MMIS Customer Service

Date

Title

Comments

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, 2014New 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, 2014Important 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, 2014Customer 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).

December 9, 2013Updated Community Health Center Rates

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

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

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

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

December 9, 2013Verification Testing/Sober Home Laboratory Requests

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

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

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

December 9, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from November 2013:

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

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

December 9, 2013Important Announcement - Provider Operations Changes

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

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

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

December 2, 2013Processing DelayDue to a processing delay this weekend, 835 payment files are delayed slightly and will be available for download on POSC on Tuesday Dec. 3, 2013. We apologize for any inconvenience.
November 18, 2013Home Health Advanced Beneficiary Notice Changes on December 9, 2013

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

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

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

November 18, 2013EFT/ERA Operating Rule Goes into Effect January 1, 2014

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

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

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

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

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

November 13, 2013Reminder: Bundling of Procedure Codes Not Allowed

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

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

November 13, 2013Reminder: MassHealth is the Payer of Last Resort

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

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

November 4, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from October 2013:

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

Transmittal Letters from October 2013:

  • ALL-204: Revised Appendix Y

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

October 21, 2013Attestation of Compliance Letter Mailing

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

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

October 21, 2013Reminder to Keep Provider Profile Information Up-to-Date

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

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

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

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

October 21, 2013Admission Dates are Required for Inpatient Claims

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

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

October 18, 2013System MaintenanceThe MMIS POSC, including the internal MMIS application, MAPIR (Medical Assistance Provider Incentive Repository), AVR, IVR, EVS, and all eligibility services will be unavailable Sunday 10/20/2013 from 4:00 AM until 7:00 AM due to system maintenance. MAP and CBHI will also be impacted. We apologize for any inconvenience this may cause. If you have any questions please contact the EHS Customer Support Center at 617-367-5500 or email SystemsSupporthelpdesk@Massmail.state.ma.us.
October 7, 2013All Providers – Billing for Services to Members Enrolled in Hospice

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

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

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

October 7, 2013Third Party Claims – Other Insurer Remittance Dates Required

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

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

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

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

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

October 7, 2013Out-of-State Hospital Providers – Notice of Rate Update

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

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

October 7, 2013New MassHealth  Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from September 2013:

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

Transmittal Letters from September 2013:

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

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

September 30, 2013Available October, 2013: Viewing Voids and Adjustments on the 835

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

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

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

September 16, 2013Chronic Disease and Rehabilitation Outpatient Crossover DenialsMassHealth has reprocessed Chronic Disease and Rehabilitation Outpatient Crossover claims with adjudication dates from 5/26/2009 through 5/21/2013 that denied in error for Edit 4801- PROCEDURE NOT COVERED BY PROVIDER CONTRACT. These reprocessed claims will appear on a future remittance advice. For questions, please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.
September 9, 2013GAFC Claims Suspended for Edit 4014MassHealth has identified an error in MMIS that caused several GAFC claims billed with service code H0043 to suspend for Edit 4014-NO PRICING SEGMENT ON FILE. This issue is being corrected and those claims currently in suspense should be released on the following week’s pay cycle. MassHealth apologizes for any inconvenience. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
September 9, 2013DME, Oxygen & Respiratory Operating Standards for Prior Authorization

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

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

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

September 9, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from August 2013:

-All Provider Bulletin 236: Payment for Vaccine Administration and Office Visit

-All Provider Bulletin 235: Section 1202 Rates for Physicians Who Provide Primary Care Services

-Hospice Bulletin 10: Changes to MassHealth Coverage Types

-School-Based Medicaid Bulletin 25: Parental Authorization to Share Information with MassHealth

Transmittal Letters from August 2013:

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

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

September 4, 2013Health Safety Net (HSN) NCCI Claim Denials Have Been Reprocessed

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

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

These claims may appear on this remittance advice or a future remittance advice. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

September 4, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from July 2013:

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

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

August 20, 2013Independent Nurses-Plan of Care Requirements

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

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

August 20, 2013Nursing Facility Hospice Day of Discharge Billing Clarification

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

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

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

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

August 14, 2013Monthly MMQ Submission ReminderNursing Facility providers are reminded: you must submit your monthly MMQs (Management Minute Questionnaires) no later than the 15th of every month. If you have questions about your MMQ submission, please contact MassHealth Customer Service for assistance at providersupport@mahealth.net or call 800-841-2900. Your issues and inquiries will be properly triaged for review and resolution.
August 6, 2013Available this Fall: Viewing Voids and Adjustments on the 835MassHealth providers will soon be able to view voids and adjustments on the 835 at both the detail line level and the header level. The level of detail of the voids and adjustments will be based upon the level of detail of the original payment. Please ensure that your systems and your business operations are able to support this change. Providers interested in testing the new recoupment modifications can do so by contacting the EDI team at 1-800-841-2900 or edi@mahealth.net.
August 6, 2013Nursing Home MMQ IssuesNursing Home providers are reminded: if you have questions or issues with MMQs (Management Minute Questionnaires), please contact MassHealth Customer Service for assistance at providersupport@mahealth.net or call 800-841-2900. Your issues/inquiries will be properly triaged for review and resolution.
August 6, 2013Nurse Practitioner and Nurse Midwife Claims AdjustmentsDue to a systems issue, some claims for Nurse Practitioners and Nurse Midwives were paid incorrectly. The original claims were either underpaid or overpaid and are being adjusted to reflect the correct payment. The adjustments may appear on this remittance advice or a future remittance advice. For questions, please contact Customer Service at providersupport@masshealth.net or 800-841-2900.
August 6, 2013Medicare Part B Denied Services That Require Manual Pricing

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

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

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

July 22, 2013Crossover Claims Missing Medicare Carrier

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

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

July 22, 2013Nursing Facility Claims Denied for Edit 2557-Potential Private Insurance in First 100 Days

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

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

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

July 16, 2013

Crossover Claims Missing Medicare Carrier

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

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

July 16, 2013Nursing Facility Claims Denied for Edit 2557-Potential Private Insurance in First 100 Days

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

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

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

July 16, 2013Hospice Claims Denying for Edit 5930 - MUE Units Exceeded

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

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

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

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

July 16, 2013Certain Hospice Claims Deny Due to Conflict with NCCI

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

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

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

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

July 1, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from June 2013:

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

Transmittal Letters from June 2013:

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

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

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

June 24, 2013Adjustments for ACA Section 1202 Rates for Physicians who Provide Primary Care Services

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

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

To submit changes through the POSC, go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

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

June 24, 2013Reminder to Group Providers - Rendering Provider NPI Must be Affiliated with Group

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

To submit provider profile changes through the Provider Online Service Center (POSC), go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

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

June 24, 2013Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Wednesday, July 17, 2013
Time: 3:00-4:00 pm ET

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002. This is one of five PERM Provider Webinar/Conference calls during PERM Cycle 2 (2013), hosted by the Centers for Medicare & Medicaid Services (CMS).

As a webinar participant, you will learn about:

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

To join the Webinar:
Audio: 1-877-267-1577, Meeting ID# 4964
Webinar: https://webinar.cms.hhs.gov/permcycle2web5/

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

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

June 24, 2013Claims Suspended for Edit 819 – Paper Claim Submission under ReviewTherapy providers are reminded: you must submit all claims electronically unless you have been approved for an electronic claim submission waiver. Paper claims will suspend for edit 819-PAPER CLAIM SUBMISSION UNDER REVIEW. If an electronic claim submission waiver form is not submitted and approved within thirty (30) days of the suspended claims, the paper claims will be denied with edit 7750-PAPER CLAIM NOT ALLOWED. Please refer to All Provider Bulletin 223 dated February 2012 at www.mass.gov/masshealthpubs for further instructions. For questions, contact Customer Service at providersupport@masshealth.net or 800-841-2900.
June 17, 2013Clinical Review of Acute Inpatient Claims for Edit 2614

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

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

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

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

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

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

June 10, 2013Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Tuesday, June 18, 2013
Time: 3:00-4:00 p.m. ET
 M

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002. This is the third of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2013), hosted by the Centers for Medicare & Medicaid Services (CMS).

As a webinar participant, you will learn about:

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

To join the Webinar:
Audio: 1-877-267-1577, Meeting ID# 4964
Webinar: https://webinar.cms.hhs.gov/permcycle2web3/

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

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

June 3, 2013Attention Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

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

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

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

-If you have a waiver to submit paper claims, you should continue to submit claims at this time, as they will be scanned during the downtime and will enter the system on June 24th.

-You may submit prior authorizations via paper during this period.  They will move through the regular process, although determination letters will not go out during this period.

-You may still use the Web Portal during this time to view eligibility, remittance information, status of claims and prior authorizations.

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

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

June 3, 2013Provider Profile Maintenance for Group Practices

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

To submit changes through the POSC, go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

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

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

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

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

June 3, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from May 2013:

-All Provider Bulletin 234: Predictive Modeling Initiative

-Dental Bulletin 42: New Claims Processing System and Web Portal Preparation for MassHealth Dental Providers Who Bill Current Dental Terminology (CDT) Service Codes   

Transmittal Letters from May 2013:

-ALL-200: Emergency Adoption of Mental Health Parity Regulations  

-AOH-30: New Modifiers for National Correct Coding Initiative  

-CHC-97: New Modifiers for National Correct Coding Initiatives  

-FPA-48: New Modifiers for National Correct Coding Initiatives  

-PHY-138: New Modifiers for National Correct Coding Initiatives  

-POD-68: New Modifiers for National Correct Coding Initiatives  

-SAT-17: 2013 HCPCS  

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

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

May 29, 2013Chronic Disease and Rehabilitation Outpatient Crossover DenialsMassHealth has resolved an issue that was causing Medicare crossover claims submitted by Chronic Disease and Rehabilitation outpatient hospitals to deny for edit 4801 - PROCEDURE NOT COVERED BY PROVIDER CONTRACT. Medicare crossovers processed after 05/22/2013 will no longer deny for this edit. MassHealth plans to reprocess the previously denied crossovers on a future remittance advice. However, providers may resubmit denied crossovers at this time. For questions, please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.
May 29, 2013Non-Group Providers Billing With a Rendering NPI

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

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

May 20, 2013MassHealth Timeframes for Bill Paying for Nursing Facility Providers

MassHealth will be modifying the timeframes for paying Nursing Facility claims for May dates of service received by MassHealth in May or June. The payment schedule will be modified by approximately 2 weeks. Below outlines the modified payment schedule.

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

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

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

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

May 17, 2013System Maintenance

The MMIS POSC, including the internal MMIS application, Voice Response application, EVSpc, MAPIR (Medical Assistance Provider Incentive Repository), and all eligibility services will be unavailable from 4:00 am to 7:00 am Sunday, 5/19, due to system maintenance.

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

May 13, 2013Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Tuesday, May 21, 2013
Time: 3:00-4:00 pm ET

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002. This is one of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2013), hosted by the Centers for Medicare & Medicaid Services (CMS).

Webinar participants will learn about:

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

To join the Webinar:

Audio: 1-877-267-1577, Meeting ID# 4964

Webinar: https://webinar.cms.hhs.gov/permcycle2web1/

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

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

May 6, 2013Adult Day Health Retroactive Rate IncreaseThis remittance advice (RA) may contain adjusted claims due to a retroactive rate increase. If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
May 6, 2013Claims Reprocessed – Edit 4801 – Procedure Not Covered by Provider Contract

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

 

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

May 6, 2013Transportation Providers – Billing with Invalid Modifiers

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

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

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

May 6, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from April 2013:

-Acute Inpatient Hospital Bulletin 147: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility

-Community Health Center Bulletin 75: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility

-Long-Term Care Facility Bulletin 107: Annual Accounting for Personal Needs Account (PNA) Funds

-Nursing Facility Bulletin 136: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility

-School-Based Medicaid Bulletin 23: Claiming Medicaid Reimbursement for Students Placed in the Judge Rotenberg Center

Transmittal Letters from April 2013:

-AIH-48: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-CHC-96: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-CDR-28: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-MHC-45: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-NF-59: Revised Appendix G - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-PIH-21: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

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

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

April 29, 2013Hospice Election Form Reminder

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

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

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

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

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

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

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

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

April 29, 2013Hospice Providers – Eligibility Verification System (EVS)

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

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

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

April 29, 2013

Independent Nurses – Billing Weekend Nursing Services

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

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

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

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

April 23, 2013Adult Day Health Retroactive Rate IncreaseThis remittance advice (RA) may contain adjusted claims due to a retroactive rate increase.  If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
April 17, 2013Deadline Extended on Health Safety Net Billing Waiver ExtensionThe Health Safety Net (HSN) has further extended the billing waiver for submission of HSN 837I and 837P claims to MMIS from April 30 to June 30, 2013. Providers should note that, effective July 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.
April 17, 2013Attention MassHealth Providers

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

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

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

(B) Serious impairment to bodily functions, or

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

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

April 8, 2013Edit 4038 – Claims AdjustmentsA recently identified system issue resulted in erroneous payments for certain claims.  This remittance advice may contain adjusted claims where line items are denied for Edit 4038 as a result of the erroneous payments. If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
April 1, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from March 2013:

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

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

-FAS-26: 2013 HCPCS

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

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

April 1, 2013Health Safety Net Billing Waiver ExtensionThe Health Safety Net (HSN) has extended the billing waiver for submission of HSN 837I and 837P claims to MMIS through April 30, 2013. Providers should note that, effective May 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.
April 1, 2013Attention Dental Providers

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

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

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

(B) Serious impairment to bodily functions, or

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

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

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

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

April 1, 2013Billing Reminder for Therapy Providers: Modifier HA is Required for Services Codes 97001, 97003, and 92506 for Members Age 21 and Under

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

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

March 18, 2013ACA Section 1202 Rates for Physicians Who Provide Primary Care Services

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

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

March 18, 2013Early Intervention Service Code T1024 Denials for Edit 8155

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

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

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

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

March 18, 2013Updated Hospice Rates

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

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

March 18, 2013New MassHealth Publication Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from February 2013:

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

Transmittal Letters from February 2013:

-ALL-197: Revised Appendix C

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

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

February 25, 2013Health Safety Net Billing Waiver ExtensionThe Health Safety Net (HSN) has extended the billing waiver for submission of HSN 837I and 837P claims to MMIS through April 30, 2013. Providers should note that, effective May 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.
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 13, 2013To all Health Safety Net (HSN) ProvidersPlease note that weekly maintenance of the HSN eligibility web service occurs on Sundays between 4:00 p.m. – 7:00 p.m. EST. HSN claims should not be submitted to the POSC during this time. Claims submitted during this time may be suspended or denied for eligibility. Questions should be directed to the HSN Help Desk at (800) 609-7232 or hsnhelpdesk@state.ma.us. Thank you.
February 1, 2013Billing for Influenza Vaccine – Notice for Physicians, Group Practices and Independent Nursing Practitioners

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

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

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

February 1, 2013Billing for Influenza Vaccine – Notice for Community Health Centers

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

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

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

February 1, 2013Billing for Influenza Vaccine – Notice for Limited Services Clinics

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

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

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

February 1, 2013Notice to Providers Submitting Direct Data Entry (DDE) Claims Using Delay Reason Code 11

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

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

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

January 14, 2013Substance Abuse Service Code H0020 Denials for Edit 5930

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

The new codes allowed for counseling are:

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

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

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

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

Providers who have denied claims with service code H0020 due to the MUE quarterly update must resubmit their claims using the new substance abuse counseling codes and modifiers. Updates to subchapter 6 of the Provider Manual are forthcoming. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.

January 14, 2012Chronic Disease and Rehabilitation Hospital UMP Post-Payment Reviews

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

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

January 14, 2012New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from December 2012

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

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

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

January 3, 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.

January 3, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from December 2012

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

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

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

December 24, 20122012 Preventive Care Guidelines  and Immunization Schedules Now Available

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

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

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

December 24, 2012Important Message for Group Practice Providers Submitting Medicare Crossover Part B Claims

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

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

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

December 24, 2012New NCCI Modifiers

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

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

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

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

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

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

December 17, 2012

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

 

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

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

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

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

December 17, 2012TPL Edits Setting on Nursing Home Claims

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

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

December 17, 2012Multiple Payer Non-Covered AmountsMassHealth has resolved an issue with some TPL exception claims that were incorrectly denying for other insurance with Edit Code 2502 - MEMBER COVERED BY OTHER INSURANCE or Edit 2505 – MEMBER COVERED BY MEDICARE when there are multiple payers reported on the claim and one of the payers has a total non-covered amount. The issue was resolved on 12/02/12 and the affected claims will be reprocessed on future remittances. Providers may also re-submit the affected claims to MassHealth. For any questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
December 17, 2012New Edit Setting on Medicare Part B Denied ServicesMassHealth implemented a new edit, 410 – MEDICARE DENIAL ON CROSSOVER CLAIM, on 12/02/12 for certain Part B crossover claim lines when Medicare has denied the service. Claims denied for Edit 410 may be resubmitted to MassHealth, including the COB adjudication details and any other required documentation, if Medicare has denied the claim for reasons other than a correctable error. For any questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
December 11, 2012Coordination of Benefits (COB) - Direct Data Entry (DDE) Enhancements on the POSC

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

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

-Subscriber Last Name

-Subscriber First Name

-Subscriber Address

-Subscriber City

-Subscriber State

-Subscriber Zip Code

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

-Carrier Code (if multiple carrier codes have been entered from the “Coordination of Benefits” tab, there will be a drop down to select the appropriate carrier code)

-Paid Units of Service

-Revenue Code (applies to Institutional claims)

-Procedure Code

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

December 11, 2012Vision Care CPT Code 92340- MUE EDIT

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

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

December 11, 2012Procedure Code Changes for Mental Health Centers

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

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

New psychiatric codes covered for Mental Health Centers include:

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

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

December 11, 2012Early Intervention Service Code T1015 Denials for Edit 5930

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

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

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

December 3, 2012

New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from November 2012

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

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

 Fiscal Year (FY) 2013  

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

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

December 3, 2012Prior Authorization Requests

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

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

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

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

November 13, 2012ICD-10 Provider SurveyIn an effort to help providers meet the ICD-10 compliance date of October 1, 2014, MassHealth and other Massachusetts health plans have collaborated to issue a second online ICD-10 provider survey. The survey will help to assess statewide compliance efforts underway, provider testing strategies, and will be used to identify resources to aid providers in their ICD-10 preparations.  Please complete this brief survey, located at: https://www.surveymonkey.com/s/HCAS_ICD10_Survey by December 1, 2012.   Since only one survey should be submitted per organization, please be sure to forward this survey request to the individual(s) that are responsible for the ICD-10 implementation effort within your organization.
November 13, 2012Notification of Change RequirementsIn accordance with MassHealth regulation, 130 CMR 450.223(B), providers are reminded that they must notify MassHealth in writing within 14 days of any change in any information submitted in their application, including, but not limited to, changes in ownership or control, criminal convictions, or license status. Failure to notify MassHealth constitutes a breach of the provider contract and may result in termination of the provider contract or other sanctions. The absence of notification constitutes confirmation of no changes. Any changes must be submitted to MassHealth. To submit changes through the Provider Online Service Center (POSC), go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile, and then on Update Your MassHealth Profile. Providers without Internet access may submit changes to Provider Enrollment and Credentialing, PO Box 9118, Hingham, MA 02043.
November 5, 2012New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from October 2012

- FPA-47: 2012 HCPCS

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

- PRT-24: Changes to MassHealth Prosthetic Regulations

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

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

October 24, 2012Outpatient Claims Suspended for Edit 829

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

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

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

October 24, 2012New MassHealth Publications Posted on the Web

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

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from September 2012

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

Provider Bulletins for September 2012

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

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

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

October 9, 2012ADMISSION HOUR REQUIRED FOR ACUTE OUTPATIENT HOSPITAL CLAIMSIt is important that all acute outpatient hospital claims are submitted with the admission hour. This information is necessary for MMIS to determine whether another claim, billed for the same date of service for the same member, is valid or a duplicate claim. If no admission hour is entered on the claim, subsequent claims for the same member on the same date of service could be denied.
October 9, 2012REMINDER TO PREVENT CLAIMS FROM DENYING FOR EDIT CODE 2502: MEMBER COVERED BY OTHER INSURANCE

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

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

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

October 9, 2012REMINDER ABOUT GLOBAL SURGERY EDITS

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

8175 – SERVICE PROVIDED ON THE SAME DAY OF A GLOBAL SURGICAL PROCEDURE IS INCLUDED IN FEE AMOUNT

8176 – SERVICE PROVIDED ON THE DAY OF AND DURING 10-DAY GLOBAL SURGICAL PROCEDURE INCLUDED

8177 – SERVICE PROVIDED DAY BEFORE AND DURING 90-DAY GLOBAL SURGICAL PROCEDURE INCLUDED

8253 – VISIT AND SURGERY NOT ALLOWED SAME DAY/SAME POS

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

October 9, 2012NEW MASSHEALTH PUBLICATIONS POSTED ON THE WEB

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from September 2012

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

Provider Bulletins for September 2012
-Home Health Agency Bulletin 48: Introduction of the New Homebound Assessment Form
-Psychiatric Inpatient Hospital Bulletin 23: Annual Accounting of Personal Needs Allowances

Manage Claims and Payments

Date

Title

Comments

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, 2014Important 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, 2014New 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, 2014Important 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, 2014Customer 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, 2014

System Maintenance

The MMIS POSC, including the internal MMIS application,  MAPIR, AVR, IVR, EVS, and all eligibility services will be unavailable Sunday 2/23/2014 from 4:00 AM until 7:00 AM due to system maintenance. MAP and CBHI will also be unavailable.

We apologize for any inconvenience this may cause.  If you have any questions please contact the EHS Customer Support Center at 617-994-5050 or email SystemsSupporthelpdesk@state.ma.us.  For provider questions regarding this outage, please contact the Virtual Gateway customer service line at 1-800-421-0938.

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).

December 9, 2013Updated Community Health Center Rates

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

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

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

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

December 9, 2013Verification Testing/Sober Home Laboratory Requests

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

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

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

December 9, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from November 2013:

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

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

December 9, 2013Important Announcement - Provider Operations Changes

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

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

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

November 18, 2013Home Health Advanced Beneficiary Notice Changes on December 9, 2013

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

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

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

November 18, 2013EFT/ERA Operating Rule Goes into Effect January 1, 2014

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

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

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

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

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

November 13, 2013Reminder: Bundling of Procedure Codes Not Allowed

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

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

November 13, 2013Reminder: MassHealth is the Payer of Last Resort

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

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

November 4, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from October 2013:

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

Transmittal Letters from October 2013:

  • ALL-204: Revised Appendix Y

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

October 21, 2013Attestation of Compliance Letter Mailing

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

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

October 21, 2013Reminder to Keep Provider Profile Information Up-to-Date

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

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

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

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

October 21, 2013Admission Dates are Required for Inpatient Claims

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

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

October 7, 2013All Providers – Billing for Services to Members Enrolled in Hospice

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

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

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

October 7, 2013Third Party Claims – Other Insurer Remittance Dates Required

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

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

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

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

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

October 7, 2013Out-of-State Hospital Providers – Notice of Rate Update

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

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

October 7, 2013New MassHealth  Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from September 2013:

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

Transmittal Letters from September 2013:

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

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

September 30, 2013Available October, 2013: Viewing Voids and Adjustments on the 835

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

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

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

September 16, 2013Chronic Disease and Rehabilitation Outpatient Crossover DenialsMassHealth has reprocessed Chronic Disease and Rehabilitation Outpatient Crossover claims with adjudication dates from 5/26/2009 through 5/21/2013 that denied in error for Edit 4801- PROCEDURE NOT COVERED BY PROVIDER CONTRACT. These reprocessed claims will appear on a future remittance advice. For questions, please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.
September 9, 2013GAFC Claims Suspended for Edit 4014MassHealth has identified an error in MMIS that caused several GAFC claims billed with service code H0043 to suspend for Edit 4014-NO PRICING SEGMENT ON FILE. This issue is being corrected and those claims currently in suspense should be released on the following week’s pay cycle. MassHealth apologizes for any inconvenience. For questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
September 9, 2013DME, Oxygen & Respiratory Operating Standards for Prior Authorization

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

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

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

September 9, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from August 2013:

-All Provider Bulletin 236: Payment for Vaccine Administration and Office Visit

-All Provider Bulletin 235: Section 1202 Rates for Physicians Who Provide Primary Care Services

-Hospice Bulletin 10: Changes to MassHealth Coverage Types

-School-Based Medicaid Bulletin 25: Parental Authorization to Share Information with MassHealth

Transmittal Letters from August 2013:

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

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

September 4, 2013Health Safety Net (HSN) NCCI Claim Denials Have Been Reprocessed

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

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

These claims may appear on this remittance advice or a future remittance advice. For questions, please contact MassHealth Customer Service at 1-800-841-2900 or providersupport@mahealth.net.

September 4, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from July 2013:

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

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

August 20, 2013Independent Nurses-Plan of Care Requirements

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

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

August 20, 2013Nursing Facility Hospice Day of Discharge Billing Clarification

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

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

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

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

August 14, 2013Monthly MMQ Submission ReminderNursing Facility providers are reminded: you must submit your monthly MMQs (Management Minute Questionnaires) no later than the 15th of every month. If you have questions about your MMQ submission, please contact MassHealth Customer Service for assistance at providersupport@mahealth.net or call 800-841-2900. Your issues and inquiries will be properly triaged for review and resolution.
August 14, 2013Monthly MMQ Submission ReminderNursing Facility providers are reminded: you must submit your monthly MMQs (Management Minute Questionnaires) no later than the 15th of every month. If you have questions about your MMQ submission, please contact MassHealth Customer Service for assistance at providersupport@mahealth.net or call 800-841-2900. Your issues and inquiries will be properly triaged for review and resolution.
August 6, 2013Available this Fall: Viewing Voids and Adjustments on the 835MassHealth providers will soon be able to view voids and adjustments on the 835 at both the detail line level and the header level. The level of detail of the voids and adjustments will be based upon the level of detail of the original payment. Please ensure that your systems and your business operations are able to support this change. Providers interested in testing the new recoupment modifications can do so by contacting the EDI team at 1-800-841-2900 or edi@mahealth.net.
August 6, 2013Nursing Home MMQ IssuesNursing Home providers are reminded: if you have questions or issues with MMQs (Management Minute Questionnaires), please contact MassHealth Customer Service for assistance at providersupport@mahealth.net or call 800-841-2900. Your issues/inquiries will be properly triaged for review and resolution.
August 6, 2013Nurse Practitioner and Nurse Midwife Claims AdjustmentsDue to a systems issue, some claims for Nurse Practitioners and Nurse Midwives were paid incorrectly. The original claims were either underpaid or overpaid and are being adjusted to reflect the correct payment. The adjustments may appear on this remittance advice or a future remittance advice. For questions, please contact Customer Service at providersupport@masshealth.net or 800-841-2900.
August 6, 2013Medicare Part B Denied Services That Require Manual Pricing

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

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

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

July 22, 2013Crossover Claims Missing Medicare Carrier

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

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

July 22, 2013Nursing Facility Claims Denied for Edit 2557-Potential Private Insurance in First 100 Days

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

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

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

July 16, 2013Hospice Claims Denying for Edit 5930 - MUE Units Exceeded

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

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

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

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

July 16, 2013Certain Hospice Claims Deny Due to Conflict with NCCI

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

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

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

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

July 1, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from June 2013:

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

Transmittal Letters from June 2013:

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

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

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

June 24, 2013Adjustments for ACA Section 1202 Rates for Physicians who Provide Primary Care Services

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

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

To submit changes through the POSC, go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

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

June 24, 2013Reminder to Group Providers - Rendering Provider NPI Must be Affiliated with Group

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

To submit provider profile changes through the Provider Online Service Center (POSC), go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

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

June 24, 2013Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Wednesday, July 17, 2013
Time: 3:00-4:00 pm ET

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002. This is one of five PERM Provider Webinar/Conference calls during PERM Cycle 2 (2013), hosted by the Centers for Medicare & Medicaid Services (CMS).

As a webinar participant, you will learn about:

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

To join the Webinar:
Audio: 1-877-267-1577, Meeting ID# 4964
Webinar: https://webinar.cms.hhs.gov/permcycle2web5/

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

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

June 24, 2013Claims Suspended for Edit 819 – Paper Claim Submission under ReviewTherapy providers are reminded: you must submit all claims electronically unless you have been approved for an electronic claim submission waiver. Paper claims will suspend for edit 819-PAPER CLAIM SUBMISSION UNDER REVIEW. If an electronic claim submission waiver form is not submitted and approved within thirty (30) days of the suspended claims, the paper claims will be denied with edit 7750-PAPER CLAIM NOT ALLOWED. Please refer to All Provider Bulletin 223 dated February 2012 at www.mass.gov/masshealthpubs for further instructions. For questions, contact Customer Service at providersupport@masshealth.net or 800-841-2900.
June 17, 2013Clinical Review of Acute Inpatient Claims for Edit 2614

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

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

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

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

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

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

June 10, 2013Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Tuesday, June 18, 2013
Time: 3:00-4:00 p.m. ET
 

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002. This is the third of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2013), hosted by the Centers for Medicare & Medicaid Services (CMS).

As a webinar participant, you will learn about:

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

To join the Webinar:
Audio: 1-877-267-1577, Meeting ID# 4964
Webinar: https://webinar.cms.hhs.gov/permcycle2web3/

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

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

June 3, 2013Attention Dental Providers Who Use CDT Service Codes and Submit Claims to DentaQuest

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

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

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

-If you have a waiver to submit paper claims, you should continue to submit claims at this time, as they will be scanned during the downtime and will enter the system on June 24th.

-You may submit prior authorizations via paper during this period.  They will move through the regular process, although determination letters will not go out during this period.

-You may still use the Web Portal during this time to view eligibility, remittance information, status of claims and prior authorizations.

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

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

June 3, 2013Provider Profile Maintenance for Group Practices

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

To submit changes through the POSC, go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

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

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

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

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

June 3, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from May 2013:

-All Provider Bulletin 234: Predictive Modeling Initiative

-Dental Bulletin 42: New Claims Processing System and Web Portal Preparation for MassHealth Dental Providers Who Bill Current Dental Terminology (CDT) Service Codes   

Transmittal Letters from May 2013:

-ALL-200: Emergency Adoption of Mental Health Parity Regulations  

-AOH-30: New Modifiers for National Correct Coding Initiative  

-CHC-97: New Modifiers for National Correct Coding Initiatives  

-FPA-48: New Modifiers for National Correct Coding Initiatives  

-PHY-138: New Modifiers for National Correct Coding Initiatives  

-POD-68: New Modifiers for National Correct Coding Initiatives  

-SAT-17: 2013 HCPCS  

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

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

May 29, 2013Chronic Disease and Rehabilitation Outpatient Crossover DenialsMassHealth has resolved an issue that was causing Medicare crossover claims submitted by Chronic Disease and Rehabilitation outpatient hospitals to deny for edit 4801 - PROCEDURE NOT COVERED BY PROVIDER CONTRACT. Medicare crossovers processed after 05/22/2013 will no longer deny for this edit. MassHealth plans to reprocess the previously denied crossovers on a future remittance advice. However, providers may resubmit denied crossovers at this time. For questions, please contact MassHealth Customer Service at providersupport@mahealthnet or 1-800-841-2900.
May 29, 2013Non-Group Providers Billing With a Rendering NPI

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

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

May 20, 2013MassHealth Timeframes for Bill Paying for Nursing Facility Providers

MassHealth will be modifying the timeframes for paying Nursing Facility claims for May dates of service received by MassHealth in May or June. The payment schedule will be modified by approximately 2 weeks. Below outlines the modified payment schedule.

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

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

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

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

May 17, 2013System Maintenance

The MMIS POSC, including the internal MMIS application, Voice Response application, EVSpc, MAPIR (Medical Assistance Provider Incentive Repository), and all eligibility services will be unavailable from 4:00 am to 7:00 am Sunday, 5/19, due to system maintenance.

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

May 17, 2013System Maintenance

The MMIS POSC, including the internal MMIS application, Voice Response application, EVSpc, MAPIR (Medical Assistance Provider Incentive Repository), and all eligibility services will be unavailable from 4:00 am to 7:00 am Sunday, 5/19, due to system maintenance.

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

May 13, 2012Webinar Notice to Providers

Event: Payment Error Rate Measurement (PERM) Provider Education Webinar
Date: Tuesday, May 21, 2013
Time: 3:00-4:00 pm ET

The PERM program is designed to measure improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs, as required by the Improper Payments Information Act (IPIA) of 2002. This is one of four PERM Provider Webinar/Conference calls during PERM Cycle 2 (2013), hosted by the Centers for Medicare & Medicaid Services (CMS).

Webinar participants will learn about:

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

To join the Webinar:

Audio: 1-877-267-1577, Meeting ID# 4964

Webinar: https://webinar.cms.hhs.gov/permcycle2web1/

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

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

May 6, 2013Adult Day Health Retroactive Rate IncreaseThis remittance advice (RA) may contain adjusted claims due to a retroactive rate increase. If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
May 6, 2013Claims Reprocessed – Edit 4801 – Procedure Not Covered by Provider Contract

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

 

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

May 6, 2013Transportation Providers – Billing with Invalid Modifiers

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

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

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

May 6, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from April 2013:

-Acute Inpatient Hospital Bulletin 147: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility

-Community Health Center Bulletin 75: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility

-Long-Term Care Facility Bulletin 107: Annual Accounting for Personal Needs Account (PNA) Funds

-Nursing Facility Bulletin 136: Centralization of Receipt of Senior Medical Benefit Request Forms for Individuals Residing in and Entering a Long-Term-Care Facility

-School-Based Medicaid Bulletin 23: Claiming Medicaid Reimbursement for Students Placed in the Judge Rotenberg Center

Transmittal Letters from April 2013:

-AIH-48: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-CHC-96: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-CDR-28: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-MHC-45: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-NF-59: Revised Appendix G - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

-PIH-21: Revised Appendix D - Coordination of Benefits Direct Data Entry Enhancements for the Provider Online Service Center

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

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

April 29, 2013Hospice Election Form Reminder

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

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

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

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

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

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

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

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

April 29, 2013Hospice Providers – Eligibility Verification System (EVS)

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

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

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

April 29, 2013

Independent Nurses – Billing Weekend Nursing Services

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

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

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

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

April 29, 2013Hospice Election Form Reminder

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

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

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

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

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

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

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

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

April 29, 2013Hospice Providers – Eligibility Verification System (EVS)

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

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

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

April 29, 2013

Independent Nurses – Billing Weekend Nursing Services

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

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

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

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

 

April 23, 2013Adult Day Health Retroactive Rate IncreaseThis remittance advice (RA) may contain adjusted claims due to a retroactive rate increase.  If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
April 17, 2013Deadline Extended on Health Safety Net Billing Waiver ExtensionThe Health Safety Net (HSN) has further extended the billing waiver for submission of HSN 837I and 837P claims to MMIS from April 30 to June 30, 2013. Providers should note that, effective July 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.
April 17, 2013Attention MassHealth Providers

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

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

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

(B) Serious impairment to bodily functions, or

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

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

April 8, 2013Edit 4038 – Claims AdjustmentsA recently identified system issue resulted in erroneous payments for certain claims.  This remittance advice may contain adjusted claims where line items are denied for Edit 4038 as a result of the erroneous payments. If you have any questions pertaining to these adjustments, please contact MassHealth Customer Service at providersupport@mahealth.net or call 1-800-841-2900.
April 1, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Transmittal Letters from March 2013:

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

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

-FAS-26: 2013 HCPCS

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

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

April 1, 2013Health Safety Net Billing Waiver ExtensionThe Health Safety Net (HSN) has extended the billing waiver for submission of HSN 837I and 837P claims to MMIS through April 30, 2013. Providers should note that, effective May 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.
April 1, 2013Attention Dental Providers

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

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

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

(B) Serious impairment to bodily functions, or

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

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

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

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

April 1, 2013Billing Reminder for Therapy Providers: Modifier HA is Required for Services Codes 97001, 97003, and 92506 for Members Age 21 and Under

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

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

March 18, 2013ACA Section 1202 Rates for Physicians Who Provide Primary Care Services

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

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

March 18, 2013Early Intervention Service Code T1024 Denials for Edit 8155

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

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

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

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

March 18, 2013Updated Hospice Rates

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

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

March 18, 2013New MassHealth Publication Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from February 2013:

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

Transmittal Letters from February 2013:

-ALL-197: Revised Appendix C

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

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

February 25, 2013Health Safety Net Billing Waiver ExtensionThe Health Safety Net (HSN) has extended the billing waiver for submission of HSN 837I and 837P claims to MMIS through April 30, 2013. Providers should note that, effective May 01, 2013, this billing waiver extension will expire and timely filing edits will be activated. For questions regarding this extension, contact Tony Sousa, HSN Operations Manager at 617-988-3162.
February 1, 2013Billing for Influenza Vaccine – Notice for Physicians, Group Practices and Independent Nursing Practitioners

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

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

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

February 1, 2013Billing for Influenza Vaccine – Notice for Community Health Centers

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

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

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

February 1, 2013Billing for Influenza Vaccine – Notice for Limited Services Clinics

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

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

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

February 1, 2013Notice to Providers Submitting Direct Data Entry (DDE) Claims Using Delay Reason Code 11

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

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

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

January 3, 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.

January 3, 2013New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from December 2012

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

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

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

December 24, 20122012 Preventive Care Guidelines  and Immunization Schedules Now Available

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

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

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

December 24, 2012Important Message for Group Practice Providers Submitting Medicare Crossover Part B Claims

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

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

December 24, 2012New NCCI Modifiers

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

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

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

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

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

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

December 17, 2012Important Message about Third Party Liability Claims for Qualified Medical Beneficiaries (QMB) Members with Medicare Advantage Plans

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

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

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

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

December 17, 2012TPL Edits Setting on Nursing Home Claims

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

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

December 17, 2012Multiple Payer Non-Covered AmountsMassHealth has resolved an issue with some TPL exception claims that were incorrectly denying for other insurance with Edit Code 2502 - MEMBER COVERED BY OTHER INSURANCE or Edit 2505 – MEMBER COVERED BY MEDICARE when there are multiple payers reported on the claim and one of the payers has a total non-covered amount. The issue was resolved on 12/02/12 and the affected claims will be reprocessed on future remittances. Providers may also re-submit the affected claims to MassHealth. For any questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
December 17, 2012New Edit Setting on Medicare Part B Denied ServicesMassHealth implemented a new edit, 410 – MEDICARE DENIAL ON CROSSOVER CLAIM, on 12/02/12 for certain Part B crossover claim lines when Medicare has denied the service. Claims denied for Edit 410 may be resubmitted to MassHealth, including the COB adjudication details and any other required documentation, if Medicare has denied the claim for reasons other than a correctable error. For any questions, please contact MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.
December 11, 2012Coordination of Benefits (COB) - Direct Data Entry (DDE) Enhancements on the POSC

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

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

-Subscriber Last Name

-Subscriber First Name

-Subscriber Address

-Subscriber City

-Subscriber State

-Subscriber Zip Code

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

-Carrier Code (if multiple carrier codes have been entered from the “Coordination of Benefits” tab, there will be a drop down to select the appropriate carrier code)

-Paid Units of Service

-Revenue Code (applies to Institutional claims)

-Procedure Code

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

December 11, 2012Vision Care CPT Code 92340- MUE EDIT

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

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

December 11, 2012Procedure Code Changes for Mental Health Centers

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

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

New psychiatric codes covered for Mental Health Centers include:

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

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

December 11, 2012Early Intervention Service Code T1015 Denials for Edit 5930

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

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

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

December 3, 2012New MassHealth Publications Posted on the Web

MassHealth has posted the following publications on the MassHealth website:

Provider Bulletins from November 2012

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

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

 Fiscal Year (FY) 2013  

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

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

December 3, 2012Prior Authorization Requests

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

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

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

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

October 24, 2012Outpatient Claims Suspended for Edit 829

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

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

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

October 9, 2012ADMISSION HOUR REQUIRED FOR ACUTE OUTPATIENT HOSPITAL CLAIMSIt is important that all acute outpatient hospital claims are submitted with the admission hour. This information is necessary for MMIS to determine whether another claim, billed for the same date of service for the same member, is valid or a duplicate claim. If no admission hour is entered on the claim, subsequent claims for the same member on the same date of service could be denied.
October 9, 2012REMINDER TO PREVENT CLAIMS FROM DENYING FOR EDIT CODE 2502: MEMBER COVERED BY OTHER INSURANCE

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

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

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

October 9, 2012REMINDER ABOUT GLOBAL SURGERY EDITS

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

8175 – SERVICE PROVIDED ON THE SAME DAY OF A GLOBAL SURGICAL PROCEDURE IS INCLUDED IN FEE AMOUNT

8176 – SERVICE PROVIDED ON THE DAY OF AND DURING 10-DAY GLOBAL SURGICAL PROCEDURE INCLUDED

8177 – SERVICE PROVIDED DAY BEFORE AND DURING 90-DAY GLOBAL SURGICAL PROCEDURE INCLUDED

8253 – VISIT AND SURGERY NOT ALLOWED SAME DAY/SAME POS

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

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 .