EVSpc Version 5010
Terminated on 9/1/2015–
MassHealth no longer supports the Eligibility Verification Software (EVSpc/EVScall) software tool. Any transaction submitted to MassHealth via the EVSpc or EVScall software will be rejected. To avoid any issue or delays when submitting transactions, please take the following steps.
- Submit eligibility and claims status transactions through one of the existing submission options. For existing options, please review Eligibility Verification Service Software (EVSpc) Available Transition Options
- Review important information on uploading batch files by reading the NewMMIS Job Aid: Eligibility Verification - Upload Batch Files
If you submit batch eligibility transactions, please follow the important eligibility submission guidelines below.
MassHealth providers and vendors submitting transactions in conformance with Phase I CORE 155: Eligibility and Benefits Batch Response Time Rules, and in accordance with HIPAA ASC X12 and MassHealth policy, must follow these submission guidelines to ensure timely and efficient processing of transactions.
- ONLY check eligibility for those MassHealth members you will actually provide services to on that day or the following day.
- DO NOT submit your entire roster of MassHealth members unless you are providing services for your entire roster of members the same day or the following day.
- DO NOT include more than 3,000 member requests in an eligibility transaction or a batch-file request. The 270/271 HIPAA Implementation Guide requires that the 270 transaction contain no more than 99 patient requests when using the transaction in batch mode, though it allows other patient request limits to be set. MassHealth agreed to the reasonable limit of up to 3,000 member requests per transaction. Transactions exceeding this limit were rejected beginning on May 10, 2015. MassHealth reserves the right to modify this limit as required, in accordance with the HIPAA standard.
- YOU MUST INCLUDE the member’s Medicaid Identification Number on the eligibility request, if known.
- POPULATE ALL subsequent eligibility requests with the member information received from MassHealth on the prior eligibility response, where applicable.
It is important that you follow these file submission guidelines to ensure a timely response to your file submission.
Visit www.mass.gov for more information on transitioning to another eligibility verification method, or contact the MassHealth Customer Service Center at 1-800-841-2900 to discuss transition options.
Management Minutes Questionnaires (MMQs)
MassHealth proprietary MMQ software is no longer available for download.
As of October 1, 2015, MassHealth no longer supports the proprietary MMQ software previously available to providers on www.mass.gov. All providers using this software should have transitioned to an alternative method of submitting MMQs through the Provider Online Service Center (POSC) by September 30, 2015. Such methods include the following
- using the direct data entry MMQ functionality;
- submitting MMQ batch files in accordance with MassHealth MMQ file specifications; or
- engaging a vendor to generate MMQ batch files.
In order to facilitate this transition, MassHealth has removed its proprietary MMQ software from the website. It is no longer available for providers to download. Support for the proprietary software ended on September 30, 2015. All providers should now be using an alternative submission method.
POSC users may refer to the MMQ Job Aid: NewMMIS Job Aid: Submit MMQ
Batch submitters may view the MassHealth MMQ file specifications: Nursing Facility Appendix D (ICD-10 DRAFT)
Both of these documents have been modified for ICD-10.
Thank you for your cooperation in making this important transition. For questions, please contact the MassHealth Customer Services Center by telephone at 1-800-841-2900 or by e-mail at email@example.com.
MMIS Trading Partner Testing
The MassHealth Vendor List gives the status of trading partner testing for vendors who are testing HIPAA-compliant claim transactions for MassHealth.