Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	
	MassHealth
	Acute Outpatient Hospital Bulletin 19
	June 2007

	TO:	Acute Outpatient Hospitals Participating in MassHealth

	FROM:	Tom Dehner, Acting Medicaid Director 

	RE:	Return of Overpayments - Medicare Crossover Claims for Outpatient Hospital Services

Background	On September 1, 2006, MassHealth began processing electronic crossover claims under the Coordination of Benefits Agreement (COBA) program (see All Provider Bulletin 158, dated September 2006).

As a result of this change, certain problems were encountered with crossover claim payments issued during the period from September 8, 2006, through March 9, 2007, for outpatient services. In some instances, providers received more than the coinsurance and deductible from MassHealth. This problem was corrected for crossover payments issued on and after March 10, 2007.

Instructions for 		MassHealth will allow providers to return these credit balances by voiding Returning Overpayments 	the claims that exceed the coinsurance and deductible amount. To 
submit voids, use the 837 void transaction or submit a paper void request. Please do not send a check. MassHealth will deduct these overpayments from future payments owed until the monies are recovered. 

For more information about the 837 electronic void transaction, please refer to section 3.4 of the 837I MassHealth Companion Guide, available on the MassHealth Web site noted below. For more information on submitting a paper void request, please refer to the May 2007 issue of the MassHealth provider newsletter Update, available on the MassHealth Web site at www.mass.gov/masshealth.  

Waiver of 			Although MassHealth may impose administrative fines against providers Administrative Fines 	that do not return overpayments classified as credit balances within 60 
days of their receipt (see 130 CMR 450.238(B)(7)), MassHealth has asked providers to await instructions on how to return these particular overpayments. Accordingly, for overpayments received as a result of MassHealth paying more than the coinsurance or deductible for claim payments issued from September 8, 2006, through March 9, 2007, 
	
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Waiver of 			MassHealth will waive its right to impose an administrative fine. To qualify  
Administrative Fines 	for this waiver, all such overpayments must be returned no later than
(cont.)                                     September 14, 2007. 

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