are remark codes present. The segment will include up to 5 remark codes.

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

June 30, 2014New Nursing Facility Rates to be Issued July 1, 2014

To all Nursing Facility Providers:

Effective July 1, 2014, EOHHS (Executive Office of Health and Human Services) will issue new rates for nursing facility services. These rates reflect the expiration of the FY2014 user fee add-on on June 30, 2014. The expiration of the user fee add-on is consistent with regulation 101 CMR 206.00.

EOHHS will issue new rates for FY2015 as soon as the budget process is completed. These rates would contain applicable add-ons that may be specified in legislation.

If you have any questions, please contact Ron Pawelski, Nursing Facility Program Manager at (617) 222-7546.

June 30, 2014Do You Need Assistance with Revalidation?  MassHealth Invites you to a Tutorial Webinar

MassHealth is offering a tutorial webinar to all providers who have been mailed letters as part of the federally mandated Revalidation Initiative and need assistance in completing the process. The webinar will provide you step-by-step instructions on how to access your information on the POSC, change/update your profile information and download and complete any original signature documents that may be required. The webinar will be offered twice:

Tuesday, July 1, 2014 from 10-11 AM                       

Monday, July 14, 2014 from 10-11 AM

To join the webinar:

Audio Login:
Toll-Free (US & Canada): 866.740.1260
Toll: 303.248.0285
Access Code: 4725653

Web Login:
Meeting URL: http://www.readytalk.com/?ac=4725653
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800.843.9166 or help@readytalk.com
Access Code: 4725653

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

June 30, 2014Third Party Liability Requirements for Independent Nurses

MassHealth reminds all Independent Nurses: you must make diligent efforts to obtain payment first from other resources so that MassHealth is the payer of last resort.  Please see All Provider Manual 130 CMR 450.316.

MassHealth will not pay you and will recover any payments from you if it determines that, among other things, you have not made such diligent efforts. “Diligent efforts” is defined as making every effort to identify and obtain payment from all other liable parties, including insurers. Diligent efforts include but are not limited to:

1. Determining the existence of health insurance by asking the member if he or she has other insurance and by using insurance databases available to the provider;

2. Verifying the member’s other health insurance coverage via EVS for each date of service and at the time of billing;

3. Submitting claims to all insurers with the insurer’s designated service code for the service provided;

4. Complying with the insurer’s billing and authorization requirements;

5. Appealing a denied claim when the service is payable in whole or in part by an insurer;

6. Returning any payment received from MassHealth after any available third-party resource has been identified. The provider must bill all available third-party resources before resubmitting a claim to MassHealth.

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

June 30, 2014Reminder to All Providers: Keep your Profile Information Up-to-Date

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

This is especially important as MassHealth continues the federally mandated Revalidation initiative.  Please make sure that when MassHealth notifies you/your entity that it is time to revalidate that you are able to access your provider profile through the POSC (Provider Online Service Center) and your profile is up-to-date.  To submit changes through the POSC, go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

You may also submit changes in writing to Provider Enrollment and Credentialing, PO Box 9162, Canton MA 02021.

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

June 30, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from June 2014:

-Community Health Center Bulletin 80: Behavioral Health Assessment Claims for Members Under 21
-Mental Health Center Bulletin 30: Behavioral Health Assessment Claims for Members Under 21
-School-Based Medicaid Provider Bulletin 27: School-Based Medicaid Program Interim Rates (State Fiscal Year 2014)

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

June 24, 2014MMQ Software to be Removed from Mass.gov by July 31, 2014

Effective October 1, 2015, MassHealth will no longer support the proprietary Management Minutes Questionnaire (MMQ) software currently available to Nursing Facility providers on mass.gov/masshealth. By September 30, 2015, all providers using this software must transition to an alternative method of submitting MMQs.

Methods include:

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

To facilitate this transition, MassHealth will remove the proprietary MMQ software from Mass.gov immediately after July 31, 2014.  If you would like to retain a copy of the software, please download it on or before July 31, 2014. MassHealth will provide support for the proprietary MMQ software until September 30, 2015, when all providers have transitioned to an alternative submission method.

POSC users may refer to the MMQ Job Aid available at http://www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf. Batch submitters may view the MassHealth MMQ file specifications available at http://www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf. Both of these documents have been modified for ICD-10.

Thank you for your cooperation in making this important transition. MassHealth will keep you informed as the process moves forward. For questions, please contact MassHealth customer service by telephone at 1-800-841-2900 or by email at providersupport@masshealth.net.

June 24, 2014

ICD-10 Trading Partner Testing Update

All providers that must test ICD-10 transactions with MassHealth are advised: MassHealth welcomes you to submit your test file to us any time you are ready. Although ICD-10’s implementation has been delayed until October, 2015, there is no need for you to wait until next year to participate in trading partner testing.

We encourage you to take advantage of testing availability times now!

To schedule a test date with the ICD-10 Testing Team, please contact MassHealth’s EDI Department directly at 855-295-4047 or edi@mahealth.net.

June 24, 2014Important Update for Nursing Facilities that Received Revalidation Request Letters

As required by the Affordable Care Act, MassHealth is continuing its Provider Revalidation effort, and nursing facilities that were enrolled in MassHealth on or before March 25, 2011 have now received letters with instruction sheets advising them to revalidate all provider information online within 45 days of the date of the letter.

Please note that the instruction sheet was missing information regarding application fees as part of the revalidation process. Your nursing facility may be required to pay an application fee when revalidating, unless you have already made payment(s) to Medicare or another state (in which case you must provide proof).

For more information on Application Fees, please visit: http://www.mass.gov/eohhs/provider/insurance/masshealth/provider-application-fees.html

To make a payment, please go to https://www.paybill.com/MassHealthApplicationFeeBillPay/

MassHealth apologizes for any inconvenience. For more information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page at www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation.  For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or by emailing providersupport@masshealth.net.

June 18, 2014Do You Need Assistance with Revalidation?  Online Tutorial Now Available

MassHealth is now offering an online tutorial to all providers who have been mailed letters as part of the federally mandated Revalidation Initiative.  If you need assistance in completing the Revalidation process, this tutorial will provide you step-by-step instructions on how to:

-Access your profile information on the POSC (Provider Online Service Center)

-Make any changes/updates necessary to your provider profile

-Download and complete any original signature documents that may be required

To access the tutorial, please go to the MassHealth Revalidation web page at www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment.  Click on Provider Revalidation and go to Job Aids. The Revalidation page also offers you the All Provider Bulletin 242 and a Revalidation FAQ document. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or by emailing providersupport@mahealth.net.

June 9, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from May 2014:

-All Provider Bulletin 245: Behavioral Health Services for Members with Temporary MassHealth Coverage

-All Provider Bulletin 244: Coverage Provided via Hospital-Determined Presumptive Eligibility

-Chronic Disease and Rehabilitation Outpatient Hospital Bulletin 5: NCCI Procedure-to-Procedure Code Pair Denial for Therapy Services

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

June 2, 2014MassHealth Timeframes for Bill Paying for Nursing Facility Providers

MassHealth will be modifying the timeframes for paying Nursing Facility claims for May dates of service received by MassHealth in May or June. The payment schedule will be modified by approximately 2 weeks. Please see the modified payment schedule outlined below.

RA DATE: 07/01/2014
PAYMENT DATE CHECKS: 07/04/2014
PAYMENT DATE EFT: 07/07/2014

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: 7/15/2014
PAYMENT DATE CHECKS: 7/18/2014
PAYMENT DATE EFT: 7/21/2014

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

June 2, 2014Adjustments for ACA Section 1202 Rates for Physicians Who Provide Primary Care

MassHealth has identified overpayments and, in some cases, underpayments of Calendar Year 2014 ACA Section 1202 rates on certain Evaluation and Management and Vaccine Administration claims submitted from January 1, 2014 to March 18,2014, due to a delay in the Section 1202 rates released by CMS. The enclosed remittance advice (and other remittance advices in the coming weeks) may contain claims processed from January to June that have been systematically adjusted to pay the corrected 1202 rate.

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

June 2, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from May 2014:

All Provider Bulletin 244: Coverage Provided via Hospital-Determined Presumptive Eligibility

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

May 19, 2014MassHealth Provider Revalidation Continues

As required by the Affordable Care Act, MassHealth is continuing its Provider Revalidation effort. The process requires that you revalidate your enrollment information for MassHealth under new enrollment screening criteria. You may also be required to submit original signature documentation to support your Revalidation, including a Federally Required Disclosures Form.

This Revalidation initiative is a.) being conducted by Provider Type and b.) is currently focusing on providers enrolled on or before March 25, 2011. These revalidations will be completed by March 24, 2016. If you enrolled as a provider after March 25, 2011, you will be revalidated on or before five years from the date of your initial enrollment. Failure to complete the Revalidation will affect your enrollment status and may result in sanctions.

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

-05 Psychologist
-06 Podiatrist
-21 Family Planning
-28 Substance Abuse
-61 Independent Nurse
-97 Group Practices comprised of Provider Types 05, 06 (Psychologist, Podiatrist)

For additional information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or by emailing providersupport@mahealth.net.

May 19, 2014Beyond the Allowable: Improving the Prior Authorization Process for Continued Therapy – Friday, June 6, 2014 Webinar

MassHealth knows that you are committed to providing quality therapy services for your patients. The Prior Authorization Unit Clinical Reviewers have the same goal in mind: ensuring that MassHealth members are getting the therapy services they need.

Please join us for an informative and interactive Webinar presentation - June 6, 2014, 12:00 PM-1:30 PM - on the Prior Authorization process for Physical, Occupational and Speech Therapy providers. During the Webinar, we will review:

-MassHealth Regulations related to Therapy Services
-Prior Authorization process for Therapy Services
-How to thoroughly complete a Request and Justification Form to ensure request approval
-For those who still submit PAs via paper: information on how to submit PAs via the POSC.

To register, please go to: http://onlinetraining.umassmed.edu/pa_therapy_webinar/event/registration.html. Or, please email priorauthorization@umassmed.edu and the registration link will be emailed to you directly. Or, please call the PAU at 1-800-862-8341 for registration assistance.

May 19, 2014One Care Plan Billing and Voids

Providers are reminded to check the EVS (Eligibility Verification System) to determine if a member is enrolled in an ICO (Integrated Care Organization), also known as a One Care Plan. Providers must bill the member’s ICO/One Care Plan for services rendered.

MassHealth will void FFS (Fee-For-Service) claims for members enrolled in One Care Plans with dates of service from October 2013 through March 2014, previously paid to the provider types identified above. Providers should re-submit One Care member claims for payment to the ICO/One Care Plan where the member or members are enrolled.  ICOs/One Care Plans have been notified and will expect claims from affected providers.  Contact information for billing the ICOs/One Care Plans is listed below.

Fallon Total Care: 1-855-508-4715
Network Health/Unify: 888-257-1985
Commonwealth Care Alliance: 1-800-306-0732 (option #5)

MassHealth members should not be billed for any services after the FFS claims are voided. Claims must be re-submitted to the member’s ICO/One Care Plan for payment. If you have questions, contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

May 13, 2014Important Reminder to Nurses ProMviding Continuous Skilled Nursing Services

This is a friendly reminder to nurses of the importance of detailed and comprehensive documentation of CSN (continuous skilled nursing) services. Your documentation must be individualized and provide details about the complexity of services, the comprehensive assessments, and the nursing care you provide to support the skilled needs of the member, per the care plan.

Please refer to the Independent Nurse Manual Subchapter 4 program regulations, 130 CMR 414.417 (B) – “Recordkeeping Requirement and Utilization Review: In order for a medical record to completely document a service to a member, the record must disclose fully the nature, extent, quality and necessity of the nursing services furnished to the member. When the information contained in a member’s record does not provide sufficient documentation for the service, the MassHealth agency may disallow payment.”

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

May 5, 2014ICD-10 Vendor Testing Schedule Update

All providers participating in ICD-10 Beta Testing are advised that testing has now been extended through May 30, 2014.

Also, Vendor Testing, originally scheduled for May 13 through June 13, 2014, has now been re-scheduled to run from July 7 through August 29, 2014. Interested providers should please contact MassHealth ICD-10 EDI Department directly at 855-295-4047 or edi@mahealth.net.

To stay current with the latest ICD-10 updates, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/icd10-implementation.html.

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

May 5, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from April 2014:

-Long-Term Care Facility Bulletin 108: Annual Accounting for Personal Needs Account

Provider Transmittal Letters from April 2014:

-MHC-47: Revised Regulations, Service Codes, and Descriptions

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

April 14, 2014Coverage of Restorative Adult Dental Services

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

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

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

Please refer to MassHealth Dental Bulletin 43 at www.mass.gov/eohhs/docs/masshealth/bull-2014/den-43.pdf.  For questions, please contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net.

April 14, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from March 2014:

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

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

April 7, 2014Important Message Regarding ICD-10On April 1, 2014 the bill H.R. 4302, Protecting Access to Medicare Act of 2014 was signed into law. A component of the law states that HHS (Department of Health and Human Services) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015.  Based upon this change, MassHealth is evaluating the impact of the delay on MassHealth and will provide more information as soon as it becomes available. In the interim MassHealth will continue to test ICD-10 transactions with its trading partners.
April 7, 2014Diagnosis Edits

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

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

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

April 7, 2014Early Intervention Service Code T1024 (40 Units Counting Method)

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

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

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

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

March 31, 2014Letters Regarding Physician Eligibility for Section 1202 Rates

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

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

Please return the completed form to MassHealth PEC, P.O. Box 9162, Canton MA 02021 OR by FAX to 1-617-988-8974.

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

March 31, 2014Orthotics and Prosthetics Claims Adjustments

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

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

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

March 31, 2014Temporary MassHealth Member Coverage

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

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

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

March 24, 2014Letters Regarding Physician Eligibility for Section 1202 Rates– Response due March 30, 2014

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

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

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

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

March 24, 2014Minor Changes to MMIS DDE (Direct Data Entry Screens

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

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

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

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

March 24, 2014Reprocessed Long Term Care Claims

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

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

March 24, 20141202 Rate Updates for 2014MassHealth is in the process of updating the calendar year 2014 Section 1202 rates. Further information, including the time frame for adjusting claims, will be forthcoming.
March 24, 2014Important Notice: EVSpc Windows Operating System Support to Change April 8th

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

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

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

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

March 24, 2014Important Message: Incorrect Fax Number in Member Booklets

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

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

THE CORRECT NUMBER IS:  617-887-8770.

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

March 24, 2014MassHealth is the Payer of Last Resort

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

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

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

March 19, 2014Important Message: Incorrect Fax Number in Member Booklets

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

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

THE CORRECT NUMBER IS:  617-887-8770.

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

March 19, 2014MassHealth Provider Revalidation Has Begun

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

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

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

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

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

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

March 19, 2014Admission Dates Required for Inpatient Claims – Advisory

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

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

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

March 10, 2014Hospice Claims that Previously Denied Due to Conflict with NCCI Edits

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

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

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

March 10, 2014Updated EFT Enrollment/Modification Request Form Now Available

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

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

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

March 3, 2014Personal Care Attendant (PCA) New Hire Orientation

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

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

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

March 3, 2014Home Health Claims Submitted with TOB (Type of Bill) 033X

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

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

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

February 25, 2014Attention Electronic Claim Submission Waivered Providers: New 1500 Claim Form Required as of March 22, 2014

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

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

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

February 20, 2014Provider Rate Change for Procedure Code 88112

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

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

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

February 20, 2014Provider Billing Reminder: CARCs and RARCs Have Changed

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

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

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

February 3, 2014CMS ICD-10 Readiness Survey for Specialty Providers

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

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

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

February 3, 2014MassHealth ICD-10 Readiness Survey – Deadline Extended

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

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

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

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

February 3, 2014MMQ Software Changes Coming in October 2014

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

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

February 3, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from January 2014:

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

Provider Transmittal Letters from January 2014:

-COH-8: New Subchapter 6

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

January 27, 2014MassHealth Reprocessing Pharmacy Claims in Payment Cycles

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

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

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

January 27, 2014Important Information: Provider Revalidation Starts March 2014

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

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

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

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

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

January 21, 2014

ICD-10 Trading Partner Testing

 

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

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

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

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

January 21, 2014ICD-10 Readiness Survey

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

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

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

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

January 21, 2014Attention All Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

All MassHealth Dental Providers billing CDT service codes should disregard the Message Text “Update to Important Announcement: Provider Operations Changes.” These changes do not affect MassHealth dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Dental providers should continue to refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, prior authorizations, claims, electronic claims, provider complaints and fraud, and provider enrollment.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

January 13, 2014Update to Important Announcement: Provider Operations Changes

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

PROVIDER ENROLLMENT AND CREDENTIALING – Please use this new mailing address to submit new enrollment applications, provider file updates or correspondence:

MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton MA 02021

PAPER CLAIMS - If you are authorized to submit paper claims, the new P.O. Box is:

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

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

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

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

January 13, 2014EFT/ERA Operating Rule in Effect January 1, 2014

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

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

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

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

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

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

January 13, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from December 2013:

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

Transmittal Letters from December 2013:

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

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

Manage Claims and Payments

Date

Title

Comments

February 1, 2016Group Practitioner Application Redesign

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

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

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

February 1, 2016Update – Get Ready for the MMIS/Provider Online Service Center (POSC) Technical Upgrade

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

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

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

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

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

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

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

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

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

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

February 1, 2016Pharmacy, DME and Oxygen – Updated Payment and Coverage Guidelines Tool Now Online

REVISED

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

To confirm that you are using the most recent version of the applicable Tool (V.25), go to www.mass.gov/masshealthpubs.  Click on Provider Library, then on MassHealth Payment and Coverage Guideline Tool.

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

January 25, 2016To Home Health Agency Providers

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

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

G0154 will be replaced with:

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

and

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

G0154 TT will be replaced with:

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

and

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

G0154 UD will be replaced with:

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

and

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

G0154 TT, UD will be replaced with:

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

and

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

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

January 25, 2016Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374

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

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

January 19, 2016Update – MMIS/Provider Online Service Center (POSC) Technical Upgrade – Effective February 22, 2016

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

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

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

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

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

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

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

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

January 19, 2016Revalidation Process Changes

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

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

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

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

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

January 19, 2016MassHealth Seeks Testing Partners for Its New Connectivity Method Option

REVISED

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

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

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

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

January 19, 2016To Hospice Providers

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

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

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

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

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

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

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

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

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

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

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

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

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

January 11, 2016MassHealth Updates the CARC’S & RARC’S List Effective January 1, 2016

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

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

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

January 11, 2016Timely Filing Regulations for Claims with Other Health Insurance

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

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

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

December 31, 2015835 and Payment DelayDue to the Christmas and New Year’s Day holidays, payments and 835s will be delayed by one business day.  For questions, please contact the MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
December 21, 2015Provider Online Service Center (POSC) Technical Upgrade

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

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

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

December 21, 2015To Home Health Agency Providers

REVISED

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

G0154 will be replaced with:

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

G0154 TT will be replaced with:

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

G0154 UD will be replaced with:

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

G0154 TT, UD will be replaced with:

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

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

December 14, 2015Rate Adjustments for Mental Health Codes

Please note the phone number correction

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

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

December 14, 2015New Updated Version of the DME/OXY Payment & Coverage Guideline Tool

REMINDER – Pharmacy, DME and Oxygen providers be advised that the MassHealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web. To confirm that you are using the most recent version of the applicable Tool, go to http://WWW.MASS.GOV/MASSHEALTHPUBS, click on Provider Library and then click on MassHealth Payment and Coverage Guideline Tool.

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

December 14, 2015To Home Health Agency Providers

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

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

December 14, 2015Correct Coding 2016 Ventilators

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

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

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

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

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

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

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

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

December 7, 2015Inpatient Hospital Grouper IssueMassHealth has identified an issue with the industry standard 3M APR/DRG grouper that is affecting in-patient hospital claims.  Specifically, for services involving a normal delivery that include a repair of a laceration, the grouper cross--walks to DRG #952 when it should cross-walk to DRG #560.  This has resulted in a number of potential overpayments to acute hospitals since October 1, 2015.  MassHealth is currently evaluating the issue and will notify providers within the next several weeks about its approach to address the issue with 3M and recoup overpayments as applicable.   If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900.
November 30, 2015Medical Practitioner Application Redesign - Update

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

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

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

November 30, 2015To Hospice Providers

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

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

November 30, 2015To Home Health Agency Providers

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

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

November 16, 2015Important Reminder – Diagnosis Indicator Field

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

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

November 16, 2015Rate Adjustments for Mental Health Codes

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

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

November 9, 2015Important Reminder – V5010 Requirements

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

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

November 2, 2015Reprocessing of Medicare Crossover Claims Denied for Edits 4371 and 4374MassHealth is aware of an issue affecting Medicare crossover claims for dual eligible members (MassHealth and Medicare coverage) who were enrolled in a MassHealth CarePlus benefit plan. The crossover claims for these members may have erroneously denied for Edit 4371 - Benefit plan claim type restriction on procedure and/or Edit 4374 - Benefit plan claim type restriction on revenue code.   MassHealth is in the process of revising the benefit plan information for these members, and will systematically reprocess affected crossovers claims on future remittance advices.
October 26, 2015ICD Error Code Resolution

Please note the phone number correction

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

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

October 13, 2015Important Reminder-Submit Valid ICD-10 Codes on Claims

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

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

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

October 13, 2015Reminder – ICD-10 Claim Submission

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

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

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

October 5, 2015MassHealth Implements ICD-10

MassHealth implemented ICD-10 on October 1, 2015.  

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

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

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

October 5, 2015Acute Inpatient Hospitals Preadmission Screening Requests Must Be Processed Through the POSC

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

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

October 5, 2015Clarification Regarding Pre-Admission Screening (PAS) SubmissionsMassHealth will continue to accept CPT codes on PAS requests for prospective admissions with dates of service on or after 10/01/2015. Providers should enter the ICD-10 diagnosis code in the appropriate field and enter the CPT code in the “notes” field. If you submit a CPT code in the notes field you must leave the ICD procedure field blank. If available, providers may choose to enter the ICD-10 PCS code in the appropriate ICD procedure field in lieu of the CPT code(s).
October 5, 2015ICD-10 Implementation Monitoring

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

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

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

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

September 28, 2015MMQ Terminates October 1st – You Must Transition Now!

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

One of the following MMQ submission methods must be used:

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

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

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

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

September 28, 2015October 1st ICD-10 Implementation is Just Days Away – Please Be Ready!

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

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

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

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

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

September 28, 2015September ICD-10 Webinar Training Sessions Still Available - Please Sign Up Now!

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

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

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

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

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

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

September 28, 2015New Medical Practitioner Application Webinar

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

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

September 28, 2015Medical Practitioner Application Redesign

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

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

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

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

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

September 28, 2015Deadline for Hospitals to Submit Adjustments for Section 1202 Payments Extended to October 15, 2015MassHealth has extended the submission deadline for Section 1202 claims adjustments for Acute Inpatient hospitals and Acute Outpatient hospitals to October 15, 2015.  Acute Inpatient hospitals and Acute Outpatient hospitals are eligible to receive Section 1202 payments for Section 1202-eligible services rendered by Section 1202-eligible physicians for dates of service in calendar years 2013 and 2014. All adjusted claims must be submitted according to the instructions in Acute Inpatient Hospital Bulletin 151 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aih-151.pdf, and Acute Outpatient Hospital Bulletin 31 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aoh-31.pdf and received by MassHealth no later than October 15, 2015. For questions, contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.
September 25, 2015RITE Way TransportationRITE Way Transportation is no longer providing transportation services.  If you have questions or need assistance, please call MassHealth Customer Service at the dedicated telephone number that has been set up to address this matter: 1-844-748-3928.
September 25, 2015September ICD-10 Training Sessions Still Available – Please Sign Up Now!

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

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

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

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

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

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

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

September 25, 2015October 1st ICD-10 Implementation is Just Days Away – Please be Ready!

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

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

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

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

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

September 14, 2015October 1st ICD-10 Implementation is Just Days Away  – Are You Ready?

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

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

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

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

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

September 8, 2015ICD-10 Implementation Q&A Web Conferences – Your Questions Answered

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

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

Conference Line Information:

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

Web Conference Schedule:

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

September 8, 2015Corrections for Edit 4037 Claims Denials

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

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

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

September 8, 2015Missed ACA Section 1202 Payments for Providers

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

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

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

September 8, 2015Professional Part B Crossover Claims: Edit 560 - M-CARE Coinsurance AMT Greater than the Amount Paid

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

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

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

August 31, 2015

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

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

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

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

August 31, 2015EVSpc and EVScall Have Terminated – Effective September 1st

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

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

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

August 31, 2015Important Reminder: MassHealth’s Proprietary MMQ Software Terminates October 1ST – You Must Transition Now!

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

One of the following MMQ submission methods must be used:

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

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

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

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

August 31, 2015ICD-10 Update For Early Intervention Specialty Services

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

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

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

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

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

August 31, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – August 2015:

  • All Provider Bulletin 252: Improving Access for MassHealth Members with Disabilities
  • All Provider Bulletin 251: Enhancements to the Claiming Process and New Certification Process for MassHealth Limited Program
  • All Provider Bulletin 250: Enhancements to the Provider Revalidation Process

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

August 31, 2015

September ICD-10 Training Session Dates – Please Sign Up Now!

ICD-10 implementation is just days away! You must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. Please sign up for one of our information sessions to get an important overview of ICD-10 and the operational impacts to the POSC:

Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 10:30-Noon
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 1:30-3:00
Burlington Public Library, 22 Sears St., Burlington, Monday, September 14th, 11:00-12:30
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 10:30-Noon
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 1:30-3:00
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 10:30-Noon
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 1:30-3:00
Boston Public Library-Hyde Park Branch, 35 Harvard Ave., Hyde Park, Thursday, September 24th, 1:30-3:00      

To register for a training session, visit www.masshealthtraining.com and, under the Events tab, select the session for the date you wish to attend.

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

Tuesday September 8th 10:00-Noon
Tuesday September 22nd 10:00-Noon

To register for a Webinar session, visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the month of October will be forthcoming.

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

August 25, 2015Masshealth Claims Denied For Edit 2548 – Non-Covered Amount is Not Equal to Billed Amount

MassHealth has identified claims adjudicated from 6/23/15 through 8/14/15 which paid erroneously.  

The affected claims contained an amount in the non-covered amount field which was not equal to the claim billed amount.  These claims have been reprocessed and will deny for Edit 2548 NON-COVERED AMT IS NOT EQUAL TO THE BILLED AMT on future remittance advices. Providers should refer to Appendix “Supplemental Instructions for Claims with Other Insurance” in the Provider Manual for instructions on billing claims using the non-covered amount field for TPL exception billing.

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

August 17, 2015Reminder: September 1st Deadline for Hospitals to Submit Adjustments for Section 1202 Payment

This is a reminder to Acute Inpatient hospitals and Acute Outpatient hospitals that, in order to receive Section 1202 payments for Section 1202-eligible services rendered by Section 1202-eligible physicians for dates of service in calendar years 2013 and 2014, all adjusted claims must be submitted to and received by MassHealth by September 1, 2015.

Please refer to Acute Inpatient Hospital Bulletin 151 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aih-151.pdf pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                 , and Acute Outpatient Hospital Bulletin 31 at www.mass.gov/eohhs/docs/masshealth/bull-2015/aoh-31.pdf pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                for additional guidance.

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

August 17, 2015Important Reminder - V5010 Requirements

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

Please ensure that you have fully complied with this 2012 requirement. Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

August 17, 2015Augmentative and Alternative Communication (AAC) Device Coverage

Coverage for electronic tablets already in effect for children under EPSDT:

Under its DME program, MassHealth covers medically necessary dedicated AAC tablets and AAC software and applications for children under age 21. A dedicated tablet is one that is configured to limit the primary use to a medical purpose, such as for use as an AAC (for example, as a speech generating device).

An evaluation by a healthcare practitioner (physician, physician assistant or nurse practitioner) and a speech therapist are required to confirm the medical need for an AAC and then the medical appropriateness of a particular device, such as a tablet. The speech therapist will then recommend a DME provider that could provide the AAC device or tablet. The DME provider should follow the existing prior authorization process to request authorization to provide the tablet to the child. New and existing DME providers should contact MassHealth customer service (1-800-841-2900) for enrollment and prior authorization information.

MassHealth is in the process of updating its regulations to (1) explicitly add, to the definition of DME, electronic devices used as for medical purposes as AAC, such as tablets dedicated to the functional speaking needs of the member and locked or configured to prevent use not related to communication and (2) include coverage of AAC software and applications.

Once the regulations have been updated, MassHealth will cover medically necessary dedicated tablets as AAC through a prior authorization process available for members of all ages.

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

August 10, 2015ICD-10 Trading Partner Testing Q&A Web Conferences in August – Please Sign Up!

The October 1st ICD-10 implementation date is fast approaching. The last day to submit your first file is August 31st!  

To ensure that all MassHealth trading partners that submit transactions to MassHealth and/or develop software for MassHealth providers are tested prior to implementation, we invite you to join us for a series of web conferences to discuss any questions that you may have regarding testing or any obstacles that could prevent or delay your testing activities. This is the perfect opportunity to have your concerns addressed and questions answered. Listed below is the schedule, conference line and web conference information:  

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

10:00 AM Thursday August 13th:
Web Conference Information: https://cc.readytalk.com/r/7eu0m3ju7zeg&eom

10:00 AM Thursday August 20th:
Web Conference Information: https://cc.readytalk.com/r/hw2kv0r0f3ur&eom

10:00 AM Thursday August 27th:
Web Conference Information: https://cc.readytalk.com/r/iiv5xdduuxww&eom

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

August 10, 2015ICD-10 Training Session Dates in August and September – Please Sign Up Now!

The October 1st ICD-10 implementation date is fast approaching. The last day to submit your first file is August 31st!  

To ensure that all MassHealth trading partners that submit transactions to MassHealth and/or develop software for MassHealth providers are tested prior to implementation, we invite you to join us for a series of web conferences to discuss any questions that you may have regarding testing or any obstacles that could prevent or delay your testing activities. This is the perfect opportunity to have your concerns addressed and questions answered. Listed below is the schedule, conference line and web conference information:  

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

10:00 AM Thursday August 13th:
Web Conference Information: https://cc.readytalk.com/r/7eu0m3ju7zeg&eom

10:00 AM Thursday August 20th:
Web Conference Information: https://cc.readytalk.com/r/hw2kv0r0f3ur&eom

10:00 AM Thursday August 27th:
Web Conference Information: https://cc.readytalk.com/r/iiv5xdduuxww&eom

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

ICD-10 Training Session Dates in August and September – Please Sign Up Now!

All MassHealth providers are again reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. MassHealth is offering information sessions that provide you an overview of ICD-10 and the operational impacts to the POSC system. Please sign up for one of the August or September training dates below:

Milford Public Library 80 Spruce St, Milford, Thursday August 20th 10:30-12:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 1:30-3:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 10:30-12:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 1:30-3:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 10:30-12:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 1:30-3:00
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 10:30-Noon
Attleboro Public Library, 74 North Main St., Attleboro, Thursday, September 10th, 1:30-3:00
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 10:30-Noon
Worcester Public Library, 3 Salem St, Worcester, Wednesday, September 16th, 1:30-3:00
Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 10:30-Noon

Taunton Public Library, 12 Pleasant St., Taunton, Thursday, September 17th, 1:30-3:00
Burlington Public Library, 22 Sears St., Burlington, Wednesday, September 23rd, 10:30-Noon
Burlington Public Library, 22 Sears St., Burlington, Wednesday, September 23rd, 1:30-3:00
Boston Public Library-Hyde Park Branch, 35 Harvard Ave., Hyde Park, Thursday, September 24th, 1:30-3:00

To register for a training session, visit www.masshealthtraining.com and, under the Events tab, select the information session for the date you wish to attend.

In addition to the live trainings, we offer the following Webinars:

Tuesday August 11th 10:00-Noon
Tuesday September 8th 10:00-Noon
Tuesday September 22nd 10:00-Noon

To register for the Webinar session, visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of September and October will be forthcoming.

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

August 10, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – July 2015

  • Acute Inpatient Hospital Bulletin 152: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
  • All Provider Bulletin 249: ICD-10 Implementation Readiness
  • Community Health Center Bulletin 83: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
  • School-Based Medicaid Bulletin 28: School-Based Medicaid Program Guidance on Indirect Cost Rates

TRANSMITTAL LETTERS – July 2015:

  • LAB-44: Subchapter 6 Revisions
  • AOH-35: Revised Service Codes 

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

August 3, 2015Thank You for Completing the ICD-10 Readiness Survey

MassHealth wants to thank the many providers who took the time to complete our brief online survey on ICD-10 readiness.

With the October 1, 2015 implementation date fast approaching, your survey answers will help MassHealth better understand the current status of provider preparation, e.g., deploying new software and testing transactions.  MassHealth can provide assistance, guidance and materials to all providers, vendors, billing intermediaries and clearinghouses.

All providers are urged to stay current with MassHealth’s latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids. Go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

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

July 27, 2015EVSpc  and EVScall Terminate September 1st – You Must Transition Now!

All MassHealth providers are again reminded: EVSpc and EVScall will terminate on September 1, 2015. All functionality will cease as MassHealth cannot provide software support after that date.

You must stop using the software immediately and transition to other eligibility verification methods outlined at http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/ and click on “Information and Software for Electronic Transactions.”

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits even if EOHHS has been advised of the possibility of such damages.

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

July 27, 2015Important Reminder to All Providers: Please Complete the ICD-10 Readiness Survey by this Friday, July 31st

ICD-10 implementation is only two months away – October 1st, 2015.  As a MassHealth provider or vendor, you must be ready for this implementation.

Please take MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 31st by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?id=416.  How are you preparing for ICD-10? Have you deployed new software?  Do you need any assistance, guidance or materials?

Your survey answers will help MassHealth to a.) better understand the status of your implementation effort and b.) provide assistance and/or guidance to providers, vendors, billing intermediaries and clearinghouses as October 1st approaches.

Please stay current with MassHealth’s latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

July 20, 2015Revamped Revalidation Webinar Now Available For Providers

All MassHealth providers are invited to join the revamped Revalidation Tutorial Webinar for guidance on how to complete the Revalidation process. 

The webinar will provide you step-by-step instructions on how to access your information on the POSC, change/update your profile information and download and complete any original signature documents that may be required.

Webinars are held every 2nd Thursday and 4th Tuesday of the month.  The next Webinar will be held: 

Tuesday, July 28, 2015
1:00 – 2:00 PM

To join the Webinar, go to:

Audio Login -
Toll-Free (US & Canada): 866.740.1260
Toll: 303.248.0285
Access Code: 4725660

Web Login -
Meeting URL: http://www.readytalk.com/?ac=4725660
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800.843.9166 or help@readytalk.com
Access Code: 4725660

We also offer more information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid.  Please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment and click on Provider Revalidation. For questions, please contact MassHealth Customer Service at revalidation@mahealth.net or call 1-800-841-2900.

July 20, 2015Deadline Extended to July 31st! Please Complete the ICD-10 Readiness Survey

Are you ready FOR ICD-10 implementation on October 1, 2015? How is your organization preparing for ICD-10? Do you need any materials, guidance or assistance from MassHealth?  Have you deployed new software? Are you ready to test transactions?

Please complete MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 31st by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?id=416

Your answers will help MassHealth better understand the status of your implementation effort and provide assistance and/or guidance to providers, vendors, billing intermediaries and clearinghouses as the implementation date approaches.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

July 20, 2015ICD-10 Training Session Dates Available in August – Please Sign Up Now!

All MassHealth providers are reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. To help you prepare for ICD-10 implementation, MassHealth is offering information sessions that provide an overview of ICD-10 and the operational impacts to the POSC system. Please view the list of August training dates below:

South Yarmouth Public Library 312 Old Main St, S. Yarmouth, Tuesday August 4th 1:30-3:00
Medford School of Nursing 107 Governors Ave, Medford, Thursday August 6th, 10:30-12:00
Medford School of Nursing 107 Governors Ave, Medford, Thursday August 6th, 1:30-3:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 10:30-12:00
Milford Public Library 80 Spruce St, Milford, Thursday August 20th 1:30-3:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 10:30-12:00
Framingham Public Library 49 Lexington St, Framingham, Wednesday August 26th, 1:30-3:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 10:30-12:00
Burlington Public Library 22 Sears St, Burlington, Thursday August 27th 1:30-3:00                    

To register for a training session, please visit www.masshealthtraining.com and, under the Events tab, select the information session for the date you wish to attend.

In addition to the live trainings, we offer the following Webinar:
Tuesday August 11th 10:00-12:00

To register for the Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of September and October will be forthcoming.

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

July 13, 2015Claims to Deny or Suspend for Duplicative Services

Effective dates of service July 1, 2015, MassHealth has implemented changes to prevent payment of duplicative services for the following providers/programs: Personal Care Attendant (PCA) program, Adult Foster Care (AFC) and Group Adult Foster Care (GAFC), Home Health Agencies (HHA) and Independent Nurses.  Audits will deny or suspend claims if there is a conflict. Examples:

  • Provider submits PCA program claim; claim will deny if member is already in AFC/GAFC
  • Provider submits AFC/GAFC claim; claim will deny if member is already in the PCA program
  • Member is in an inpatient/institutional setting (chronic, acute, SNF); claim should suspend if member is already in PCA, AFC/GAFC or HHA/Continuous Skilled Nursing

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

July 13, 2015Claims Edits to Identify Potential Duplicative Services for Assessments/Evaluations/Re-Evaluations

Effective dates of service July 1, 2015, MassHealth has implemented changes to identify potential duplicative services for the following providers: Personal Care Management (PCM) Agencies and Adult Foster Care (AFC).  Audits will be posted on the Remittance Advice (RA) if there is a conflict. Examples:

  • Provider submits PCA program evaluation or reevaluation; claim will pay with the edit that indicates that the member is already in AFC/GAFC
  • Provider submits an AFC assessment; claim will pay with the edit that indicates that the member is already in the PCA program

PCM and AFC providers receiving this edit will need to work with the member to resolve any conflicts in service before proceeding to enroll the member into the PCA or AFC program to prevent fraud and denials.

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

July 13, 2015Claims Submitted for Therapy Services Provided by Assistants Will Not be Paid

Therapy providers are reminded that MassHealth does not currently pay for therapy services provided by physical, occupational or speech therapy assistants as per MassHealth regulation 432.412 in the Therapy Provider Manual:

432.412: Nonpayable Services
The MassHealth agency does not pay a therapist for any of the following services:

(A) Services provided by any person under the therapist's supervision;

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

July 7, 2015Important Reminder on V5010 Requirement to Include Attending Provider NPI on Claims

REMINDER: As previously communicated in March, 2015, providers and other trading partners that submit claims transactions to MassHealth must adhere to the HIPAA V5010 requirements as mandated on January 1, 2012. This includes ensuring that the attending provider’s NPI is submitted on any/all institutional claims except for claims that only include non-scheduled transportation. 

Please note that effective August 9, 2015 MassHealth will begin to reject institutional claims that do not contain the Attending Provider’s NPI. The only exception will be for claims containing non-scheduled transportation services.

Please ensure that you have fully complied with this 2012 requirement.   Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

July 7, 2015Important Reminder: MMQ Software Terminates in Three Months – Have You Transitioned Yet?

All nursing facility providers are again reminded: As of October 1, 2015, MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software. By September 30, 2015, you must transition to another method of submitting MMQs, such as:

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

Do you need help in transitioning? MassHealth has posted a Job Aid online at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf.

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

For questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

July 7, 2015EVSpc AND EVScall Terminate in Two Months – You Must Transition Now

All MassHealth providers are again reminded: EVSpc and EVScall will terminate on September 1, 2015. All functionality will cease as MassHealth cannot provide software support after that date. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)
    • You must coordinate with MassHealth Customer Service to test batch and HTS files before you will be allowed to submit and receive HIPAA transactions in an electronic batch file format through the POSC or HTS methods.
    • If you already use a vendor that submits “270” requests for you from a system that does NOT use the EVSpc/EVScall software, you should not be impacted by the EVS termination. Confer with your software vendor if you have any questions regarding its submission methods.

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits even if EOHHS has been advised of the possibility of such damages.

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

July 7, 2015ICD-10 is Just 90 Days Away – You Must Test Transactions Now!

All MassHealth providers are reminded: ICD-10 will be implemented on October 1, 2015. Both providers and vendors that submit transactions on behalf of providers must test ICD-10 transactions with MassHealth prior to implementation. If you or your vendor do not test with MassHealth, there is a risk that your claims may deny in “production,” which may negatively impact financials.

  • Please contact the MassHealth EDI team immediately at 1-855-295-4047 or at edi@mahealth.net to schedule a test date.
  • If you do not plan to test, please contact the EDI team to confirm why you are not testing.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at  www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

July 7, 2015Changes to the Personal Care Attendant (PCA) Orientation Service Code

Effective July 1, 2015 dates of service, the service code that Fiscal Intermediaries use to bill for PCA Orientation will be changing.

The new service code is:

  • 99509 U3 - Home Visit Day Life Activity (Personal Care Services) (Use to bill for PCA New Hire Orientation, per diem, per eligible PCA)

Fiscal Intermediaries should use the payroll claiming number when billing this code to MassHealth. Updates to subchapter 6 of the Provider Manual are forthcoming.

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

July 7, 2015Personal Care Attendant (PCA) Earned Sick Leave Pay

Effective July 1, 2015 dates of service, Fiscal Intermediaries will be able to submit claims to MassHealth for PCAs who have earned PCA Sick Leave pay.

The service code for billing the PCA Sick Leave is:

  • 99509 U1 - Home Visit Day Life Activity (Personal Care Services per 15 minutes) (Use to bill for PCA Earned Sick Leave pay) (Current PA for PCA Services required for each member)

Fiscal Intermediaries should use the payroll number when billing this code to MassHealth. Updates to subchapter 6 of the Provider Manual are forthcoming.

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

June 29, 2015ICD-10 Training Session Dates Available in July – Please Sign Up Now!

REMINDER: All MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015. To help you prepare for ICD-10 implementation, MassHealth is providing training sessions to guide you on how to implement ICD-10 with MassHealth. Please view the list of July training dates below:

-Tuesday July 14: 10:00 AM-Noon, Baystate Medical Center, 101 Watson Ave., Springfield MA
-Tuesday July 14: 1:00-3:00 PM, Baystate Medical Center, 101 Watson Ave., Springfield MA
-Wednesday July 15: 10:00 AM-Noon, Worcester Library, 3 Salem Street, Worcester MA
-Wednesday July 15: 1:00 PM - 3:00 PM, Worcester Library, 3 Salem Street, Worcester MA

To register for a training session, please visit www.masshealthtraining.com and under the Webinar tab select LIVE ICD-10 Training for the date you wish to attend.

In addition to the live trainings, we offer the following Webinar:

Monday July 13, 2015 10:00 AM – 12:00 PM

To register for the Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then select the date. Additional training session dates, times and locations for the months of August through October will be forthcoming.

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

June 22, 2015Please Complete the ICD-10 Readiness Survey

ICD-10 must be implemented on October 1st, 2015. As a MassHealth provider or vendor, are you ready? How is your organization preparing for ICD-10? Do you need any materials, guidance or assistance from MassHealth?  Have you deployed new software? Are you ready to test transactions?

Please take MassHealth’s brief online ICD-10 Provider & Vendor Readiness Survey on or before Friday, July 10th by going to: http://webapps.ehs.state.ma.us/ReviewSurvey/ReviewSurvey.aspx?preview=show&id=416.

Your answers will help MassHealth to better understand the status of your implementation effort and provide assistance and/or guidance to providers and vendors, billing intermediaries and clearinghouses as the implementation date approaches.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD-10 Implementation.

June 22, 2015ICD-10 Training Session Dates Now Available June and July – Please sign Up!

REMINDER: MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015.  To help you prepare for ICD-10 implementation, MassHealth is providing training sessions to guide you on how to implement ICD-10 with MassHealth. Please view the list of June and July training dates below:

-Wednesday, June 24, 10:30 am–12:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Wednesday, June 24, 1:30 pm–3:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Thursday, June 25, 10:30 am–12:00 pm, Brightwood Library, 359 Plainfield St. Springfield MA
-Thursday, June 25 1:30 pm–3:00 pm, Brightwood Library, 359 Plainfield St. Springfield, MA
-Tuesday, June 30, 10:30 am–12:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday, June 30, 1:30 pm–3:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday July 14: 10:00 am-Noon, Baystate Medical Center, 101 Watson Ave., Springfield MA
-Tuesday July 14: 1:00-3:00 pm, Baystate Medical Center, 101 Watson Ave., Springfield MA
-Wednesday July 15: 10:00 am-Noon, Worcester Library, 3 Salem Street, Worcester MA
-Wednesday July 15: 1:00 PM - 3:00 pm, Worcester Library, 3 Salem Street, Worcester MA

To register for a training session, please visit www.masshealthtraining.com and under the Webinar tab select LIVE ICD-10 Training for the date you wish to attend.

In addition to the live trainings, we offer the following Webinars:

Monday June 29, 2015 10:00 AM – 12:00 PM
Monday July 13, 2015 10:00 AM – 12:00 PM

To register for a Webinar session, please visit www.masshealthtraining.com, select the Webinar tab and then the date you wish to attend. Additional training session dates, times and locations for the months of August through October will be forthcoming.

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

June 22, 2015Attention All Providers: Important New Changes to Revalidation Process

All MassHealth providers are advised that there are two new changes that affect how you complete revalidation and enrollment, as explained below.

  1. An original “wet” signature is no longer required on the FRDF (Federally Required Disclosures Form). You may now submit a FRDF to MassHealth by uploading it onto the POSC, by e-mail or by fax (1-617-988-8974). Please provide a fax cover sheet requesting that the document be scanned to your PID/SL or ATN.
  2. There are now revalidation-specific document type labels in the drop-down menu on the POSC (Provider Online Service Center). Please select document types that begin with “REV” when you submit documents in response to a Revalidation Notification and follow these steps:
    1. Go to the Steps panel and click Attachments.
    2. nder List of Attachments, click New Item.
    3. Under Attach and Send Files:
      1. From the Document Type drop-down menu, click the applicable document type.
      2. Click Browse and then select your document to upload.
      3. Click Add/Upload to add the document to the provider file.

If you need assistance, MassHealth offers revalidation tutorial webinars on the 2nd Thursday and 4th Tuesday of every month. To register for the webinar, please go to: http://www.masshealthtraining.com/lms/_portal/account/?2.

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

June 9, 2015ICD-10 Training Sessions Now Available – Have You signed Up Yet?

REMINDER: MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes for dates of service or dates of discharge on or after October 1, 2015.

To help you prepare for ICD-10 implementation, MassHealth is providing training sessions to guide providers on how to implement ICD-10 with MassHealth.  The sessions will be conducted from June 24, 2015 to October 8, 2015.  Please view the list of June training dates below:

-Wednesday, June 24, 10:30 am–12:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Wednesday, June 24, 1:30 pm–3:00 pm, Pittsfield Library, 1 Wendell Ave. Pittsfield MA
-Thursday, June 25, 10:30 am–12:00 pm, Brightwood Library, 359 Plainfield St. Springfield MA
-Thursday, June 25 1:30 pm–3:00 pm, Brightwood Library, 359 Plainfield St. Springfield, MA
-Tuesday, June 30, 10:30 am–12:00 pm, Old Colony Library, 2 Main St. Randolph, MA
-Tuesday, June 30, 1:30 pm–3:00 pm, Old Colony Library, 2 Main St. Randolph, MA

To register for one of these training sessions, please visit www.masshealthtraining.com.  Additional training session dates, times and locations for the months of July through October will be forthcoming.

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

June 9, 2015ICD-10 Starts October 1st – Time is Running Out For Transaction Testing

REMINDER:  The ICD-10 implementation is just four months away. If you are a vendor that submits transactions to MassHealth on behalf of providers, you must test transactions with MassHealth before implementation. Please contact the MassHealth EDI team immediately at 1-855-295-4047 or at edi@mahealth.net to schedule a test date.  If you do not plan to test, please contact the EDI team to confirm why you are not testing.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

June 1, 2015MassHealth Prior Authorization Requirements

Reminder: MassHealth requires providers to obtain prior authorization (PA) for certain services.

Please review your MassHealth program regulations for a proposed service to determine when PA is required.

Please note that PA requests for certain services require additional forms that must accompany your request. In addition to program regulations that apply to your provider type, and the all provider regulations at130 CMR 450.303, PA requirements may appear in Subchapter 6 of certain provider manuals, in provider bulletins or in other written issuances from MassHealth. You can access the MassHealth provider manuals and provider bulletins from the MassHealth online Provider Library at www.mass.gov/masshealthpubs. 

Durable Medical Equipment, Oxygen, Orthotics and Prosthetics should also refer to coverage guideline tools for PA requirements. These providers can access the coverage guideline tools by clicking on Provider Library and then on MassHealth Payment and Coverage Guideline Tool.

Providers must follow these PA guidelines to avoid such claim denials as Edit Code 3003 (Procedure code requires PA).  For any PA questions, please contact the Prior Authorization Unit (PAU) at PriorAuthorization@umassmed.edu or 1-800-862-8341.

June 1, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – May 2015:

  • DEN-93: Revised Service Codes
  • FPA-52: 2015 HCPCS
  • PHY-144: 2015 HCPCS
  • ROC-3: 2015 HCPCS

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

May 26, 2015

To DME Providers and Hospice Providers

This is a reminder that the hospice provider is responsible for all durable medical equipment (DME) and medical supplies for the management of terminal illness for the member receiving hospice services.

Claims from DME providers for DME and medical supplies for members receiving hospice services will be automatically denied. DME providers are required to re-submit their claims with documentation showing that the services provided are not related to the terminal illness. Providers should resubmit these claims with the supporting documentation on the POSC according to All Provider Bulletin 225, using Delay Reason Code 11. Program managers will review these claims. In certain cases where the member has been receiving supplies before initiation of hospice services, and/or if supplies are not related to the terminal illness, claims will be paid.

Hospice Provider Manual: 437.423: Covered Services
(G) Drugs and Durable Medical Equipment and Medical Supplies. The hospice must provide and be responsible for all drugs and durable medical equipment and medical supplies needed for the palliation and management of the terminal illness and related conditions, according to the member's plan of care.

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

May 18, 2015MassHealth Timeframes for Bill Paying for Nursing Facility Providers

MassHealth will be modifying the timeframes for paying Nursing Facility claims for May dates of service received by MassHealth in May or June. The payment schedule will be modified by approximately 3 weeks.  Please see the modified payment schedule outlined below.

RA DATE: 07/07/2015
PAYMENT DATE CHECKS: 07/10/2015
PAYMENT DATE EFT: 07/13/2015

Claims for June dates of service will go back to the regular schedule. (Remittance Advice (RA) dated the third Tuesday of the month)

RA DATE: 07/21/2015
PAYMENT DATE CHECKS: 07/24/2015
PAYMENT DATE EFT: 07/27/2015

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

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

May 18, 2015

Attention Dental Providers: Important Information Regarding Adult Dentures

Effective May 15, 2015 MassHealth will cover dentures for adult members.

The affected service codes covered are:

D5110, D5120, D5211, D5212, D5510, D5520, D5610, D5620, D5630, D5640, D5650, D5660, D5710, D5711, D5730, D5731, D5750, D5751

Prior Authorization is not required; however, other limitations may apply. Please check the Office Reference Manual at www.masshealth-dental.net for complete coverage information.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

May 11, 2015

Member Eligibility Submission Limit in Effect as of May 8th

Effective Friday, May 08, 2015, MassHealth began placing a limit on member eligibility batch transactions. Any single transaction including more than 3,000 members will be rejected. This limit allows for more efficient and timely processing of all eligibility transactions.

OF IMPORTANCE: Due to technical issues, this submission limit went into effect two days prior to the original effective date communicated (May 10, 2015). If you were not able to support this change until the original implementation date of May 10th and you experienced validation issues due to the 3,000 limit on either May 8th or May 9th, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

To ensure the efficient processing of your eligibility request, please adhere to these submission guidelines:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. ALWAYS INCLUDE the member’s Medicaid ID number on the eligibility request if known.
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received.
May 11, 2015ICD-10 Implementation – Urgent Reminder – Vendor-PHASE II Testing Ends on May 29, 2015

An urgent reminder from MassHealth: Vendor Phase II testing will end on May 29, 2015.

To date there has been limited vendor participation in the MassHealth ICD-10 testing phase.

If you are a vendor that submits transactions to MassHealth on behalf of providers you must test that transaction with MassHealth before implementation.

MassHealth strongly urges vendors that are ready for testing to arrange a test date immediately. Contact the EDI team directly at 1-855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

May 4, 2015Important Information for Chronic Disease and Rehabilitation Hospitals: Billing for Administrative Days (ADs)

For inpatient admissions on or after April 17, 2015, MassHealth will limit payment for Administrative Day (AD) coverage.  MassHealth will no longer pay for the first approved 45 administrative days of a member’s inpatient hospital stay. For any approved administrative day stay beyond 45 days, MassHealth will pay the hospital at its current AD rate.

For this matter, hospitals will be required to split their claims when billing for a continued inpatient stay that includes both hospital level of care and administrative day level of care in addition to entering an Occurrence Span Code on their claims.  The following are revised billing instructions that hospitals must follow when billing for administrative days:

  1. For hospital level of care days, hospitals should continue to bill as they currently do.
  2. For administrative day level of care stay, up to the first 45 days, hospitals should bill with an Occurrence Span Code of 22 along with the Occurrence Span Dates for the member’s stay.
  3. For administrative days that exceed 45 days (i.e., day 46 and beyond), hospitals should bill with an Occurrence Span Code of 21 with the Occurrence Span Dates for the member’s stay.

MassHealth policy regarding pre-admission screening, conversion and continued stay reviews has not changed.  Claims will continue to require a Preadmission Screening (PAS) number when billing any inpatient hospital stay.

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

May 4, 2015EVSpc and  EVScall Terminate September 1st – Do you need Assistance in Transitioning?

MassHealth continues to remind all providers that EVSpc and EVScall will terminate on September 1, 2015. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)

To help you choose another verification method, MassHealth has posted a detailed Job Aid online. Go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

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

May 4, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – April 2015:

  • AFC-14: Alternative Placement Days
  • CDR-30: Elimination of Payment for Administrative Days

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

April 27, 2015Important Information to Dental Providers: DentaQuest Provider Web Portal Availability

Due to a DentaQuest system update, there was an interruption in the loading of updated MassHealth member eligibility information to the provider web portal over the weekend of April 24th 2015. Please note:

  • The member eligibility data that will be available will be current as of 2:00 PM, Thursday April 23rd, and will likely not be updated until Tuesday April 28. DentaQuest will update the message on the provider portal if the files are not updated by this date.
  • During this time, while you can print copies of the member’s eligibility screen for appeals purposes, please be aware that MassHealth will NOT pay claims for members who have lost eligibility during this time.
  • Claims entered via the portal during the migration will experience a delay in processing.
  • Remittance Advices will not be posted until Tuesday April 28th.

The DentaQuest system update is essential to the improvement of their systems. Thank you for your patience while DentaQuest completes these enhancements.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

April 21, 2015MMQ Software Terminates on October 1, 2015 – PLEASE TRANSITION NOW

All nursing facility providers are again reminded that MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software as of October 1, 2015.

By September 30, 2015, you must transition to an alternative method of submitting MMQs, such as:

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

To assist you in transitioning, MassHealth has posted a Job Aid online at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf.

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

For questions, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@mahealth.net.

April 13, 2015MassHealth Hospice Provider Training Webinar on May 6th

To all Hospice Providers - Admitting Nurses, Billing Staff and Quality Managers: MassHealth invites you to attend a Provider Training Webinar on May 6th from 1:30 – 3:00 pm.

Information will include updates to regulations, review of current regulations that impact payment, information on the hospice election form, nursing facility guidelines, program eligibility, and claims and payment information. To join the webinar:

Conference Call Login:

Toll-Free (US & Canada): 866-740-1260
Access Code: 4725653

Web Login:

Meeting URL: http://www.readytalk.com/?ac=4725653
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800.843.9166 or help@readytalk.com
Access Code: 4725653

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

April 13, 2015Update – Customer Service Center Experiencing Unusual High Call Volume

As the MassHealth Customer Service Center continues to experience unusually high call volume, providers are advised to avoid long wait times on the telephone by using the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please include your full name, MassHealth provider name, PIDSL (Provider Identification Service Location Number) and/or NPI, phone number and the details of the inquiry. The MassHealth Customer Service Center will direct your question(s) to the appropriate customer service specialist to assist you as quickly as possible.

OF IMPORTANCE: Please do not send member PHI (protected health information) in your email.  Instead, please notify MassHealth by email that you have a question that requires transmission of PHI and we will respond by initiating a secure email discussion with you.

April 13, 2015ICD-10 Trading Partner Testing – Have You Signed Up Yet?

MassHealth reminds all providers: you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2015, as required by federal law. To help you prepare for ICD-10 implementation, MassHealth is currently testing with trading partners. Full Trading Partner Testing began April 1, 2015 and will continue through September 30, 2015.

If you submit batch claims transactions to MassHealth, it is imperative that you schedule a test date immediately.  The MassHealth EDI testing team has been outreaching to providers to schedule test dates.  Please ensure that your organization responds to all outreach attempts made by MassHealth.

If you are not certain that your organization has scheduled a test date, please contact the MassHealth EDI testing team directly at 855-295-4047 (toll free) or at edi@mahealth.net.

To stay current with the latest ICD-10 updates, including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, Provider Bulletins and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

April 6, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

BULLETINS – March 2015:

  • Long-Term Care Facility Bulletin 109: Annual Review of Personal Needs Allowance Account

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

April 6, 2015Important Message for Acute Inpatient Hospitals – Information on Claims Adjustments and Billing Instructions for Admissions Spanning 10/1/14 are now Available Online

In-state and out-of-state acute inpatient hospitals are advised that information on claim adjustments and additional billing instructions for hospital stays that span October 1, 2014, and that exceed 20 days are now available online.

Inpatient acute hospitals are now being paid using the new FFY15 (Federal Fiscal Year 2015) APAD (Adjudicated Payment Amount per Discharge) methodology and, for qualifying discharges as applicable, the FFY15 Outlier Payment methodology. These replace the prior FFY14 SPAD (Standard Payment Amount per Discharge) and outlier per diem methodologies. The web page clarifies payment and details claims adjustments and billing instructions for admissions that occurred before and extended beyond October 1, 2014, with a length of stay of greater than 20 acute days.

MassHealth will be voiding and correctly paying certain claims for these admissions.

Hospitals must now follow the new billing instructions outlined on the web.

Please go to: www.mass.gov/eohhs/provider/insurance/masshealth/claims/customer-services/billing/ and then click on Billing Tips.

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

March 30, 2015Important Reminder: EVSpc and EVScall Terminate September 1st

All providers who are still using EVSpc and EVScall to verify member eligibility are again reminded: EVSpc and EVScall will terminate on September 1, 2015. Please stop using the software immediately and transition to other eligibility verification methods:

  • Use DDE (Direct Data Entry)
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check member eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions through the POSC or via HTS (Healthcare Transaction Services)

To help you with these suggested transition methods, MassHealth has posted a detailed Job Aid online. Go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

Please do not delay! EVSpc/EVScall has already stopped displaying current key eligibility messages regarding MassHealth member coverage.

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

March 30, 2015Important Reminder to Dental Providers: All TPL Claims Must Be Sent Electronically Effective May 1, 2015

Dental providers are reminded: all TPL claims must be sent electronically, effective May 1, 2015.

Paper TPL claims sent on or after this date will be denied.  Please see the Dental Provider web portal for more information: www.masshealth-dental.net.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

March 30, 2015Attention All Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

All MassHealth Dental Providers billing CDT service codes are again reminded: please disregard any past RA message texts that advised of MassHealth mail forwarding ending on 12/31/14.

This message does not affect MassHealth Dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Please send all Dental Claims to the following address only:

DentaQuest – MassHealth Dental Claims
12121 North Corporate Parkway
Mequon, WI 53092

Dental providers should continue to refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, prior authorizations, claims, electronic claims, provider complaints and fraud, and provider enrollment.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

March 23, 2015Clarification Regarding Submission of Hospital-Based Nonbilling Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

The Hospital-Based Nonbilling Provider Enrollment Form must be submitted to MassHealth on or before April 1, 2015 for services of hospital-based physicians working in hospital-licensed health centers, acute inpatient hospitals or acute outpatient hospitals to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.             

Physicians can obtain Hospital-Based Nonbilling Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) can be found  in MassHealth Provider Bulletins issued in February 2015 at: www.mass.gov/eohhs/provider/insurance/masshealth/section-1202-rates-for-physicians-who-provide-pcs.html

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

March 23, 2015V5010 – Reminder to Providers

REMINDER: Providers and other trading partners that submit claims transactions to MassHealth must adhere to the HIPAA V5010 requirements as mandated on January 1, 2012. This includes ensuring that the attending provider’s NPI is submitted on any/all institutional claims except for claims that only include non-scheduled transportation.

Please ensure that you fully comply with this 2012 requirement as MassHealth will fully enforce it to ensure HIPAA compliance. Please refer to the HIPAA ASC X12 Implementation Guide for more information on the specific data elements required by HIPAA.

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

March 16, 2015

Customer Service Center Experiencing Unusual High Call Volume

MassHealth Customer Service Center is currently experiencing unusually high call volume. We apologize for this inconvenience.

To avoid long wait times on the telephone, please be aware that providers can make use of the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please make sure to include the caller's full name, MassHealth provider name, Provider Identification Service Location (PIDSL) Number and/or National Provider Identifier (NPI), telephone number and the details of the inquiry or question(s). The MassHealth Customer Service Center will direct your inquiry to the appropriate customer service specialist to assist you as quickly as possible.

March 16, 2015ICD-10 Trading Partner Testing Update

REMINDER: All MassHealth providers must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2015, as required by federal law.

MassHealth is continuing to prepare for ICD-10 implementation and is currently testing with trading partners. Vendor Phase II testing continues through March 31, 2015. Full Trading Partner Testing begins April 1, 2015, continuing through August 31, 2015. The MassHealth EDI testing team will be outreaching over the next several months to help you prepare for testing.

If you have questions or you are ready to schedule a test date, please contact the MassHealth EDI testing team directly at 855-295-4047 (toll free) or at edi@mahealth.net.

To stay current with the latest ICD-10 updates, including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, Provider Bulletins and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

March 16, 2015Important Notification:  MMQ Software Will Terminate on October 1, 2015

Effective October 1, 2015, MassHealth will no longer support the proprietary MMQ (Management Minutes Questionnaire) software currently used by nursing facility providers. By September 30, 2015, all providers using this software must transition to an alternative method of submitting MMQs. Other methods include:

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

MassHealth will provide support for the proprietary MMQ software only until September 30, 2015, when all nursing facility providers must have transitioned to alternate methods.

To facilitate the transition, MassHealth has already removed the MMQ software from the web site and has made available updated MMQ file specifications. POSC users may refer to the MMQ Job Aid available at www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf. Batch submitters may view the MassHealth MMQ file specifications available at www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf. Both of these documents were modified for ICD-10.

If you have questions or need assistance in transitioning off the MassHealth MMQ software tool, please contact MassHealth Customer Service at 800-841-2900 (toll-free) or by email at providersupport@masshealth.net.

March 9, 2015Customer Service Center Experiencing Unusual High Call Volume

MassHealth Customer Service Center is currently experiencing unusually high call volume. We apologize for this inconvenience.

To avoid long wait times on the telephone, please be aware that providers can make use of the following email support addresses for assistance with questions and inquiries:

  1. For general provider inquiries, questions about claims, POSC access and navigation, etc., please contact: providersupport@mahealth.net
  2. For questions about EDI, please contact: edi@mahealth.net
  3. For questions about Revalidation, please contact: Revalidation@mahealth.net

Please make sure to include the caller’s full name, MassHealth provider name, Provider Identification Service Location (PIDSL) Number and/or National Provider Identifier (NPI), telephone number and the details of the inquiry or question(s). The MassHealth Customer Service Center will direct your inquiry to the appropriate customer service specialist to assist you as quickly as possible.

March 9, 2015Section 1202 Notice of Overpayment Letters Mailed

During the week of March 9, 2015 MassHealth will begin to mail Notice of Overpayment letters to group practices that did not respond to the Final Notice of Lack of Section 1202 Eligibility dated December 9, 2014.

The Notice of Overpayment contains the amount of Section 1202 overpayments made to the group practice for identified claims for certain dates of service submitted in connection with Section 1202 of the Affordable Care Act, which should not have been paid Section 1202 rates. As a result, MassHealth is taking steps to recover any Section 1202 payments that have been made to the group practice since January 1, 2013. Details can be seen on remittance advices at the end of March and throughout April.  Remittance Advice Code 9985 will appear on affected claims.

If the group practice seeks to dispute the amount of the identified overpayments indicated in the Notice of Overpayment letter, it must respond timely to the Notice of Overpayment as noted in the letter; otherwise, it will forfeit any rights to an adjudicatory hearing or to appeal the agency decision.

All communications to MassHealth concerning this matter, including any reply, should be sent to the MassHealth Customer Service Center (CSC) by e-mail at providersupport@mahealth.net, by fax at 617-988-8974 or by mail to the following address:

MassHealth Customer Service Center
Attn: Provider Enrollment, Section 1202 Reply to Notice of Overpayment
P.O. Box 9162
Canton MA 02021

March 2, 2015Reminder: Member Eligibility Inquiry Submission Guideline Now Expanded from 1,000 to 3,000 Per Transaction

Providers and vendors are reminded: MassHealth has adjusted its member eligibility submission guideline to accommodate up to 3,000 members in an eligibility transaction.

MassHealth strongly encourages providers to modify their eligibility submission practices immediately as, effective May 10, 2015, the agency will begin to reject transactions that exceed 3,000 members. The 270/271 HIPAA Implementation Guide requires that the 270 transaction contain no more than ninety-nine patient requests when using the transaction in batch mode but allows for other patient request limits to be set. MassHealth agrees to the reasonable limit of up to 3,000 member request per transaction and reserves the right to modify this limit as required in accordance with the HIPAA standard.

To ensure the timely and efficient processing of your eligibility files, please adhere to these submission guidelines:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. YOU MUST INCLUDE the member’s Medicaid ID number on the eligibility request if known
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received.

Please begin immediately to adhere to these batch file submission guidelines as non-conformance will impact the timely response to your file submission. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

March 2, 2015

Update: Crossover Claims Denied Erroneously for Edits 853 AND 855

Providers are advised: crossover claims that were denied erroneously for Edit 853 and Edit 855 on claims processed from 10/26/2014 through 12/18/2014 have been reprocessed and will appear on a future remittance advice.  

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

March 2, 2015

Crossover Claims Denied Erroneously for Modifier Edits

As indicated by a message text published in December 2014, MassHealth has resolved an issue that resulted in erroneous denials of crossover claims that processed from 10/26/2014 through 12/18/2014 for the following edits:

EDIT 4010 - MODIFIER REQUIRES MEDICAL REVIEW
EDIT 4033 - INVALID PROC MOD COMBINATION
EDIT 4203 - MODIFIER IS NOT COVERED

The crossover claims adjudicated after 12/18/2014 will no longer deny for these edits. Providers may resubmit denied crossover claims as MassHealth will NOT be reprocessing these claims.  No changes are necessary to the modifiers on the crossover claim when resubmitting these claims.

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

March 2, 2015

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

BULLETINS – February 2015:

  • Acute Inpatient Hospital Bulletin 151: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services
  • Acute Inpatient Hospital Bulletin 150: New Fax Number for MassHealth Applications and Documents
  • Acute Outpatient Hospital Bulletin 31: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services
  • Community Health Center Bulletin 82: New Fax Number for MassHealth Applications and Documents
  • Physician Bulletin 98: Section 1202 Rates for Hospital-Based Physicians and Physicians Working in Group Practices Who Provide Primary Care Services

TRANSMITTAL LETTERS – February 2015:

  • DME-33: 2014 HCPCS
  • ORT-24: 2014 HCPCS
  • OXY-31: 2014 HCPCS
  • PRT-25: 2014 HCPCS

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

February 23, 2015

Pharmacy, DME and Oxygen – Updated Payment and Coverage Guidelines, PA Operating Standards Now Online

Pharmacy, DME and Oxygen providers are advised: The MassHealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web.

To confirm that you are using the most recent version of the applicable Tool (v.23), go to www.mass.gov/masshealthpubs.  Click on Provider Library and then on MassHealth Payment and Coverage Guideline Tool.

You will also find the newly-updated Operating Standards for the Prior Authorization process on the Payment and Coverage Guideline page.  Click on the “Click Here” box on the upper right corner of the page.  This will bring you to the Quick Links page. Please note: this must be open in POSC to view deferral reasons. If you have any PA questions, please contact the PAU at PriorAuthorization@umassmed.edu or 1-800-862-8341.

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

February 23, 2015ICD-10 Implementation – Vendor-Phase II Testing Underway – Have You Signed Up Yet?

A reminder from MassHealth: With the implementation of ICD-10 scheduled for October 1, 2015, MassHealth is continuing to test with trading partners. Vendor Phase II testing is underway from February 2 – March 31, 2015. MassHealth strongly urges vendors that are ready for testing to arrange a test date immediately.

Testing involves submitting test claims, receiving test results, submitting corrected test claims and getting approved for production. Please schedule your testing immediately if you have not done so already. Contact the EDI team directly at 855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

February 23, 2015Deadline Extended to April 1, 2015 to Submit Hospital-Based Non-Billing Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

The Hospital-Based Non-Billing Provider Enrollment Form must be submitted to MassHealth on or before April 1, 2015 for services of a hospital-based physician to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.

Physicians can obtain Hospital-Based Non-billing Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) will be forthcoming in a MassHealth Provider Bulletin.

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

February 3, 2015ICD-10 Implementation – Vendor-Phase II Testing is Underway

A reminder from MassHealth: With the implementation of ICD-10 scheduled for October 1, 2015, MassHealth is continuing to test with trading partners. Vendor Phase II testing is underway from February 2 – March 31, 2015. Full Trading Partner Testing – Phase II is scheduled for April 1 – August 31, 2015. However, any trading partner that is currently ready to test should contact MassHealth immediately to arrange a test date.  

Testing involves submitting test claims, receiving test results, submitting corrected test claims and getting approved for production. MassHealth strongly urges you to schedule testing immediately if you have not done so already. Please contact the EDI team directly at 855-295-4047 or at edi@mahealth.net.

To stay current with the latest ICD-10 updates including Quick Tips for Submitting ICD-10 Test Files to MassHealth, ICD-10 Provider FAQs, and Job Aids, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/ and click on ICD Implementation.

February 3, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS – January 2015:

-ABR-16: Revisions to Abortion Services Regulations
-AIH-52: Gender Dysphoria, Sterilization, and Hysterectomy Policies
-ALL-212: Revised Payment Methodology for Out-of-state Chronic Disease and Rehabilitation Hospitals
-AOH-34: Revisions to Abortion Services Regulations
-AOH-33: Updated Gender Dysphoria and Sterilization Policies; Out-of-State Chronic Disease and Rehabilitation Hospitals
-AUD-17: Addition of Cochlear Implant External Components and Subchapter 6 Updates
-CHC-102: Gender Dysphoria, Sterilization, Hysterectomy, and Laboratory Services Policy
-COH-9: Updated Gender Dysphoria and Sterilization Policies; Out-of-State Chronic Disease and Rehabilitation Hospitals
-FAS-28: Updated Gender Dysphoria and Sterilization Policies, and Provider Eligibility Requirements
-FPA-51: Updated Sterilization Provisions and Subchapter 6
-HIS-25: Regulation and Subchapter 6 Updates
-PHM-61: Updated Gender Dysphoria Policy
-PHY-142: Updated Gender Dysphoria and Sterilization Policies
-POD-71: Updated Gender Dysphoria Policy
-STR-18: Updated Sterilization Clinic Regulations

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

January 20, 2015

Member Eligibility Inquiry Submission Guideline Now Expanded from 1,000 TO 3,000 Per Batch File

Providers and vendors are advised: MassHealth has adjusted its member eligibility submission guideline to accommodate up to 3,000 members in a single eligibility batch file request.

MassHealth strongly encourages providers to modify their eligibility submission practices immediately as the agency will begin this spring (mid-late March) to reject submissions that exceed 3,000 members.

REMINDER: To ensure the timely and efficient processing of your transactions, please adhere to these submission guidelines which conform to Phase I CORE 155: Eligibility and Benefits Batch Response Time Rules, HIPAA ASC X12 and MassHealth policy:

  1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.
  2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.
  3. DO NOT include more than 3,000 members in any single eligibility batch file request.
  4. YOU MUST INCLUDE the member’s Medicaid ID number on the eligibility request if known.
  5. ALWAYS POPULATE all subsequent eligibility requests with the member information received from MassHealth on the prior eligibility response (where applicable).

It is important that you adhere to these batch file submission guidelines as non-conformance will impact the timely response to your file submission. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

January 20, 2015

Job Aid Now Posted Online For Help in Transitioning From EVSpc and EVScall

MassHealth has now posted a Job Aid online for all providers who are still using EVSpc and EVScall and need to transition to another method of member eligibility verification and claim status inquiry.

Please go to: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf for a list of EVS transition options, access methods, set-up processes, resources and helpful links.

MassHealth has extended the termination date for EVSpc and EVScall software to September 1st, 2015. Please note that MassHealth will reject any/all transactions that are generated from this tool on or after the termination date.  However, providers should not delay! Please make this transition as soon as possible, as the software tool no longer displays key eligibility messages regarding MassHealth member coverage.

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

January 20, 2015

Important MassHealth Disclaimer Regarding EVSpc and EVScall Software Termination

All MassHealth Providers were notified on August 18, 2014, to stop using EVSpc to verify member eligibility as the software tool does not provide eligibility notifications, warnings, and other important messages about MassHealth Members that are provided by other MassHealth eligibility access methods noted below. Pursuant to that August notification, you must transition to one of the eligibility verification methods available on the POSC or via MassHealth Automated Voice Response (AVR).

If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits, even if EOHHS has been advised of the possibility of such damages. To the maximum extent permitted by applicable law, EOHHS disclaims all warranties, conditions, representations or guaranties of any kind, either express, implied, statutory or otherwise including, but not limited to, any implied warranties or conditions of satisfactory quality or fitness for a particular purpose.

MassHealth has extended the termination date for EVSpc and EVScall software to September 1st, 2015. MassHealth will reject any/all transactions generated from the tool after this date. To choose a new eligibility verification method, please refer immediately to the EVSpc/EVScall Job Aid page now online: www.mass.gov/eohhs/docs/masshealth/newmmis/evspc-transition.pdf.

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

January 20, 2015

Response Deadline Approaching: Letter Regarding 1202 Rate Eligibility

This is a reminder to all providers who received a letter from MassHealth, dated December 9, 2014 regarding ACA Section 1202 Physician Eligibility:

If you believe that a physician is eligible for Section 1202, you must submit the Physician Certification and Attestation Form by February 1, 2015 in order to reinstate a physician’s 1202 eligibility and receive any missed 1202 payments.

If you do not respond to the notice dated December 9, 2014, MassHealth will calculate and recover any Section 1202 payments that have been made to group practices since January 1, 2013 for services provided by physicians who did not attest to 1202 eligibility and did not return a completed Certification and Attestation form by the deadline

The Form is available at: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf and should be returned to MassHealth PEC, P.O. Box 9162, Canton MA 02021 or by FAX to 1-617-988-8974.

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

January 12, 2015Deadline to Submit Hospital-Based Non-Billing Provider Enrollment Form for Section 1202 Eligibility for 2013-2014 Dates of Service

This is a reminder that the Hospital-Based Non-Billing Provider Enrollment Form must be submitted to MassHealth on or before March 1, 2015 for services of a hospital-based physician to be eligible for Section 1202 rates for claims with dates of service January 1, 2013 through December 31, 2014.

Physicians can obtain Hospital-Based Non-billing Provider Enrollment Forms from their hospital’s Medical Staff Offices or Enrollment Departments. Information about how hospitals can be paid for dates of service starting January 1, 2013 (or the physician’s date of eligibility for Section 1202 rates, whichever is later) will be forthcoming in a MassHealth Provider Bulletin.

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

January 5, 2015New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS – December 2014:

-Acute Inpatient Hospital Bulletin 149: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
-All Provider Bulletin 248: Information about ICD-10
-Community Health Center Bulletin 81: Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3)
-Nursing Facility Bulletin 138: Increase in Medical Leave-of-Absence (MLOA) Days

TRANSMITTAL LETTERS - December 2014:

-CHC-101: 2014 HCPCS and Vaccine Codes

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

January 5, 2015Important Date Change:  EVSpc and EVScall Software Termination Extended to September 1, 2015

IMPORTANT INFORMATION – All MassHealth Providers were notified on August 18, 2014, to stop using EVSpc to verify member eligibility as the software tool does not provide eligibility notifications, warnings, and other important messages about MassHealth Members that are provided by other MassHealth eligibility access methods noted below. Pursuant to that August notification, you must transition to one of the eligibility verification methods available on the POSC or via Automated Voice Response (AVR). If you continue to use the software tool, EOHHS is not responsible for any action or inaction taken based on the information or lack of information provided by this tool and will not be liable to you or any third party for any consequential, indirect, incidental, reliance or special damages including, but not limited to, lost profits, even if EOHHS has been advised of the possibility of such damages. To the maximum extent permitted by applicable law, EOHHS disclaims all warranties, conditions, representations or guaranties of any kind, either express, implied, statutory or otherwise including, but not limited to, any implied warranties or conditions of satisfactory quality or fitness for a particular purpose.

MassHealth has extended the termination date for EVSpc and EVScall software from February 28th to September 1st, 2015. All functionality will end and there will be no support for the software after that date. Please refer to: www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/evspc.html.

EVSpc/EVScall has already stopped displaying current key eligibility messages regarding MassHealth member coverage. Therefore, you must immediately stop using EVSpc and EVScall and transition to one of the following POSC or other access methods:

-Use DDE (Direct Data Entry)

-Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files

-Check eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042 or

-Submit and receive Health Care Benefit Inquiry & Response (270/271) batched file transactions in accordance with MassHealth specifications:

-Upload 270 batches through the POSC or

-Submit and receive batched transactions directly (system-to-system) via HTS (Healthcare Transaction Services)

OF IMPORTANCE: To submit and receive HIPAA transactions in an electronic batch file through the POSC or through the HTS method, you must first coordinate with MassHealth Customer Service. For questions or assistance, contact the MassHealth Customer Service Center immediately at 1-800-841-2900 or providersupport@mahealth.net.

January 5, 2015Important Reminder: 1202 Enhanced Payments Have Ended Effective 12/31/2014

Physicians and group practices that have been receiving enhanced rates under ACA Section 1202 are advised: the enhanced rates have expired effective 12/31/14.

For dates of service January 1, 2015 and forward, your remittance advices will reflect standard, unenhanced MassHealth physician rates.

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

January 5, 2015Medicare Crossover Claims Denied for Edit 519 – Admit Date is After Statement Period “From” Date

MassHealth has resolved an issue that resulted in erroneous denials of Inpatient Part A crossover claims for Edit 519 with process dates from 9/11/2014 through 12/23/2014. 

Crossover claims adjudicated after 12/23/2014 will no longer deny for Edit 519. MassHealth has reprocessed the previously denied crossover claims which will appear on a future remittance advice.

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

January 5, 2015MassHealth Mail Forwarding Has Ended Effective 12/31/14

All providers are reminded that mail forwarding - from the old MassHealth Hingham address to the current Canton address – has ended as of December 31, 2014. Please make sure you use the correct address or your mail will be returned to you as undeliverable.

PROVIDER ENROLLMENT AND CREDENTIALING – Use this mailing address to submit new enrollment applications, provider file updates or correspondence:

MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton MA 02021

PAPER CLAIMS - If you are authorized to submit paper claims, the P.O. Box is:

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

PAPER PRIOR AUTHORIZATIONS - Send PA-1 request forms to:

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

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

January 5, 2015Dental Providers: Please Use Correct DentaQuest Address For Claims

All MassHealth Dental Providers billing CDT service codes should disregard the message text “MassHealth Mail Forwarding Has Ended Effective 12/31/14.” This message does not affect dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Please send all Dental Claims to:

DentaQuest – MassHealth Dental Claims
12121 North Corporate Parkway
Mequon, WI 53092

Please refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, provider enrollment, prior authorizations, claims, electronic claims, provider complaints and fraud.

For questions, contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

December 29, 2014Updated Approved Vendor List Now Available on Web

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

To access this new list and a helpful list of “Questions You Should Ask Your

Vendor/Clearinghouse/Billing Intermediary,” please go to:  www.mass.gov/eohhs/gov/laws-regs/privacy-security/masshealth/edi/vendor-list.html.

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

December 29, 2014Reminder: 1202 Enhanced Payments End 12/31/2014

All physicians and group practices that have been receiving enhanced rates under ACA Section 1202 are advised: the enhanced rates expire effective 12/31/14.

Please note that for dates of service January 1, 2015 and forward, your remittance advices reflect standard, unenhanced MassHealth physician rates.

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

December 29, 2014

New Modifiers to Bypass PTP Editing

Please note that there are four new HCPCS modifiers, listed below, that will be effective for use for dates of service on or after January 1, 2015. These modifiers should be used to bypass PTP (procedure-to-procedure) editing only when the code pair is designated by CMS as eligible for a modifier and when the second service is a distinct procedural service:

XE - Separate encounter: a service that is distinct because it occurred during a separate encounter
XP - Separate practitioner: a service that is distinct because it was performed by a different practitioner
XS - Separate structure: a service that is distinct because it was performed on a separate organ/structure
XU - Unusual non-overlapping service: the use of a service that is distinct because it does not overlap usual components of the main service

These modifiers describe clinical situations that currently are indicated by appending Modifier 59 – “Distinct Procedural Service”. However, CMS has identified that Modifier 59 is often misused to bypass PTP edits, partly because it is so non-specific. The new modifiers were established so that providers can specify more clearly the situations in which PTP edits, designated by CMS as eligible for a modifier, are eligible to be bypassed.

Modifier 59 remains a valid PTP-associated modifier. However, the coding instructions for Modifier 59 specify that it should be used “only if no more descriptive modifier is available.” Therefore, providers should use one of the new modifiers instead if the clinical situation described by one of the new modifiers is present.

Providers should consult the CPT code book for additional information about how to appropriately use modifiers. Please also refer to All Provider Bulletin 227 for more information on the appropriate use of PTP Modifiers. For questions, contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

December 22, 2014Support for Older Browser Connections Ends in January — Please Upgrade

Effective January 26, 2015, the MassHealth POSC (Provider Online Service Center) will no longer support browser connections using the SSL protocol. These are browser connections coming from older browsers such as Internet Explorer 6 or 7 that explicitly disable the TLS 1.0 protocol. If you are running Internet Explorer 6 or 7, we ask that you install Mozilla Firefox.

If you wish to use Internet Explorer, we recommend that you update to Internet Explorer 11. If you are running Internet Explorer 8, please validate that you have the TLS 1.0 Protocol enabled. This can be done within Internet Explorer under the Menu item Tools > Internet Options > Advanced Tab. Scroll down to the security section and make sure that TLS 1.0 is enabled. If not, add a check mark next to it to enable. Stop and restart your browser.

For other browsers such as Google Chrome and Mozilla Firefox, our testing has confirmed that TLS 1.0 has been enabled by default.  We recommend that you share this information with your IT department.

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

December 22, 2014Crossover Claims Denied Erroneously

MassHealth has resolved an issue that resulted in erroneous denials of crossover claims that processed from 10/26/2014 through 12/18/2014 for the following edits:

EDIT 853 FINAL DEADLINE EXCEEDED - DETAIL
EDIT 855 FINAL DEADLINE EXCEEDED - HEADER
EDIT 4010 MODIFIER REQUIRES MEDICAL REVIEW
EDIT 4033 INVALID PROC MOD COMBINATION
EDIT 4203 MODIFIER IS NOT COVERED

The crossover claims adjudicated after 12/18/2014 will no longer deny for these edit. MassHealth plans to reprocess the previously denied crossover claims on a future remittance advice. However, providers may resubmit denied crossover claims at this time.

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

December 15, 2014Letters Regarding Physician Eligibility For Section 1202 Rates

This is a reminder to all physicians who received a letter from MassHealth, dated December 9, 2014 regarding ACA Section 1202 Physician Eligibility:

If you believe that a physician is eligible for Section 1202, you must submit the Physician Certification and Attestation Form by February 1, 2015 in order to reinstate a physician’s 1202 eligibility and receive any missed 1202 payments.

If you do not respond to the notice dated December 9, 2014, MassHealth will calculate and recover any Section 1202 payments that have been made to group practices since January 1, 2013 for services provided by physicians who did not attest to 1202 eligibility and did not return a completed Certification and Attestation form by the deadline.

The form is available at: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf and should be returned to MassHealth PEC, P.O. Box 9162, Canton MA 02021 or by FAX to 1-617-988-8974.

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

December 8, 2014Reminder – MassHealth Mail Forwarding Ends December 31, 2014

MassHealth alerted all providers of new mailing addresses that became effective January 2, 2014. As part of the transition, MassHealth allowed mail still being sent to the old addresses to be forwarded.  However, all mail forwarding will cease on December 31, 2014. Please make sure you use the correct address or your mail will be returned to you as undeliverable.

PROVIDER ENROLLMENT AND CREDENTIALING – Use this mailing address to submit new enrollment applications, provider file updates or correspondence:

MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton MA 02021

PAPER CLAIMS - If you are authorized to submit paper claims, the P.O. Box is:

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

PAPER PRIOR AUTHORIZATIONS - Send PA-1 request forms to:

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

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

December 8, 2014Attention All Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

All MassHealth Dental Providers billing CDT service codes should disregard the message text “Reminder – MassHealth Mail Forwarding Ends December 31, 2014.” This message does not affect MassHealth dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Please send all Dental Claims to the following address:

DentaQuest – MassHealth Dental Claims
12121 North Corporate ParkwayMequon, WI 53092

Dental providers should continue to refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, prior authorizations, claims, electronic claims, provider complaints and fraud, and provider enrollment.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

December 8, 2014Crossover Claims Denied for Edit 4033 – Invalid PROC MOD Combination

MassHealth has resolved an issue that resulted in erroneous denials of crossover claims that processed from 10/26/2014 through 11/26/2014 for Edit 4033-INVALID PROC MOD COMBINATION.

The crossover claims adjudicated after 11/26/2014 will no longer deny for this edit. MassHealth plans to reprocess the previously denied crossover claims on a future remittance advice. However, providers may resubmit denied crossover claims at this time.

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

December 1, 2014Urgent Reminder to Stop Using EVSpc and EVScall Software Immediately

All providers still using EVSpc and EVScall Software are again reminded: MassHealth will terminate use of this software on February 28, 2015. All functionality will be terminated and there will be no support for the software after that date. EVSpc/EVScall has already ceased displaying current key eligibility messages regarding MassHealth member coverage. MassHealth will not accept any files with “.snd” suffix after February 28, 2015.

Please stop using EVSpc and EVScall immediately and transition to one of the following POSC or other access methods:

  • Use POSC DDE (Direct Data Entry)
  • Submit a Health Care Benefit Inquiry & Response (270/271) or Health Care Claims Status Inquiry & Response (276/277) batch file transaction in accordance with MassHealth specifications. You must coordinate with MassHealth Customer Service for this.
  • Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
  • Check eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042
  • Submit and receive batched transactions directly (system-to-system) via HTS (Healthcare Transaction System).You must coordinate with MassHealth Customer Service for this.

Please note: you must coordinate with MassHealth Customer Service to test batch and HTS files before you can submit and receive HIPAA transactions in an electronic batch file format through the POSC or the HTS method. If you already use a vendor that submits your “270” requests from a system that does NOT use the EVSpc/EVScall software, you should not be impacted by this upcoming EVS termination. Please check with your vendor regarding its submission methods.

For more information, go to www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/. Click on Information and Software for Electronic Transactions.

With the February 28, 2015 date to terminate EVSpc/EVScall approaching, you must take time now to make this very important transition. If you have questions or need assistance in transitioning to one of the access methods, please contact the MassHealth Customer Service Center immediately at 1-800-841-2900 or providersupport@mahealth.net.

December 1, 2014HCPCS Code G0463 – Outpatient Medicare Crossover Claim Denials

MassHealth has resolved an issue that resulted in erroneous denials of outpatient crossover claims for Edit 4021-PROCEDURE NOT COVERED FOR BENEFIT PLAN when billed with HCPCS G0463-HOSPITAL OUTPT CLINIC VISIT.

Outpatient crossover claims adjudicated after 08/15/2014 containing HCPCS G0463 will no longer deny for Edit 4021. MassHealth will not reprocess outpatient crossovers that previously denied for Edit 4021. Providers should resubmit their previously denied crossovers at this time.

All MassHealth providers are reminded to bill with MassHealth-covered Evaluation and Management CPT Codes for all other outpatient non-crossover claims.

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

December 1, 2014Third Party Liability (TPL) Claims Denied for Referral

MassHealth has identified TPL claims processed from 05/26/2009 through 10/02/2013 that were erroneously denied for Edit 3120-REFERRAL REQUIRED ON CLAIM. The affected claims have been reprocessed. The reprocessed claims will appear on future remittance advices.

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

December 1, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

TRANSMITTAL LETTERS - November 2014:

ALL-211: Revised Regulations about Electronic Health Records

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

November 24, 2014

Important Reminder – Please Adhere to File Submission Guidelines

Providers and vendors have been submitting excessively large HIPAA Eligibility Inquiry and Response transactions (270/271) to MassHealth for processing. In order to ensure the timely, efficient processing of transactions submitted by MassHealth providers and vendors in conformance with Phase I CORE 155: Eligibility and Benefits Batch Response Time Rules and in accordance with HIPAA ASC X12 and MassHealth policy, providers and vendors must adhere to the following submission guidelines:

1. ONLY check eligibility for those MassHealth members that you will actually service that day or the following day.

2. DO NOT submit your entire roster of MassHealth members if you are not servicing your entire roster of members that day or the following day.

3. DO NOT include more than 1,000 members in any single eligibility request.

4. YOU MUST INCLUDE the member’s Medicaid ID number on the eligibility request if known.

5. ALWAYS POPULATE all subsequent eligibility requests with the member information received from MassHealth on the prior eligibility response (where applicable).

It is important that you adhere to these file submission guidelines as non-conformance will impact the timely response to your file submission. For questions, please contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net.

November 10, 2014New PCC Application Available

All PCC (Primary Care Clinician) Providers and providers wishing to become PCCs are advised: MassHealth is now introducing a new, updated PCC Application for those providers eligible as stated in the MassHealth all provider regulation 450.118.

We ask that you immediately begin using this new PCC application to enroll in the PCC Plan (Primary Care Clinician Plan). The application is not available online and you must contact the MassHealth Customer Services Center to receive the new form. Please discard any blank copies of the old PCC application you may have. The older version of the application will no longer be accepted after December 31, 2014.

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

November 3, 2014IMPORTANT: EVSpc AND EVScall WILL BE TERMINATED ON FEBRUARY 28, 2015 – PLEASE TRANSITION NOW

MassHealth has now moved the termination date of EVSpc/EVScall Eligibility Verification Software to February 28, 2015. All EVSpc/EVScall functionality will cease after that date as MassHealth cannot provide support for the software after that date. All transactions submitted via EVSpc/EVScall will be rejected. EVSpc/EVScall already cannot display current key eligibility messages regarding MassHealth member coverage.

Providers must stop using EVSpc and EVScall immediately! Please transition to one of the following POSC or other access methods:

-Use POSC DDE (Direct Data Entry).
-Submit a Health Care Benefit Inquiry & Response (270/271) or Health Care Claims Status Inquiry & Response (276/277) batch file transaction in accordance with MassHealth specifications. You must coordinate with MassHealth Customer Service for this.
-Hire a vendor to generate your Health Care Benefit or Claims Status Inquiry batch files
-Check eligibility by calling the AVR (Automated Voice Response) system at 1-800-554-0042.
-Submit and receive batched transactions directly (system-to-system) via HTS (Healthcare Transaction System).You must coordinate with MassHealth Customer Service for this.

Please note: you must coordinate with MassHealth Customer Service to test batch and HTS files before you will be allowed to submit and receive HIPAA transactions in an electronic batch file format through the POSC or the HTS method. If you already use a vendor that submits “270” requests for you from a system that does NOT use the EVSpc/EVScall software, you should not be impacted by this upcoming EVS termination. Please confer with your vendor if you have any questions regarding its submission methods.

For additional information please go to: www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/training/ and click on Information and Software for Electronic Transactions.

The February 28, 2015 date to terminate use and support of EVSpc/EVScall is fast approaching! Please take time now to make this very important transition. For questions or assistance with transitioning to one of the access methods, contact the MassHealth Customer Service Center immediately at 1-800-841-2900 or providersupport@mahealth.net.

October 20, 2014

New EVS Message For Individuals with Temporary MassHealth Coverage and Commonwealth Care

Temporary coverage is ending soon for individuals with temporary MassHealth coverage and those currently covered through Commonwealth Care. Beginning in November 2014, and continuing through December, MassHealth and the Massachusetts Health Connector will be sending these individuals call-to-action notices asking them to submit new applications for 2015 coverage. These notices will provide the information needed to ensure these members re-apply and enroll in appropriate coverage before temporary MassHealth or Commonwealth Care coverage ends. We have posted messages on EVS for these impacted populations in order to help you identify and assist individuals who need to submit new applications.

Individuals with temporary MassHealth will receive notices between November 15th and December 15th. These members will have 60 days from the date of the notice they receive to take action before temporary coverage ends. Current Commonwealth Care members will receive notices on November 13th, 2014 and in order to avoid any gaps in coverage must submit a new application and enroll in new coverage by January 31, 2015.

Starting on October 20 2014, MassHealth will be posting the following EVS messages to help you identify those impacted by these changes:

  • EVS message for individuals with temporary MassHealth coverage: “This member’s temporary benefits are ending soon! They need to submit a new application on or after November 15, 2014 at MAhealthconnector.org”
  • EVS message for Commonwealth Care members: “This member’s Commonwealth Care coverage is ending soon! They need to submit a new application on or after November 15, 2014 at MAhealthconnector.org”

If this EVS message is displayed, please encourage and, if able, assist the individual to submit a new application at MAhealthconnector.org on or after November 15, 2014. These members do not have to wait to get a letter from MassHealth or the Health Connector to take action.

If an assistor, such as a Navigator or Certified Application Counselor, is available at your facility, please coordinate with them to schedule an appointment for these individuals to submit an application. If an assistor is not available, please direct the individuals to visit http://bettermahealthconnector.org/get-help/ for a complete list of assistors who can provide free help with submitting an application.

October 20, 2014Update to Homebound Assessment Form

Home Health Agency providers are advised that updates to the Homebound Assessment Form have been posted as of 09/30/2014.

Please note the change in the title for Section V: “Provider of DME Attestation, Signature and Date” has been changed to “Provider Attestation, Signature and Date.” This change was made because the signature must be from the Home Health Provider and not the DME Provider.

To access the updated form, please go to: http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/hba.pdf. For questions, please contact the MassHealth Customer Services Center at providersupport@mahealth.net or 1-800-841-2900.

October 14, 2014MassHealth Reprocessing Physician Claims to Adjust for Rate Changes

MMIS files for rates effective July 1, 2012 were updated on August 23, 2012. Recent audits identified incorrectly paid claims.

MassHealth will be reprocessing claims for dates of service July 1, 2012 through August 23, 2012 to correct this. The adjusted claims will appear over the next several pay cycles. We apologize for the inconvenience.

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

October 14, 2014ICD-10 Trading Partner Testing Update

MassHealth would like to extend a thank you to all of the providers who participated in the ICD-10 Trading Partner Testing activities to date. Please note that Beta testing ended on May 30, 2014 and Vendor testing ended on August 29, 2014. To see the results of the Vendor Testing, please visit the MassHealth ICD-10 web page on www.mass.gov.

We also thank all of the providers who scheduled a test date for 2014 or 2015, and who are currently testing ICD-10 transactions with MassHealth. If you missed your test date and need to reschedule, please contact MassHealth’s EDI Department directly at 855-295-4047 or edi@mahealth.net. The ICD-10 Testing Team will be happy to assist you.

MassHealth strongly encourages you to begin testing preparations now even though you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 2015, as required by federal law. To stay current with the latest ICD-10 updates, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/.  Click on ICD Implementation.

If you are interested in testing ICD-10 transactions with MassHealth, or you have been notified that you are required to test ICD-10 transactions with MassHealth, please contact the ICD-10 Testing Team directly at 855-295-4047 or edi@mahealth.net for more information.

October 14, 2014DME & Oxygen Claim Denials for Dual Eligible Members

DME and Oxygen services that have been rendered in a nursing facility (place of service 31 or 32) may be billed to MassHealth as the primary insurance only when the member’s Medicare Part A coverage has been exhausted.

MassHealth plans to reprocess claims with adjudication dates from 9/20/2013 through 9/26/2014 that denied for: Edit 2505- MEMBER COVERED BY MEDICARE or Edit 2593-DETAIL/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE when HIPAA group code PR and claim adjustment reason code 5 were reported on the claim. The reprocessed claims will appear on future remittance advices.

Please continue to refer to the online MassHealth DME & Oxygen Payment and Coverage Guideline Tool regarding Prior Authorization requirements for service codes covered by MassHealth.

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

October 14, 2014DME/OXY Payment and Coverage Guideline Tool  - Updated

Pharmacy, DME and Oxygen providers are advised: the Masshealth DME/OXY Payment and Coverage Guideline Tool has been updated and posted on the Web.

To confirm that you are using the most recent version of the applicable tool, please go to www.mass.gov/masshealthpubs. Click on Provider Library and then on Masshealth Payment and Coverage Guideline Tool.

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

October 6, 2014Independent Nurses: No Payment for Services in Institutional Settings

Independent nurses are reminded that MassHealth will not pay for nursing services provided in institutional settings per MassHealth regulation 414.409:

414.409: Conditions of Payment

(A) Place of Service. The MassHealth agency pays for nursing services to a member who meets the clinical criteria in 130 CMR 414.408 and resides in a non-institutional setting which may include, without limitation, a homeless shelter or other temporary residence or a community setting. In accordance with 42 CFR 440.70(c), the MassHealth agency does not pay for nursing services provided in a hospital, nursing facility, intermediate care facility for the mentally retarded or any other institutional setting providing medical, nursing, rehabilitative or related care.

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

October 6, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS - September 2014:

-All Provider Bulletin 247: Free Enhanced Text Messaging Service to Support Pregnant Women and New Mothers

-Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 88: Revised Screening Process for Chronic Disease and Rehabilitation Hospitals

TRANSMITTAL LETTERS - September 2014:

-ALL-210: Revised Appendix A

-AIH-51: Elimination of 20-day coverage limitation for acute inpatient hospital stays of members aged 21 or older

-ALL-209: Revised payment methodology for out-of-state acute hospitals

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

September 29, 2014Mental Health Center Crossover Adjustments for E&M Procedure Codes

MassHealth has systematically adjusted professional crossover claims with E&M (evaluation and management) procedure codes billed by Mental Health Centers. Claims with dates of service on or after January 1, 2014 were adjusted due to a change in the reimbursement rate. These adjusted claims will appear on a future remittance advice.

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

September 22, 2014MassHealth Provider Revalidation Continues

MassHealth is continuing its Provider Revalidation effort, as required by the federal Affordable Care Act. The process requires that you revalidate your enrollment information for MassHealth under new screening criteria.  You are receiving this remittance advice message because you/your entity may have received a Revalidation Request letter in August or September.

This Revalidation initiative:

-Is being conducted by Provider Type.

-Is currently focusing only on MassHealth providers enrolled on or before March 25, 2011 and will be completed by March 24, 2016. If you enrolled as a provider after March 25, 2011, you will be revalidated on or before five years from the date of your initial enrollment.

-Must be completed within 45 days of the date on the request letter.

OF IMPORTANCE: With certain higher-volume provider types, the revalidation will be conducted over several months, e.g., only a portion of pharmacies or nurse practitioners will be called to revalidate per month. Therefore, you may not necessarily have been called to revalidate yet, although all in your provider type have been sent this message.

To verify whether you have been mailed a Revalidation Request letter, contact the MassHealth Customer Service Center at 1-800-841-2900 or email providersupport@mahealth.net.

For more information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation.

September 22, 2014COB Claims Submitted with Invalid HIPAA Claim Adjustment Reason Codes

Providers are reminded that claims involving COB (Coordination of Benefits) information must be submitted to MassHealth with a valid HIPAA CARC (Claim Adjustment Reason Code). Beginning September 16, 2014, claims submitted with invalid CARCs may result in denials for the following edits:

2558 - OTHER PAYER DENIAL ARC IS NOT ON TABLE – HEADER
2559 - OTHER PAYER DENIAL ARC IS NOT ON TABLE – DETAIL

Providers should refer to the Washington Publishing Company website http://www.wpc-edi.com/reference for a complete list of valid HIPAA Claim Adjustment Reason Codes.

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

September 22, 2014How to Check your Revalidation Status

Many MassHealth providers have been asking about the current Revalidation initiative, as required by the federal Affordable Care Act:

1. When will it be my turn to revalidate?

If you and/or your entity were enrolled on or before March 25, 2011 and you have not yet received a Revalidation request letter from MassHealth, you will eventually be notified by U.S. mail at your DBA address to revalidate between now and March 25, 2016. MassHealth selects a limited number of provider types each month for revalidation. Those providers have 45 days from the date on the letter to complete the online revalidation process.

To check whether you were mailed a letter, contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net.

2. I completed the online revalidation process and mailed in required documents. How do I know my revalidation is complete?

If you successfully completed the online revalidation process on the POSC (Provider Online Service Center) and your submitted documents are complete, MassHealth will mail you a confirmation letter to your DBA address. Otherwise, a revalidation specialist will call you/your entity directly to assist you in completing the process correctly. Because of high volume, the review and response time to providers is slightly delayed at this point.

To check your revalidation status, please contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net. 

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

September 15, 2014Claims Adjustments for Procedure Codes 99495 AND 99496

MassHealth has systematically adjusted professional crossover claims for physicians and group practice providers who billed with procedure codes 99495 or 99496 for dates of service on or after 1/1/2013.  These services were paid the ACA Section 1202 reimbursement rates in error. These adjusted claims will appear on a future remittance advice.

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

September 8, 2014Confirmation: Bed Hold Days Increased to Twenty Days

To all Nursing Facility Providers: A message was sent on July 29, 2014 stating that the number of allowable MLOA (Medical Leave of Absence) days, also known as Bed Hold days, will be increased to up to 20 days, effective September 1, 2014. This message confirms the increase.

Effective September 1, 2014, MassHealth now allows up to 20 MLOA days. Any existing MLOA events that commenced prior to that date will fall under the previous policy of ten (10) MLOA days. MLOA applies to admissions to Acute, Chronic Disease, Psychiatric and Rehabilitation hospitals.

All other policy provisions consistent with regulation 130 CMR 456.000 will remain in effect. The payment rate for MLOA days will remain at $80.10 per day. A provider bulletin on this change in allowed MLOA days will be issued at a later date.

For questions about this policy change, please contact Program Manager Ron Pawelski at 617-222-7546 or by email at Ronald.Pawelski@state.ma.us.

September 2, 2014Reprocessing of T1020 – Fiscal Intermediary Administrative Fees

MassHealth has identified an issue that resulted in claims for the Fiscal Intermediary administrative fees (Service Code T1020) being paid at the incorrect rate. MassHealth is reprocessing these claims and the adjustments will begin to appear on this and future remittance advices.

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

September 2, 2014Letters Regarding Physician Eligibility for Section 1202 Rates

This is a message to all physicians in group practices who have not responded to a letter from MassHealth, dated August 1, 2014, regarding ACA Section 1202 eligibility for physicians that have not returned the Physician Certification and Attestation Form:

The letter included a deadline of August 30, 2014 to return completed attestation forms.  This message is a notification that MassHealth is extending the deadline to submit the form to September 12, 2014.

Physicians who received the August 1, 2014 letter and are eligible under Section 1202 should complete the Physician Certification and Attestation Form available at http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/aca-1202.pdf by September 12, 2014. Physicians who do not return their attestation form by this deadline will no longer be paid Section 1202 rates, as of October 1, 2014.

As explained in the letter, MassHealth will calculate and recover any Section 1202 payments that have been made to group practices since January 1, 2013 for services provided by physicians who do not attest to 1202 eligibility and did not return a completed Physician Certification and Attestation Form by the September 12, 2014 deadline.

Completed forms should be returned to MassHealth PEC, P.O. Box 9162, Canton MA 02021 OR by FAX to 1-617-988-8974.

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

September 2, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

PROVIDER BULLETINS - August 2014:

-Hospice Bulletin 11: Change in Fax Number for MassHealth Hospice Election Forms

TRANSMITTAL LETTERS - August 2014:

-LAB-43: Subchapter 6 Revisions
-ALL-208: Site Visits
-HCBS-3: Home and Community-Based Services (HCBS) Waiver Manual (HCBS Service Codes, Descriptions and Modifiers)

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

August 18, 2014New Fax Number for MassHealth Hospice Election Forms

Effective immediately, all Hospice providers must use a new fax number to submit Hospice Election Forms on behalf of MassHealth members who seek to elect hospice services, revoke or terminate hospice services or change hospice providers.

The new fax number is: 617-886-8402.

You may also mail Hospice Election forms to:

MassHealth Hospice Unit
UMMS-CHCF
529 Main St., Ste. 320
Charlestown MA 02129

Hospice Election forms must be completed fully and submitted under separate cover for each member.

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

August 18, 2014Important Notification: EVSpc Will Terminate in December 2014

MassHealth will terminate the use of EVSpc on December 31, 2014 and will no longer provide support for the software tool after that date. The software is no longer compatible with the EVS functionality on the POSC (Provider Online Service Center). Providers that use the EVSpc software will not receive key eligibility messages related to MassHealth members’ coverage. Providers are strongly encouraged to stop using the EVSpc immediately and transition to one of the following POSC or telephone access methods:

-DDE (Direct Data Entry)
- Submit a Health Care Benefit Inquiry & response (270/271) batch file transaction in accordance with MassHealth specifications
-Engage a vendor to generate your Health Care Benefit Inquiry batch files
-Check eligibility by calling the Provider AVR (Automated Voice Response) system at 1-800-554-0042

The tool will no longer be available for download. The December 31, 2014 termination date will provide ample time for providers to transition to one of the POSC access methods.

July 21, 2014Provider Billing Reminder: MassHealth DME and Oxygen Payment and Coverage Guidelines Tool

Pharmacy, DME and Oxygen providers are reminded that the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool has been updated and posted on the Web. To confirm that you are using the most recent version of the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool, go to WWW.MASS.GOV/MASSHEALTHPUBS click on Provider Library and then click on Masshealth Payment and Coverage Guideline Tools.

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

July 15, 2014MassHealth Provider Revalidation Continues for Chain Pharmacies

As required by the Affordable Care Act, MassHealth is continuing its Provider Revalidation effort. This process requires that you revalidate your enrollment information for MassHealth under new enrollment screening criteria. You may also be required to submit original signature documentation to support your Revalidation, including a Federally Required Disclosures Form.

Revalidation is a.) being conducted by Provider Type and b.) currently focusing on providers enrolled on or before March 25, 2011. These revalidations will be completed by March 24, 2016.  If you enrolled as a provider after March 25, 2011, you will be revalidated on or before five years from the date of your initial enrollment. Failure to complete the Revalidation will affect your enrollment status and may result in sanctions.

Chain Pharmacies are the next group of provider type that have been mailed Revalidation letters and must complete the Revalidation process on the POSC (Provider Online Service Center) within 45 days of the date on the revalidation letter. If you need access to the POSC, you will need to complete a Data Collection Form (DCF) or request access from the primary user at your practice. Please note: Independent pharmacies will be among the next waves of provider types to be revalidated.

For additional information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation.

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

July 15, 2014Community Health Center – Type of Bill 77X – Outpatient Crossover Claim Denials

MassHealth has systematically reprocessed CHC outpatient crossover claims with adjudication dates on 05/26/2009 through 05/06/2014 that denied in error for Edit 4036-PROV CONTRACT POS RESTRICTION ON PROCEDURE. These reprocessed claims will appear on a future remittance advice. 

Please Note: If the claims denied for other valid reasons, providers are responsible to correct the denial and resubmit their claims to MassHealth accordingly. For questions, please contact MassHealth Customer Services Center at 1-800-841-2900 or providersupport@masshealth.net.

July 7, 2014Header-Related Remark Codes in the MIA Segment of the HIPAA 835

Effective July 1, 2014, MassHealth will be reporting header-related remark codes in the MIA segment of the HIPAA 835. This will be provided when a claim is priced and reported at the header and there are remark codes present. The segment will include up to 5 remark codes.

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

June 30, 2014New Nursing Facility Rates to be Issued July 1, 2014

To all Nursing Facility Providers:

Effective July 1, 2014, EOHHS (Executive Office of Health and Human Services) will issue new rates for nursing facility services. These rates reflect the expiration of the FY2014 user fee add-on on June 30, 2014. The expiration of the user fee add-on is consistent with regulation 101 CMR 206.00.

EOHHS will issue new rates for FY2015 as soon as the budget process is completed. These rates would contain applicable add-ons that may be specified in legislation.

If you have any questions, please contact Ron Pawelski, Nursing Facility Program Manager at (617) 222-7546.

June 30, 2014Do You Need Assistance with Revalidation?  MassHealth Invites you to a Tutorial Webinar

MassHealth is offering a tutorial webinar to all providers who have been mailed letters as part of the federally mandated Revalidation Initiative and need assistance in completing the process. The webinar will provide you step-by-step instructions on how to access your information on the POSC, change/update your profile information and download and complete any original signature documents that may be required. The webinar will be offered twice:

Tuesday, July 1, 2014 from 10-11 AM                       

Monday, July 14, 2014 from 10-11 AM

To join the webinar:

Audio Login:
Toll-Free (US & Canada): 866.740.1260
Toll: 303.248.0285
Access Code: 4725653

Web Login:
Meeting URL: http://www.readytalk.com/?ac=4725653
Test Your Computer: http://test.readytalk.com/?host=readytalk
Support: U.S. and Canada: 800.843.9166 or help@readytalk.com
Access Code: 4725653

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

June 30, 2014Third Party Liability Requirements for Independent Nurses

MassHealth reminds all Independent Nurses: you must make diligent efforts to obtain payment first from other resources so that MassHealth is the payer of last resort.  Please see All Provider Manual 130 CMR 450.316.

MassHealth will not pay you and will recover any payments from you if it determines that, among other things, you have not made such diligent efforts. “Diligent efforts” is defined as making every effort to identify and obtain payment from all other liable parties, including insurers. Diligent efforts include but are not limited to:

1. Determining the existence of health insurance by asking the member if he or she has other insurance and by using insurance databases available to the provider;

2. Verifying the member’s other health insurance coverage via EVS for each date of service and at the time of billing;

3. Submitting claims to all insurers with the insurer’s designated service code for the service provided;

4. Complying with the insurer’s billing and authorization requirements;

5. Appealing a denied claim when the service is payable in whole or in part by an insurer;

6. Returning any payment received from MassHealth after any available third-party resource has been identified. The provider must bill all available third-party resources before resubmitting a claim to MassHealth.

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

June 30, 2014Reminder to All Providers: Keep your Profile Information Up-to-Date

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

This is especially important as MassHealth continues the federally mandated Revalidation initiative.  Please make sure that when MassHealth notifies you/your entity that it is time to revalidate that you are able to access your provider profile through the POSC (Provider Online Service Center) and your profile is up-to-date.  To submit changes through the POSC, go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

You may also submit changes in writing to Provider Enrollment and Credentialing, PO Box 9162, Canton MA 02021.

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

June 30, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from June 2014:

-Community Health Center Bulletin 80: Behavioral Health Assessment Claims for Members Under 21
-Mental Health Center Bulletin 30: Behavioral Health Assessment Claims for Members Under 21
-School-Based Medicaid Provider Bulletin 27: School-Based Medicaid Program Interim Rates (State Fiscal Year 2014)

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

June 24, 2014MMQ Software to be Removed from Mass.gov by July 31, 2014

Effective October 1, 2015, MassHealth will no longer support the proprietary Management Minutes Questionnaire (MMQ) software currently available to Nursing Facility providers on mass.gov/masshealth. By September 30, 2015, all providers using this software must transition to an alternative method of submitting MMQs.

Methods include:

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

To facilitate this transition, MassHealth will remove the proprietary MMQ software from Mass.gov immediately after July 31, 2014.  If you would like to retain a copy of the software, please download it on or before July 31, 2014. MassHealth will provide support for the proprietary MMQ software until September 30, 2015, when all providers have transitioned to an alternative submission method.

POSC users may refer to the MMQ Job Aid available at http://www.mass.gov/eohhs/docs/masshealth/provlibrary/pocs-job-aids/sco-pace-submit-mmq.pdf. Batch submitters may view the MassHealth MMQ file specifications available at http://www.mass.gov/eohhs/docs/masshealth/provlibrary/draft-nf-d-icd-10.pdf. Both of these documents have been modified for ICD-10.

Thank you for your cooperation in making this important transition. MassHealth will keep you informed as the process moves forward. For questions, please contact MassHealth customer service by telephone at 1-800-841-2900 or by email at providersupport@masshealth.net.

June 24, 2014

ICD-10 Trading Partner Testing Update

All providers that must test ICD-10 transactions with MassHealth are advised: MassHealth welcomes you to submit your test file to us any time you are ready. Although ICD-10’s implementation has been delayed until October, 2015, there is no need for you to wait until next year to participate in trading partner testing.

We encourage you to take advantage of testing availability times now!

To schedule a test date with the ICD-10 Testing Team, please contact MassHealth’s EDI Department directly at 855-295-4047 or edi@mahealth.net.

June 24, 2014Important Update for Nursing Facilities that Received Revalidation Request Letters

As required by the Affordable Care Act, MassHealth is continuing its Provider Revalidation effort, and nursing facilities that were enrolled in MassHealth on or before March 25, 2011 have now received letters with instruction sheets advising them to revalidate all provider information online within 45 days of the date of the letter.

Please note that the instruction sheet was missing information regarding application fees as part of the revalidation process. Your nursing facility may be required to pay an application fee when revalidating, unless you have already made payment(s) to Medicare or another state (in which case you must provide proof).

For more information on Application Fees, please visit: http://www.mass.gov/eohhs/provider/insurance/masshealth/provider-application-fees.html

To make a payment, please go to https://www.paybill.com/MassHealthApplicationFeeBillPay/

MassHealth apologizes for any inconvenience. For more information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page at www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation.  For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or by emailing providersupport@masshealth.net.

June 18, 2014Do You Need Assistance with Revalidation?  Online Tutorial Now Available

MassHealth is now offering an online tutorial to all providers who have been mailed letters as part of the federally mandated Revalidation Initiative.  If you need assistance in completing the Revalidation process, this tutorial will provide you step-by-step instructions on how to:

-Access your profile information on the POSC (Provider Online Service Center)

-Make any changes/updates necessary to your provider profile

-Download and complete any original signature documents that may be required

To access the tutorial, please go to the MassHealth Revalidation web page at www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment.  Click on Provider Revalidation and go to Job Aids. The Revalidation page also offers you the All Provider Bulletin 242 and a Revalidation FAQ document. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or by emailing providersupport@mahealth.net.

June 9, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from May 2014:

-All Provider Bulletin 245: Behavioral Health Services for Members with Temporary MassHealth Coverage

-All Provider Bulletin 244: Coverage Provided via Hospital-Determined Presumptive Eligibility

-Chronic Disease and Rehabilitation Outpatient Hospital Bulletin 5: NCCI Procedure-to-Procedure Code Pair Denial for Therapy Services

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

June 2, 2014MassHealth Timeframes for Bill Paying for Nursing Facility Providers

MassHealth will be modifying the timeframes for paying Nursing Facility claims for May dates of service received by MassHealth in May or June. The payment schedule will be modified by approximately 2 weeks. Please see the modified payment schedule outlined below.

RA DATE: 07/01/2014
PAYMENT DATE CHECKS: 07/04/2014
PAYMENT DATE EFT: 07/07/2014

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: 7/15/2014
PAYMENT DATE CHECKS: 7/18/2014
PAYMENT DATE EFT: 7/21/2014

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

June 2, 2014Adjustments for ACA Section 1202 Rates for Physicians Who Provide Primary Care

MassHealth has identified overpayments and, in some cases, underpayments of Calendar Year 2014 ACA Section 1202 rates on certain Evaluation and Management and Vaccine Administration claims submitted from January 1, 2014 to March 18,2014, due to a delay in the Section 1202 rates released by CMS. The enclosed remittance advice (and other remittance advices in the coming weeks) may contain claims processed from January to June that have been systematically adjusted to pay the corrected 1202 rate.

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

June 2, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from May 2014:

All Provider Bulletin 244: Coverage Provided via Hospital-Determined Presumptive Eligibility

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

May 19, 2014MassHealth Provider Revalidation Continues

As required by the Affordable Care Act, MassHealth is continuing its Provider Revalidation effort. The process requires that you revalidate your enrollment information for MassHealth under new enrollment screening criteria. You may also be required to submit original signature documentation to support your Revalidation, including a Federally Required Disclosures Form.

This Revalidation initiative is a.) being conducted by Provider Type and b.) is currently focusing on providers enrolled on or before March 25, 2011. These revalidations will be completed by March 24, 2016. If you enrolled as a provider after March 25, 2011, you will be revalidated on or before five years from the date of your initial enrollment. Failure to complete the Revalidation will affect your enrollment status and may result in sanctions.

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

-05 Psychologist
-06 Podiatrist
-21 Family Planning
-28 Substance Abuse
-61 Independent Nurse
-97 Group Practices comprised of Provider Types 05, 06 (Psychologist, Podiatrist)

For additional information, including All Provider Bulletin 242, a FAQ document and the Revalidation Job Aid, please visit the MassHealth Revalidation web page. Go to www.mass.gov/eohhs/provider/insurance/masshealth/provider-enrollment. Click on Provider Revalidation. For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or by emailing providersupport@mahealth.net.

May 19, 2014Beyond the Allowable: Improving the Prior Authorization Process for Continued Therapy – Friday, June 6, 2014 Webinar

MassHealth knows that you are committed to providing quality therapy services for your patients. The Prior Authorization Unit Clinical Reviewers have the same goal in mind: ensuring that MassHealth members are getting the therapy services they need.

Please join us for an informative and interactive Webinar presentation - June 6, 2014, 12:00 PM-1:30 PM - on the Prior Authorization process for Physical, Occupational and Speech Therapy providers. During the Webinar, we will review:

-MassHealth Regulations related to Therapy Services
-Prior Authorization process for Therapy Services
-How to thoroughly complete a Request and Justification Form to ensure request approval
-For those who still submit PAs via paper: information on how to submit PAs via the POSC.

To register, please go to: http://onlinetraining.umassmed.edu/pa_therapy_webinar/event/registration.html. Or, please email priorauthorization@umassmed.edu and the registration link will be emailed to you directly. Or, please call the PAU at 1-800-862-8341 for registration assistance.

May 19, 2014One Care Plan Billing and Voids

Providers are reminded to check the EVS (Eligibility Verification System) to determine if a member is enrolled in an ICO (Integrated Care Organization), also known as a One Care Plan. Providers must bill the member’s ICO/One Care Plan for services rendered.

MassHealth will void FFS (Fee-For-Service) claims for members enrolled in One Care Plans with dates of service from October 2013 through March 2014, previously paid to the provider types identified above. Providers should re-submit One Care member claims for payment to the ICO/One Care Plan where the member or members are enrolled.  ICOs/One Care Plans have been notified and will expect claims from affected providers.  Contact information for billing the ICOs/One Care Plans is listed below.

Fallon Total Care: 1-855-508-4715
Network Health/Unify: 888-257-1985
Commonwealth Care Alliance: 1-800-306-0732 (option #5)

MassHealth members should not be billed for any services after the FFS claims are voided. Claims must be re-submitted to the member’s ICO/One Care Plan for payment. If you have questions, contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@mahealth.net.

May 13, 2014Important Reminder to Nurses Providing Continuous Skilled Nursing Services

This is a friendly reminder to nurses of the importance of detailed and comprehensive documentation of CSN (continuous skilled nursing) services. Your documentation must be individualized and provide details about the complexity of services, the comprehensive assessments, and the nursing care you provide to support the skilled needs of the member, per the care plan.

Please refer to the Independent Nurse Manual Subchapter 4 program regulations, 130 CMR 414.417 (B) – “Recordkeeping Requirement and Utilization Review: In order for a medical record to completely document a service to a member, the record must disclose fully the nature, extent, quality and necessity of the nursing services furnished to the member. When the information contained in a member’s record does not provide sufficient documentation for the service, the MassHealth agency may disallow payment.”

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

May 5, 2014ICD-10 Vendor Testing Schedule Update

All providers participating in ICD-10 Beta Testing are advised that testing has now been extended through May 30, 2014.

Also, Vendor Testing, originally scheduled for May 13 through June 13, 2014, has now been re-scheduled to run from July 7 through August 29, 2014. Interested providers should please contact MassHealth ICD-10 EDI Department directly at 855-295-4047 or edi@mahealth.net.

To stay current with the latest ICD-10 updates, please go to the ICD-10 Web Page at www.mass.gov/eohhs/gov/newsroom/masshealth/providers/icd10-implementation.html.

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

May 5, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from April 2014:

-Long-Term Care Facility Bulletin 108: Annual Accounting for Personal Needs Account

Provider Transmittal Letters from April 2014:

-MHC-47: Revised Regulations, Service Codes, and Descriptions

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

April 14, 2014Coverage of Restorative Adult Dental Services

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

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

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

Please refer to MassHealth Dental Bulletin 43 at www.mass.gov/eohhs/docs/masshealth/bull-2014/den-43.pdf.  For questions, please contact the MassHealth Customer Services Center at 1-800-841-2900 or providersupport@mahealth.net.

April 14, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from March 2014:

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

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

April 7, 2014Important Message Regarding ICD-10On April 1, 2014 the bill H.R. 4302, Protecting Access to Medicare Act of 2014 was signed into law. A component of the law states that HHS (Department of Health and Human Services) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015.  Based upon this change, MassHealth is evaluating the impact of the delay on MassHealth and will provide more information as soon as it becomes available. In the interim MassHealth will continue to test ICD-10 transactions with its trading partners.
April 7, 2014Diagnosis Edits

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

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

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

April 7, 2014Early Intervention Service Code T1024 (40 Units Counting Method)

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

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

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

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

March 31, 2014Letters Regarding Physician Eligibility for Section 1202 Rates

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

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

Please return the completed form to MassHealth PEC, P.O. Box 9162, Canton MA 02021 OR by FAX to 1-617-988-8974.

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

March 31, 2014Orthotics and Prosthetics Claims Adjustments

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

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

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

March 31, 2014Temporary MassHealth Member Coverage

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

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

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

March 24, 2014Letters Regarding Physician Eligibility for Section 1202 Rates– Response due March 30, 2014

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

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

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

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

March 24, 2014Minor Changes to MMIS DDE (Direct Data Entry Screens

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

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

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

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

March 24, 2014Reprocessed Long Term Care Claims

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

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

March 24, 20141202 Rate Updates for 2014MassHealth is in the process of updating the calendar year 2014 Section 1202 rates. Further information, including the time frame for adjusting claims, will be forthcoming.
March 24, 2014Important Notice: EVSpc Windows Operating System Support to Change April 8th

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

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

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

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

March 24, 2014Important Message: Incorrect Fax Number in Member Booklets

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

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

THE CORRECT NUMBER IS:  617-887-8770.

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

March 24, 2014MassHealth is the Payer of Last Resort

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

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

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

March 19, 2014Important Message: Incorrect Fax Number in Member Booklets

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

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

THE CORRECT NUMBER IS:  617-887-8770.

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

March 19, 2014MassHealth Provider Revalidation Has Begun

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

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

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

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

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

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

March 19, 2014Admission Dates Required for Inpatient Claims – Advisory

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

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

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

March 10, 2014Hospice Claims that Previously Denied Due to Conflict with NCCI Edits

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

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

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

March 10, 2014Updated EFT Enrollment/Modification Request Form Now Available

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

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

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

March 3, 2014Personal Care Attendant (PCA) New Hire Orientation

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

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

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

March 3, 2014Home Health Claims Submitted with TOB (Type of Bill) 033X

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

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

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

February 25, 2014Attention Electronic Claim Submission Waivered Providers: New 1500 Claim Form Required as of March 22, 2014

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

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

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

February 25, 2014Attention Electronic Claim Submission Waivered Providers: New 1500 Claim Form Required as of March 22, 2014

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

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

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

February 20, 2014Provider Rate Change for Procedure Code 88112

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

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

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

February 20, 2014Provider Billing Reminder: CARCs and RARCs Have Changed

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

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

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

February 3, 2014CMS ICD-10 Readiness Survey for Specialty Providers

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

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

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

February 3, 2014MassHealth ICD-10 Readiness Survey – Deadline Extended

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

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

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

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

February 3, 2014MMQ Software Changes Coming in October 2014

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

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

February 3, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from January 2014:

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

Provider Transmittal Letters from January 2014:

-COH-8: New Subchapter 6

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

January 27, 2014MassHealth Reprocessing Pharmacy Claims in Payment Cycles

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

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

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

January 27, 2014Important Information: Provider Revalidation Starts March 2014

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

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

The process will require that you revalidate your enrollment information for MassHealth and complete and return a Federally Required Disclosures form. See 42 CFR 455.414, Section 6401 of the Affordable Care Act (ACA) and 42 CFR 455.104 (c)(1)(iii).

Failure to complete the revalidation will affect your enrollment status and ability to receive MassHealth claim payments.

Additional information about the Revalidation initiative is forthcoming. Please continue to check www.mass.gov/masshealth.

January 21, 2014

ICD-10 Trading Partner Testing

 

All MassHealth providers are reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2014, as required by federal law.

MassHealth is continuing to prepare for ICD-10 implementation and, to that end, invites you to participate in planned trading partner testing in the second quarter of 2014. Details on the testing timeline, requirements and instructions will be announced shortly. As we prepare for the testing, MassHealth EDI Analysts will be outreaching our trading partners over the next several months to gather preliminary information and assess provider readiness for ICD-10.

For more details, please read MassHealth All Provider Bulletin 241. Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. Click on Provider Bulletins, then 2014 Provider Bulletins.

For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

January 21, 2014

ICD-10 Trading Partner Testing

 

All MassHealth providers are reminded: you must begin billing with ICD-10 diagnosis and inpatient procedure codes as of October 1, 2014, as required by federal law.

MassHealth is continuing to prepare for ICD-10 implementation and, to that end, invites you to participate in planned trading partner testing in the second quarter of 2014. Details on the testing timeline, requirements and instructions will be announced shortly. As we prepare for the testing, MassHealth EDI Analysts will be outreaching our trading partners over the next several months to gather preliminary information and assess provider readiness for ICD-10.

For more details, please read MassHealth All Provider Bulletin 241. Go to www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/. Click on Provider Bulletins, then 2014 Provider Bulletins.

For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

January 21, 2014ICD-10 Readiness Survey

ICD-10 is coming! And MassHealth is very interested in how you are preparing for this October 1, 2014 implementation.

A readiness survey has been developed to gather key information and enable MassHealth to better anticipate the needs of our providers and to coordinate effectively with billing intermediaries, clearinghouses and software vendors.

Please complete the ICD-10 Readiness Survey at http://webapps.ehs.state.ma.us/reviewsurvey/ReviewSurvey.aspx?id=381 no later than January 31, 2014. Please make every effort to review and submit your entry within the timeframe requested.

If you have any questions about the survey, please contact MassHealth Customer Service at 1- 800-841-2900 or providersupport@mahealth.net.

January 21, 2014Attention All Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

All MassHealth Dental Providers billing CDT service codes should disregard the Message Text “Update to Important Announcement: Provider Operations Changes.” These changes do not affect MassHealth dental providers who use CDT service codes and submit claims to DentaQuest, either electronically or with a waiver to submit paper claims.

Dental providers should continue to refer to the Office Reference Manual for all information concerning customer service contacts, provider services, member eligibility and benefits, prior authorizations, claims, electronic claims, provider complaints and fraud, and provider enrollment.

For questions, please contact MassHealth Dental Customer Service at 1-800-207-5019 or by email at inquiries@masshealth-dental.net.

January 13, 2014Update to Important Announcement: Provider Operations Changes

MassHealth advised all providers last month that, during the period from December 16-31, 2013, all Provider Services functions would transition from Hewlett Packard Enterprise Services (HPES) to the MAXIMUS MassHealth Customer Service Center (CSC). The transition is now complete effective January 2, 2014, and we want to remind you of four changes that impact you as a provider:

PROVIDER ENROLLMENT AND CREDENTIALING – Please use this new mailing address to submit new enrollment applications, provider file updates or correspondence:

MassHealth Customer Service
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton MA 02021

CSC will keep the existing Hingham P.O. box through May 31, 2014 only.

PAPER CLAIMS - If you are authorized to submit paper claims, the new P.O. Box is:

MassHealth
Attn: Original Paper Claims Submissions
P.O. Box 9152
Canton MA 02021

PAPER PRIOR AUTHORIZATIONS - Effective immediately, please send PA-1 request forms to:

MassHealth
Attn: Prior Authorization
100 Hancock Street, 6th Floor
Quincy MA 02171

Some MassHealth Customer Service Center staff/positions and their direct contact information have changed. However, regular contact information remains the same: MassHealth CSC’s main phone number at 1-800-841-2900, the Provider Support mailbox at providersupport@mahealth.net and the EDI Support mailbox at edi@mahealth.net.

January 13, 2014EFT/ERA Operating Rule in Effect January 1, 2014

On January 1, 2014, MassHealth implemented the EFT/ERA Operating Rule in accordance with Section 1104 of the Administrative Simplification provisions of the ACA (Affordable Care Act).

Providers who enroll or modify an existing EFT arrangement on or after January 1, 2014 must complete the new EFT Enrollment/Modification Form, available at the MassHealth EFT web page. Go to www.mass.gov/masshealth, click on the Information for MassHealth Providers link, then Insurance (Including MassHealth), then MassHealth, then ACA, and then ACA Operating Rules.

Contact your financial institution to ensure it supports the new CCD+ Addenda file format used to transmit payment information.

Also effective January 1, 2014, providers who sign up to receive the 835 ERA (Electronic Remittance Advice) or modify the receiver of the 835 must complete the new ERA Enrollment Modification form, available on the MassHealth ACA Operating Rules Web page. Go to www.mass.gov/masshealth, click on the Information for MassHealth Providers link, then Insurance (Including MassHealth), then MassHealth, then ACA, and then ACA Operating Rules.

Providers can view the TRN (Re-association Trace Number) segment on the 835. MassHealth will continue to provide the voucher number and the invoice/remittance advice number to enable providers to re-associate the remittance and the payment. Providers may also view the new CARCs (Claims Adjust Reason Codes) and RARCs (Remittance Advice Remark Codes) on the 835.

For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

January 13, 2014New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from December 2013:

-Managed Care Organization Bulletin 3: Current Procedural Terminology (CPT) Codes and Payment to Providers for Behavioral Health Services
-All Provider Bulletin 240: Temporary Coverage for Applicants for Subsidized Health Insurance
-Nursing Facility Bulletin 137: Nursing Facility Pay for Performance Program for Fiscal Year 2014

Transmittal Letters from December 2013:

-AIH-49: Revisions to MassHealth Regulations-Affordable Care Act
-ALL-205: Revisions to Regulations for the Affordable Care Act
-AOH-31: Revisions to MassHealth Regulations-Affordable Care Act
-CHC-99: Revisions to MassHealth Regulations-Affordable Care Act
-CHC-98: 2013 HCPCS and Vaccine Codes
-FAS-27: Revisions to MassHealth Regulations-Affordable Care Act
-FPA-50: Revisions to MassHealth Regulations-Affordable Care Act
-HHA-49: Revisions to MassHealth Regulations-Affordable Care Act
-IDTF-13: Revisions to MassHealth Regulations-Affordable Care Act
-LAB-42: Revisions to MassHealth Regulations-Affordable Care Act
-PHM-60: Revisions to MassHealth Regulations-Affordable Care Act
-PHY-140: Revisions to MassHealth Regulations-Affordable Care Act
-PHY-139: 2013 HCPCS
-POD-70: Revisions to MassHealth Regulations-Affordable Care Act
-POD-69: 2013 HCPCS

You can download a copy of a Bulletin or Transmittal Letter from the online Provider Library (www.mass.gov/masshealthpubs).

Manage Provider Information

Date

Title

Comments

February 25, 2013Notification 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.

February 25, 2013Provider 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.

 

Important. Please Read MMIS Notices - Chronological Archive

Thank you in advance for your cooperation. If you have questions about any of these messages, please call 1-800-841-2900.


This information is provided by MassHealth .