Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111 www.mass.gov/dma

MASSHEALTH
TRANSMITTAL LETTER ALL-117
August 2003
TO:      All Providers Participating in MassHealth
FROM:      Douglas S. Brown, Acting Commissioner
RE:      All Provider Manuals (Revisions to Appendix Y)

This letter transmits revisions to Appendix Y in all provider manuals. Appendix Y lists the active REVS (Recipient Eligibility Verification System) codes and their respective service-restriction messages. Providers accessing REVS to verify a member’s eligibility before providing medical services will receive one or more of the restriction messages. These revisions are effective September 1, 2003.
Appendix Y is also available on the Division’s Web site at www.mass.gov/dma.
If you have any questions about this transmittal letter or REVS codes, please contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.
NEW MATERIAL
(The pages listed here contain new or revised language.)
All Provider Manuals
Pages Y-1 through Y-4
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
All Provider Manuals
Pages Y-1 through Y-4 — transmitted by Transmittal Letter ALL-112

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX Y: REVS CODES/MESSAGES	PAGE
Y-1	

	TRANSMITTAL LETTER
ALL-117	DATE
09/01/03	
This appendix lists the active REVS (Recipient Eligibility Verification System) codes and their respective service-restriction messages. Providers accessing REVS to verify a patient's eligibility before providing medical services will receive one or more of the following restriction messages.

Code
006

Message
NHP MEMBER. FOR MEDICAL SERVICES CALL 1-800-432-9449. FOR BEHAVIORAL HEALTH SERVICES CALL 1-800-414-2820.

011

NHP MEMBER. FOR MEDICAL SERVICES CALL 1-800-432-9449. FOR BEHAVIORAL HEALTH SERVICES CALL 1-800-414-2820.

021

BMC HEALTH NET MEMBER. FOR MEDICAL SERVICES CALL 1-888-566-0008. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-217-3501.

031
035 036

PRIOR AUTHORIZATION MANDATORY FOR ALL CARE. CALL ELDER SERVICES PLAN OF THE NORTH SHORE, INC. AT 781-599-0110.
MASSHEALTH/DMH CLIENT.
PRIOR AUTHORIZATION MANDATORY FOR ALL CARE. CALL ESP OF THE CAMBRIDGE HOSPITAL AT 617-868-6323.

041

PRIOR AUTHORIZATION MANDATORY FOR ALL CARE. CALL ELDER SERVICES PLAN AT FALLON AT 508-852-2026.

046

PRIOR AUTHORIZATION MANDATORY FOR ALL CARE. CALL ELDER SERVICES PLAN OF MUTUAL HEALTHCARE AT 617-288-0970.

051

PRIOR AUTHORIZATION MANDATORY FOR ALL CARE. CALL HARBOR ELDER SERVICES AT 617-296-5100.

056

NETWORK HEALTH MEMBER. FOR MEDICAL SERVICES CALL 1-888-257-1985. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-257-1986.

061

BMC HEALTHNET PLAN MEMBER. FOR MEDICAL SERVICES CALL 1-888-566-0008. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-217-3501.

066

NETWORK HEALTH MEMBER. FOR MEDICAL SERVICES CALL 1-800-257-1985. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-257-1986.

071
096

MEMBER ENROLLED IN PROGRAM THAT LIMITS HIM/HER TO 1 PHARMACY. FOR INFORMATION, MEMBER MAY CALL 1-800-841-2900, 8AM-5PM MON-FRI.
CARE MANAGEMENT PILOT PROGRAM MEMBER. PLEASE CALL 413-794-9428 TO COORDINATE ALL MEDICAL AND BEHAVIORAL HEALTH SERVICES.

111

RESIDENT AT LONG-TERM-CARE FACILITY.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX Y: REVS CODES/MESSAGES	PAGE
Y-2	

	TRANSMITTAL LETTER
ALL-117	DATE
09/01/03	
Code	Message
116	EAEDC (CAT. 04). SERVICES RESTRICTED. SEE 130 CMR 450.106. FOR
QUESTIONS, CALL PROVIDER SERVICES AT 1-800-325-5231.
126	COMMUNITY CASE MANAGEMENT MEMBER. PRIOR AUTHORIZATION NOW
REQUIRED FOR HOME HEALTH (PDN, NURSING, HH AIDE, PCW) INFO 1-800-863-6068.
131	FALLON MEMBER. FOR MEDICAL SERVICES CALL 1-800-868-5200. FOR
BEHAVIORAL HEALTH SERVICES CALL 1-888-421-8861.
171	PRIOR AUTHORIZATION MANDATORY FOR ALL CARE. CALL EAST BOSTON
ELDER SERVICE PLAN AT 617-539-5060 OR EVES AT 617-567-3600.
311	FALLON MEMBER. FOR MEDICAL SERVICES CALL 1-800-868-5200. FOR
BEHAVIORAL HEALTH SERVICES CALL 1-888-421-8861.
386	MEDICARE-COVERED SERVICES ONLY.
461	PRIMARY CARE CLINICIAN (PCC) PLAN MEMBER. CALL PCC FOR
AUTHORIZATION FOR ALL SERVICES EXCEPT THOSE LISTED IN 130 CMR 450.118(I).
480	BILL MEMBER’S PRIVATE HEALTH INSURANCE. MASSHEALTH PAYS ONLY
FOR COPAYS AND DEDUCTIBLES.
485	BILL MEMBER’S PRIVATE HEALTH INSURANCE. MASSHEALTH PAYS ONLY
FOR COPAYS AND DEDUCTIBLES FOR WELL-CHILD VISITS.
490	DMH-COVERED SERVICES ONLY. NOT ELIGIBLE FOR MASSHEALTH.
495	ELIGIBLE FOR PREMIUM ASSISTANCE ONLY. BILL MEMBER'S PRIVATE
HEALTH INSURANCE.
500	SPECIAL NHP PROGRAM. CALL NHP FOR AUTHORIZATION FOR ALL SERVICES
EXCEPT FAMILY PLANNING, GLASSES, AND MOST DENTAL. 1-888-816-6000
505	MASSHEALTH COMMONHEALTH MEMBER. FOR QUESTIONS, CALL
1-800-325-5231.
516	CALL HRCA AT 617-325-8000 FOR AUTHORIZATION OF ALL SERVICES EXCEPT
ACUTE INPATIENT ADMISSIONS.
520	ELIGIBLE FOR AMBULATORY PRENATAL CARE ONLY.
522	ELIGIBLE FOR EMERGENCY SERVICES ONLY.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX Y: REVS CODES/MESSAGES	PAGE
Y-3	

	TRANSMITTAL LETTER
ALL-117	DATE
09/01/03	
Code	Message
525	FOR MENTAL HEALTH OR SUBSTANCE ABUSE SERVICE AUTHORIZATION,
CALL THE PARTNERSHIP AT 1-800-495-0086.
530	NO PCC/MCO AUTHORIZATIONS NEEDED. FOR MH/SA SERVICE
AUTHORIZATION, CALL THE PARTNERSHIP AT 1-800-495-0086.
545	DMH CLIENT. NOT ELIGIBLE FOR MASSHEALTH. HAS OTHER HEALTH
INSURANCE: TPL AND/OR MEDICARE.
580	LESS THAN 60 DAYS UNTIL THIS POS WILL BE DISABLED. CALL EDS AT
1-800-462-7738 FOR INFO ON PURCHASING A NEW VERIFONE POS.
585	LESS THAN 30 DAYS UNTIL THIS POS WILL BE DISABLED. CALL EDS AT
1-800-462-7738 FOR INFO ON PURCHASING A NEW VERIFONE POS.
590	LESS THAN 20 DAYS UNTIL THIS POS WILL BE DISABLED. CALL EDS AT
1-800-462-7738 FOR INFO ON PURCHASING A NEW VERIFONE POS.
595	LESS THAN 10 DAYS UNTIL THIS POS WILL BE DISABLED. CALL EDS AT
1-800-462-7738 FOR INFO ON PURCHASING A NEW VERIFONE POS.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX Y: REVS CODES/MESSAGES	PAGE
Y-4	

	TRANSMITTAL LETTER
ALL-117	DATE
09/01/03	
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