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Technical Requirements and Support

What are the technical requirements for using the POSC?

To use the POSC, you will need

  • Internet Explorer 5.5 or higher or Mozilla Firefox 1.5 or higher;
  • full 128-bit encryption support; and
  • Adobe Acrobat Reader 7.1 or higher.

Whom can I contact if I have questions about the technical requirements?

If you have questions about technical requirements, you may contact MassHealth Customer Service by phone at 800-841-2900, by fax at 617-988-8971, or via e-mail at edi@mahealth.net.

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Security

How secure is my information on the POSC site?

The Commonwealth of Massachusetts recognizes the importance of protecting the information entrusted to us. To ensure that the information is protected, we have followed industry-standard security procedures and implemented a solution that protects the data in all stages. While the data is in transit between your browser and our servers, we use 128-bit Secure Socket Layer (SSL) security. After the data is submitted to our systems, it is protected by multiple layers of firewalls. The data is stored on secure, “hardened” servers that allow access only to a minimum set of authorized users. Additionally, the Health Insurance Portability and Accountability Act (HIPAA) privacy guidelines are followed when accessing data.

Can other providers view my information?

Other providers will not be able to view your information unless you give them access to your information by using the “Administer Account” function on the Provider Online Service Center (POSC).

Who is eligible to conduct business with MassHealth using the POSC?

Enrolled MassHealth providers and MassHealth business partners who have registered to use the POSC are eligible to conduct business with MassHealth using the POSC.

How do I register to use the POSC?

Applicants can register as MassHealth providers or business partners using the Provider Online Service Center (POSC). They will be asked to supply registration information at the time of enrollment. Their user ID and password will be displayed on the screen and they will receive a confirmation e-mail with the registration instructions. While this user ID and password will enable applicants to complete their application, full access to the POSC will be given only after they have been approved for participation in MassHealth.

Applicants using the paper application to apply as a MassHealth provider or business partner will receive a user ID and password to access the POSC after they have been approved for participation in MassHealth.

What type of services will be available to providers on the POSC?

Virtually all business that providers conduct with MassHealth can be conducted via the POSC. These services are listed through a series of Web links on the left side of each page on the POSC, and are listed below, organized by function.  

Manage Service Authorizations:

  • Preadmission Screening (PAS):
    • Enter PAS Request 
    • Inquire/Maintain PAS Request
  • Prior Authorization (PA):
    • Enter PA Request 
    • Inquire/Maintain PA Request
  • Referrals:
    • Enter New Referral
    • Inquire Referral
  • Request Transportation
  • Batch-Process Service Authorizations:
    • Upload Batch Files
    • Download Responses

Manage Correspondence and Reporting:

  • View Broadcast Messages
  • View Notifications
  • View Metrics/Reports
  • Inquire Financial Data
  • View Contracts and Documents
  • Submit Feedback

Manage Members:

  • Eligibility:
    • Verify Member Eligibility
    • Inquire Eligibility Request
    • Upload Batch Files
    • Download Responses
  • Enrollment:
    • Enroll/Disenroll PACE Members
    • Enroll/Disenroll SCO Members
    • Upload MCO/BH Batch Files
    • Download MCO/BH Responses
    • Upload Batch 834 PACE Files
    • Upload Batch 834 SCO Files
    • Download 834 PACE Responses
    • Download 834 SCO Responses
  • Long Term Care:
    • Enter Management Minutes Questionnaires (MMQ)
    • Upload MMQ Batch Files
    • Download MMQ Responses

Manage Claims and Payments:

  • Enter Single Claim
  • Inquire Claim Status
  • Batch-Process Claims:
    • Upload Batch Files
    • Download Responses
  • Test 837:
    • Upload Batch Files
    • Download Responses
  • View PACE Payments:
    • Download PACE Payment Reports
    • Download PACE 820 payment confirmations
  • View SCO Payments:
    • Download SCO Payment Reports
    • Download SCO 820 payment confirmations
    • Download Capitation Information

Manage Provider Information:

  • Enrollment:
    • Start an Enrollment Application
    • Continue Application
  • Inquire Enrollment Application Status
  • Maintain Profile:
    • Update Your MassHealth Profile
    • Inquire Profile Update Status
    • Business Partners (Non-Provider):
    • Enroll as Business Partner
    • Update Business Partner Profile

Administer Account:

  • Change Password
  • Manage Subordinate Accounts

Reference Publications:

  • View Publications
  • Order Publications
  • Choose Your Preferred Communication Method
  • Download Forms
  • Training Registration
  • Regulations
  • FAQs
  • Training and Assistance Materials

How long will transactions and reports be available for download on the POSC?

Transactions, such as claims and prior-authorization requests, and reports on the POSC will be available for download for six months. If you want to be able to refer to information that is older than six months, you should save copies of the relevant files on a local drive while it is still available on the POSC.

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Administer Account

What is this service?

This service is restricted to the primary user for the provider or business partner. Providers and business partners must designate a person as the security administrator for their organization. The security administrator can give access to the POSC to other people in their organization and to business partners, such as software vendors and billing intermediaries who perform MassHealth-related tasks on behalf of the provider. The security administrator can perform the following actions using this service:

  • change the primary user's password for accessing the POSC; and
  • manage subordinates' accounts. The security administer can perform the following actions from this option:
    • set up user accounts for subordinates;
    • reset subordinates' passwords;
    • manage subordinates' authorization to perform services online; and
    • link account information to allow other entities to view data or perform services on the provider's behalf.

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Batch Process

Who is eligible to upload batch files?

Before a MassHealth provider can submit online batch transactions via the POSC, the provider must

  • successfully submit a HIPAA batch test file; and
  • pass HIPAA trading partner testing.

Where do I obtain instructions for submitting batch files to MassHealth?

MassHealth companion guides outline the requirements for submitting batch files.

What type of HIPAA batch transactions can a provider upload?

Providers can upload the following batch HIPAA transactions.

  • 270 - Eligibility Verification Inquiry
  • 276 - Claim Status Request
  • 834 - Benefit Enrollment and Maintenance
  • 837P - Professional Health Care Claim - Test
  • 837P - Professional Health Care Claim - Production
  • 837I - Institutional Health Care Claim - Test
  • 837I - Institutional Health Care Claim - Production

What other type of batch files can providers upload?

Providers can upload Management Minutes Questionnaires (MMQ).

What type of HIPAA batch transactions can a provider download?

Providers can download the following HIPAA transactions:

  • 271 – Eligibility Verification Response
  • 277 – Claim Status Response
  • 820 – Insurance Premiums
  • 835 – Remittance Advice
  • TA1 – Interchange Acknowledgement (upon receipt of batch file)
  • 999 – Functional Acknowledgement (upon receipt of batch file)

How else may providers submit HIPAA batch transactions?

Providers may submit HIPAA batch transactions system-to-system using the Healthcare Transactions Services (HTS) method. Providers may submit both synchronous and asynchronous transactions. For more information about submitting claims via HTS, please contact MassHealth Customer Service by phone at 800-841-2900, by fax at
617-988-8971, or via e-mail at edi@mahealth.net.

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Business Partner Enrollment

What is this service?

MassHealth works closely with a variety of entities that support our provider and member communities. Business partners may enroll via the POSC. Given below are examples of business partners who may enroll via the POSC.

  • Billing intermediaries – This type of business partner submits electronic claims for their clients who are providers. They need to be enrolled in the POSC in order to submit electronic claims for their clients.
  • Health-care advocacy groups – These are groups that represent providers or members.
  • Provider associations – These associations represent physicians and hospitals.
  • Software vendors – These are health-care-related software vendors.

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Claims

What is this service?

This service is used to submit claims to MassHealth. Claims may be submitted online individually using direct data entry (DDE) or a batch process. 

How do I use this service?

Direct Data Entry (DDE). Use this service to submit electronic claims to MassHealth individually. Providers do not need to submit test files in order to submit claims via DDE. Providers may log into the POSC and begin submitting claims via DDE 24 hours a day, seven days a week, by following the prompts.

Batch Processing. Use this service to submit electronic, HIPAA-compliant claims to MassHealth in batches. Providers must successfully submit a test file and be approved to submit production claims before they may submit files for batch processing through the POSC or system-to-system.

Inquire Claim Status. Use this service to check the status of claims submitted via batch, DDE, or paper.

Test 837. Use this service to submit test non-HTS batch files.

View PACE Payments. This service is for PACE (Program of All-inclusive Care for the Elderly) providers only. Use this service to check PACE payments, download PACE payment reports, and download PACE 820 payment confirmations.

View SCO Payments. This service is for Senior Care Options (SCO) providers only. Use this service to check SCO payments, download SCO payment reports, and download SCO 820 payment confirmations.

Download Capitation Information. This service is for managed care organizations only. Use this service to download the following capitation reports.

  • Capitation Payment 820 Report (MCO and BH)
  • MCO and BH Capitation Payment Reconciliation Report
  • SCO Capitation Payment Report
  • PACE Capitation Payment Report
  • SCO Quarterly Capitation Payment Report
  • PACE Quarterly Capitation Payment Report
  • SCO Annual Capitation Payment Report
  • PACE Annual Capitation Payment Report
  • SCO Capitation Demographics Report
  • PACE Capitation Demographics Report

Will I receive confirmation once I submit my claims?

If you submit your claims using DDE, you will receive a response indicating the status of the claim immediately after submission.

If you submit your claims using batch processing (HIPAA-compliant files), a confirmation screen panel will provide you with a tracking number for your submission. After your claims are processed, a HIPAA-compliant acknowledgement (TA1 and/or 999) will be posted on the POSC under your account.

Can I check the status of my claims?

If you submit your claims using DDE, you can check the status of a claim by clicking on the Inquire Claims Status link in POSC. In addition, when you submit your claims via DDE, you will receive an immediate response indicating the status of the claims.  

If you submit your claims using batch processing, you may submit a 276 request to check the status. This action will generate a 277 response.

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Eligibility

How do I verify a member's eligibility?

You can verify member eligibility using the following methods:

  • DDE (single request - online in real-time);
  • batch-upload process;
  • HTS; and
  • MassHealth’s Interactive Voice Response System (IVR).

How do I check eligibility if I do not have the member ID?

You may use any of the following information to check member eligibility:

  • the member’s social security number;
  • the member’s last name, first name, date of birth, and gender; or
  • the member’s ID from DSS or DYS.

Can I verify a member's eligibility for a span of dates?

You can verify member eligibility up to a 31-day span of time in a single transaction.

How far back in the past can I verify a member's eligibility?

You can verify member eligibility up to 36 months in the past. 

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Inquire Financial Data

What is this service?

This service lets a MassHealth provider view the summary of claims-payment-related data compiled from the provider’s remittance advices and 835 transactions. 

A provider can search by year and month to quickly determine, for a given period, how much the provider has been paid and how many claims have been paid and denied.

By using this service each week, a provider will be able to view the payment requests sent to/generated by the Office of the State Comptroller, and claim-payment ratios.

What type of financial data will providers be able to view?

Financial data is available at a provider ID and service location number level. The summary includes a count of paid claims, a count of denied claims, and total payment amount requested for the current cycle, month to date, fiscal year to date, and year (calendar) to date

How often will the data be made available?

Providers can view data 24 hours a day, seven days a week. Updates will be made once a week, typically after the weekend claim cycle has been run.

Will I be able to download the data?

Yes

How long will the data be available online?

The data will be available for six months.

Who else will have access to my data?

Other providers will not be able to view your information unless you give them access to your information by using the “Administer Account” function on the POSC.

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Long Term Care - Management Minute Questionnaire

What is this service?

This service allows nursing facility providers and their agents to submit Management Minutes Questionnaires (MMQs) via the POSC, either individually or as a batch.

How do I submit my MMQ?

MassHealth providers must log into the POSC to submit MMQs. Providers may submit MMQs either individually by DDE or as a batch. Refer to Appendices D and E of the Nursing Facility Manual for instructions on submitting MMQs.

Will I receive confirmation once I submit my MMQ?

Yes. If you submit your MMQs using DDE, you will receive a confirmation immediately after submission. If you submit your MMQs as a batch, a confirmation screen panel will provide you with a tracking number for your submission. 

Will I be able to update previously submitted MMQs for my semi-annual submissions?

Providers will be able to copy and modify previous MMQs for their semi-annual submissions.

If I have questions about my MMQ, whom should I contact?

You may contact MassHealth Customer Service by phone at 800-841-2900, by fax at 617-988-8971, or via e-mail at edi@mahealth.net.

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Manage Provider Information

Enrollment

What is this service?

This service allows you to

  • initiate an application for enrollment as a MassHealth provider;
  • save a partially completed provider application;
  • continue work on a saved provider application; and
  • inquire on the status of a provider application.

Can I update my information online?

Yes, you can request to update your MassHealth Profile online.

How will I know that my request for changes was received and my file was updated?

All requests for changes to your provider information via the POSC will be tracked. Providers will be able to check the status of an update request by contacting MassHealth Customer Service by phone at 800-841-2900, by fax at
617-988-8971, or via e-mail edi@mahealth.net.

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Business Partners

What is this service?

MassHealth works closely with a variety of entities that support the MassHealth provider and member communities. These entities include provider associations, health care advocacy groups, software vendors, and billing intermediaries.

Business partners will be able to use this service to

  • enroll as a business partner; and
  • update their MassHealth business partner profile.

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PACE, SCO Enrollment, and Related Materials

What is this service?

This service allows PACE (Program for All-inclusive Care for the Elderly) and SCO (Senior Care Options) providers to enroll or disenroll MassHealth members in either the PACE or SCO programs.

How do I enroll and disenroll members in PACE or SCO?

Log on to the POSC. On the left navigation panel, click Manage Members. Click on PACE or SCO enrollment/disenrollment. The search screen will be displayed. Enter the member ID, last name, and first name, and click the Submit button. Either an enrollment or disenrollment panel will be returned depending on the member’s status.         

Will I be able to submit enrollment/disenrollment transactions?

Yes. PACE and SCO providers may also submit the following transactions through the portal.

  • Batch HIPAA 834 enrollment/disenrollment files
  • Provider directory files
  • Enrollment history requests

Submission of HIPAA 834 transactions and history requests are optional for PACE and SCO providers.  

Will I be able to upload HIPAA transactions?

Yes. PACE and SCO providers will also be able to download HIPAA 834 enrollment confirmations and 820 payment files from the portal.                   

Will I receive confirmation after I enroll or disenroll a member?

Yes, every transaction receives confirmation.

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PACE, SCO Reports

What is this service?

This service lets PACE and SCO providers download the following enrollment and capitation payment reports.

  • Monthly Member Enrollments
  • Monthly Member Disenrollments
  • Monthly Capitation Payments
  • Quarterly and Annual Capitation Reconciliation

How can I access my SCO or PACE reports?

MassHealth providers can view and download PACE and SCO reports under the View Metrics & Reports section of the POSC.

How long will the reports be available online?

Reports will be available online for six months.

Will I also have access to older reports?

You will not have online access to older reports. To obtain copies of older reports, contact the Coordinated Care Systems Unit at the Office of Long Term Care at the following phone numbers.

PACE - 617-222-7413 

SCO - 617-222-7418

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Pre-Admission Screening (PAS)

How do I use the Preadmission Screening Service?

Preadmission screening (PAS) is the MassHealth authorization process for elective, acute inpatient hospital admissions, rehabilitation services provided in an acute inpatient hospital, or chronic hospital stays for MassHealth members who require these services.

The screenings determine if the admission is medically necessary and if the inpatient setting is appropriate.

For additional information about preadmission screening requirements, see MassHealth regulations at 130 CMR 450.207 through 450.209 for acute admissions and 130 CMR 435.408 through 435.415 for rehabilitation services provided in an acute inpatient hospital and chronic or rehabilitation admissions and extensions.

How do I submit a PAS request?

Providers can submit their PAS request through the POSC as a single transaction using direct data entry (DDE).

What type of PAS requests can providers submit online?

Providers can submit the following types of PAS requests online.

  • Requests for new admission for elective inpatient hospital stays in acute, chronic, or acute with rehabilitation facilities
  • Requests for concurrent review (extensions) for chronic or rehabilitation stays and acute stays with rehabilitation services
  • Requests for conversion from other insurance for chronic or rehabilitation stays and acute stays with rehabilitation services

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Prior Authorization

How do I use the Prior Authorization (PA) Service?

Prior Authorization (PA) enables MassHealth to review, assess, approve, modify, or deny selected nonemergency medical services prior to payment.

For regulatory information about prior authorization, see MassHealth regulations at 130 CMR 450.303 and other applicable program regulations.

How do I submit a PA request?

Providers can submit PA requests via the POSC using DDE.

What type of PA requests and functions can providers perform online?

Providers can perform the following requests and functions online using the POSC.

  • Submit requests for medical services and products
  • Check the status of a request
  • Receive PA notices communicating decision information

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Publications

What is this service?

Providers will be able to link to the MassHealth Provider Library and Member Library to view and download MassHealth publications, such as regulations, provider bulletins, forms, brochures, and booklets. Providers may also use this service to request a supply of forms and other publications, such as brochures and booklets.

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Referrals

How do I use this service?

Primary Care Clinicians (PCCs) use this service to refer members enrolled in the PCC Plan to specialty providers when members require services that cannot be provided by the PCC and are not exempt from referral approval requirements.

What type of processes can PCCs and specialists perform using the POSC?

PCCs can submit referrals via DDE and receive notification of closed referrals when the link between the member and the PCC is broken.

Specialists can receive referral notices communicating referral information.

How will the referral number be used?

  • The referred-to provider submits the claim with the referral number after providing services to the member. Refer to the applicable companion guide for electronic claims, or billing guide for paper claims for correct reporting of the referral number.

Will claims be denied if the referral number is not listed on the claim?

  • No. The claim will not be denied if the referral number is not listed on the claim. However, if you know the referral number, it is best to enter it on the claim for quicker and more efficient processing.

What if a member shows up to a doctor's appointment without a referral?

If the service requires a referral, you may contact the member's PCC, who can submit the referral online. The referral will be processed in real time, so the referring physician will be able to provide the servicing physician with a referral number right on the spot. If the PCC does not agree to submit a referral you can reschedule the member when the referral is in place.

Also, the specialist can search for referrals for new patients prior to their visits via the Web, and call the PCC if there is no referral. For further questions or problems, the specialist should contact MassHealth Customer Service by phone at 800-841-2900, by fax at 617-988-8971, or via e-mail at edi@mahealth.net.

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Regulations

What is this service?

Providers may click on the Regulations link to view MassHealth regulations and other MassHealth publications.

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Request Transportation

What is this service?

Providers may click on the Request Transportation link to complete and submit prescriptions for transportation (PT-1) requests via the POSC.

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Submit Feedback

What is this service?

Providers may click on the Submit Feedback link to submit questions or comments to MassHealth about the POSC.

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Training and Assistance Materials

What is this service?

MassHealth providers may click on the Training and Assistance Materials link to view and download training and assistance materials.

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Training Registration

What is this service?

Providers and business partners may click on the Training Registration link to register for upcoming provider trainings and educational sessions. Providers can use this service to:

  • view upcoming trainings available for MassHealth providers;
  • register for upcoming trainings available for MassHealth providers;
  • choose the location and view availability of upcoming trainings; and
  • view training materials from past provider educational sessions.

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View Broadcast Messages

What is this service?

This service allows providers to view broadcast messages that have been issued by MassHealth. Broadcast messages are viewable by providers once they log into the POSC. Broadcast messages are generally intended as alerts, important information, and reminders.

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View Contracts and Documents

What is this service?

This service allows providers to view their provider application for enrollment and contract documentation, where applicable.

Will I have access to older enrollment contracts and documents?

Yes. Contract information will be available for viewing as far back as January 2007.

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View Metrics / Reports

What is this service?

This service allows providers to view and download metrics and reports about activity with MassHealth (for example, PCC reports, top 10 claims denials, etc.).

How will I access my metrics and reports?

Your metrics and reports will be viewable through the View Metrics & Reports link on the POSC.

How long will the metrics and reports be available online?

Metrics and reports will be available for six months.

Will the metrics and reports be tailored for my practice?

Yes. The metrics and reports will be tailored to your individual practice.  

For example the top 10 claims denials report will display the top 10 claims denials for your provider ID and service location number.

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View Notifications

What is this service?

This service allows providers to view and download certain types of notices and letters generated by MMIS and sent to providers by MassHealth (for example, PA decision letters and referral notifications).

How will I access my notices/letters?

Your notices and letters will be viewable through the View Notices/Letters link on the POSC.

How long will the notices and letters be available online?

Notices and letters will be available online for six months.


 


This information is provided by MassHealth