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-120
October 2003
TO:      All Providers Participating in MassHealth FROM:      Beth Waldman, Acting Commissioner
RE:      All Provider Manuals (Revisions to Appendix A)
This letter transmits revisions to Appendix A in all provider manuals. Appendix A is a directory of MassHealth-related addresses, phone numbers, fax numbers, and e-mail addresses. The appendix is organized by function. Appendix A is also available on the Division’s Web site at www.mass.gov/dma.
These revisions are effective October 1, 2003.
If you have any questions about this transmittal letter, 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 A-1 through A-14
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
All Provider Manuals
Pages A-1 through A-14 — transmitted by Transmittal Letter ALL-104

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-1	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
This appendix contains the names, addresses, and telephone numbers of units, agencies, and contractors that you may need to contact in the course of doing business with the Division of Medical Assistance. This appendix is also available on the Division’s Web site at www.mass.gov/dma. Click on “DMA Publications,” then on “Provider Manual Appendices.”
Benefit Plans and Utilization Management
The Division has entered into agreements with various entities to manage and review the quality and appropriateness of care.

If you have questions about the PCC Plan, PCC Plan Network Management Services, or referral requirements:

PCC Plan Hotline
1-800-495-0086
(TTY: 617-790-4132 for people
with partial or total hearing loss)
1-800-790-4138 (fax)

If you have questions about service authorization or claims for members enrolled in the Behavioral Health Program:

1-800-495-0086 617-790-4815 (fax)

If you have questions about the Acute Hospital Utilization Management Program, including:
 •	admission screening;
 •	prepayment review;
 •	OPD PCC review; and
 •	postpayment review

MassPRO
235 Wyman Street
Waltham, MA 02451-1231
781-890-0011

for admission screening only:

1-800-732-7337 1-800-752-6334 (fax)

for prepayment review only:

781-290-5784 (fax)

If you have questions about the Chronic Disease and Rehabilitation Hospital Utilization Management Program, including:
 •	preadmission screening;
 •	conversion screening;
 •	concurrent review; and
 •	postpayment review

MassPRO
235 Wyman Street
Waltham, MA 02451-1231
781-890-0011
1-800-554-5127
1-800-752-6334 (fax)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-2	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Claims Submission and Resolution
The Division has contracted with Unisys to receive MassHealth claims, except for pharmacy claims, and to answer providers' questions about the payment of services covered by MassHealth.

MassHealth Provider Services:
If you have questions about claims or MassHealth policy, or want to request a replacement remittance advice:
If you have a question about the status of a claim (limit of three inquiries per call and three calls per day):

MassHealth Provider Services P.O. Box 9101 Somerville, MA 02145
617-628-4141 1-800-325-5231 Hours: Mon.-Fri. 8:45 A.M.-5:00 P.M. mainquiries@unisys.com
1-877-382-8890 Hours: Mon.-Fri. 9:00 A.M.-12:00 Noon 1:00 P.M.-4:00 P.M.

If you have questions about policies and procedures for submitting electronic claims, technical support, or testing for HIPAA claims transactions:
After you are approved to submit claims electronically, send your electronic claims to:
If you have questions about Provider Claim Submission Software (PCSS):
Send original paper claims to:
Send paper adjustments of all paid claims to:

MassHealth
HIPAA Support Center
P.O. Box 9101
Somerville, MA 02145
mahipaasupport@unisys.com
MassHealth
ATTN: Production Control 5 Middlesex Avenue Somerville, MA 02145
1-888-848-5068
MassHealth ATTN: Originals P.O. Box 9101 Somerville, MA 02145
MassHealth ATTN: Adjustments P.O. Box 9101 Somerville, MA 02145

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-3	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	

Send paper resubmittals of all denied claims to:
Send voids of all claims paid in error to:
If you have Medicare/MassHealth claims that do not cross over systematically, send paper crossover claims to:
Send 90-day waiver requests
for inpatient UB-92 hospital claims only:
for all other claims:
If you have questions about final deadline appeals before the Final Deadline Appeals Unit:

MassHealth ATTN: Resubmittals P.O. Box 9101 Somerville, MA 02145
MassHealth ATTN: Voids P.O. Box 9101 Somerville, MA 02145
MassHealth
ATTN: Crossover Claims P.O. Box 9101 Somerville, MA 02145
Division of Medical Assistance ATTN: 90-Day Waivers, Inpatient 600 Washington Street Boston, MA 02111
MassHealth
ATTN: 90-Day Waivers P.O. Box 9101 Somerville, MA 02145
Division of Medical Assistance ATTN: Final Deadline Appeals 600 Washington Street Boston, MA 02111 617-210-5538 fdeappeals@nt.dma.state.ma.us

The Division has contracted with ACS State Healthcare (ACS) to receive MassHealth pharmacy claims and answer providers’ questions about the Pharmacy On-line Processing System (POPS).

ACS Help Desk:

1-866-246-8503
24 hours a day, seven days a week

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-4	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	

If you have questions about 90-day waiver requests for pharmacy claims:
Send the completed form and any pertinent documentation to:
Send written questions related to claims, MassHealth policy, registration for electronic remits, or replacement of a remittance advice to:

ACS Help Desk 1-866-246-8503
ACS State Healthcare ATTN: MassHealth-90 Day Waivers 365 Northridge Center 1 Suite 400
Atlanta, GA 30350 1-866-556-9314 (fax)
ACS State Healthcare ATTN: MassHealth 131 Tremont Street, 4th Floor Boston, MA 02111 masshealth.providerrelations@acs-inc.com

If the service date on the claims exceeds 12 months (or 18 months, if another insurer is involved), submit your appeal to:
Hearings

Division of Medical Assistance
ATTN: Final Deadline Appeals
Unit
600 Washington Street
Boston, MA 02111
617-210-5538
fdeappeals@nt.dma.state.ma.us

If you have questions about a fair hearing or an adjudicatory hearing:

Division of Medical Assistance
Board of Hearings
2 Boylston Street
Boston, MA 02116
617-210-5800
1-800-655-0338
617-210-5820 (fax)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-5	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Member Eligibility
The Division has contracted with Electronic Data Systems (EDS) to maintain and monitor the MassHealth Recipient Eligibility Verification System (REVS). This system provides 24-hour access to member eligibility information for the previous six months. Be sure to have the member’s card, MassHealth identification number, or name and date of birth when making eligibility inquiries. REVS access methods require a user ID and password. If you have not submitted a Trading Partner Agreement, you cannot access REVS.
ACS, the contractor responsible for operating the Pharmacy On-line Processing System (POPS), receives the same MassHealth member eligibility information as EDS. The pharmacy claim-adjudication process at ACS includes the same eligibility verification as is available through REVS. Therefore, it is not necessary for retail pharmacists to separately validate through REVS member eligibility for pharmacy claims.

Automated Voice Response (AVR): (Limit five inquiries per call during business hours.)
Eligibility Operator (24-hour eligibility operator):
REVS Help Desk:
Answers questions about:
 •	REVS access methods (point-of-service, PC software, and automated-voice-response systems)
 •	MassHealth cards
 •	REVS Provider Manual
 •	availability of REVS
 •	how to verify eligibility
 •	purchasing a point-of-service (POS) device and printer
Send correspondence, POS, or REVS-related forms or equipment to:

1-800-554-0042
1-800-833-7582
1-800-462-7738
Hours: Mon.-Fri., excluding
holidays 8:00 A.M.-5:00 P.M.
EDS MassHealth 155 Federal Street, 6th Floor Boston, MA 02110 617-350-8180 (fax)

If members have questions about MassHealth, they should call the MassHealth Customer Service Center: Note: Providers should not call this number.

1-800-841-2900
(TTY: 1-800-497-4648 for people
with partial or total hearing loss)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-6	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Payments
Providers are encouraged to receive MassHealth payments by electronic funds transfer (EFT).
To receive payments by EFT, you must complete the Authorization for Electronic Funds Transfer (EFT) of MassHealth Payments.
Send the completed form to:	Division of Medical Assistance
ATTN: EFT Unit, Finance 600 Washington Street Boston, MA 02111
Your EFT request will not be approved unless you have a W-9 form on file.
If you have questions about W-9 form completion and	MassHealth
all other changes:	Provider Enrollment and Credentialing
P.O. Box 9101 Somerville, MA 02145 617-576-4424 1-800-322-2909 703-917-4933 (fax) maproviderupdates@unisys.com
For replacement of a lost or damaged check:	617-210-5072
MassHealth payment information is available on-line. You may access the amount of your check or EFT by going to the Office of the State Comptroller’s Web site at www.mass.gov/massfinance. Go to “VendorWeb” and follow the instructions.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-7	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Prior Authorization (pharmacy services)
Claims for certain drugs submitted through the Pharmacy On-line Processing System (POPS) require prior authorization (PA). Please see Subchapter 4 of your provider manual and the MassHealth Drug List on the Division’s Web site at www.mass.gov/dma. Click on “Pharmacy,” then on “MassHealth Drug List.”
Other claims will be denied because of certain drug utilization review (DUR) edits. Where appropriate, the pharmacist should discuss the medical necessity of prescribing such drugs with the prescriber before calling for DUR certification. Use the following telephone and fax numbers to request DUR certification or to check on the status of your pharmacy PA request if you have not received a response within 24 hours. If you have not received a response within 24 hours, the pharmacist may provide a 72-hour supply of a requested covered drug.
University of Massachusetts Medical Center:	1-800-745-7318
1-877-208-7428 (fax)
Send requests for all drugs that require PA to:	MassHealth Drug Utilization Review
Program
Note: Telephone requests for PA will be accepted only in       P.O. Box 2586
the case of a medical emergency.	Worcester, MA 01613-2586
1-800-745-7318 1-877-208-7428 (fax)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-8	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Prior Authorization (non-pharmacy services)
Some services need PA before you can provide them. These items are identified in Subchapters 4 and 6 of your provider manual.

Mail all PA requests, except those for personal emergency response systems (PERS) and those listed below for Massachusetts Commission for the Blind (MCB) members to:

Division of Medical Assistance ATTN: Prior Authorization Unit
(include name of program area) 600 Washington Street Boston, MA 02111

Mail PA requests for MCB members for durable medical equipment, personal care attendant, private duty nursing, and oxygen and respiratory therapy services to:

Massachusetts Commission for
the Blind 48 Boylston Street Boston, MA 02116

Mail PA requests for independent nurse, personal care attendant, and PERS to:

The member’s local aging service access point (see Appendix D in the Durable Medical Equipment Manual)

You may call the Division’s PA Unit or MCB, as applicable, to ask about the status of a PA request sent to one of the above addresses. Please wait the specified time before calling.

PA Unit (after 15 days for durable medical equipment and 21 days for all other services):
PA for independent nurse (after 14 days):
PA for skilled nursing for MassHealth Basic members (after 21 days):

617-451-7000 1-800-862-8341
617-451-7176 617-451-7132

MCB PA Unit (after 14 to 21 days, depending on the	617-727-5550
service):

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-9	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Provider Enrollment and Credentialing
The Division has contracted with Unisys to manage provider enrollment and credentialing activities. Provider Enrollment and Credentialing establishes and maintains a file on every MassHealth provider.
You must contact Provider Enrollment and Credentialing to report any changes in:
 •	your licensure and certification;
 •	Medicare provider status;
 •	ownership information; or
 •	any other qualifications that may affect your participation in MassHealth.

Contact Provider Enrollment and Credentialing by telephone to:
 •	request a provider application;
 •	ask about the status of your provider application;
 •	verify your participation status; or
 •	verify the information in your provider file.
Write to Provider Enrollment and Credentialing on your letterhead stationery and include your MassHealth provider number and tax identification number to:
 •	report changes in information, such as your provider name and address;
 •	change or add your Medicare provider number to your MassHealth provider file.

report a change in ownership:

MassHealth
Provider Enrollment and Credentialing
P.O. Box 9101
Somerville, MA 02145
617-576-4424
1-800-322-2909
703-917-4931 (fax)
Hours: Mon.-Fri.
8:45 A.M.-5:00 P.M.
maproviderenrollment@unisys.com
MassHealth
Provider Enrollment and Credentialing
P.O. Box 9101
Somerville, MA 02145
617-576-4424
1-800-322-2909
703-917-4933 (fax)
Hours: Mon.-Fri.
8:45 A.M.-5:00 P.M.
maproviderupdates@unisys.com
703-917-4936 (fax) maproviderupdates@unisys.com

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-10	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	

To notify Provider Enrollment and Credentialing of any change in licensure, certifications, and qualifications or data that may affect participation in MassHealth:
MassHealth
Provider Enrollment and Credentialing
P.O. Box 9101
Somerville, MA 02145
617-576-4424
1-800-322-2909
703-917-4934 (fax)
Hours: Mon.-Fri.
8:45 A.M.-5:00 P.M.
maprovidercredentialing@unisys.com
To apply for managed care or to change your managed care information:
MassHealth
Provider Enrollment and Credentialing
P.O. Box 9101
Somerville, MA 02145
617-576-4424
1-800-322-2909
703-917-4935 (fax)
Hours: Mon.-Fri.
8:45 A.M.-5:00 P.M.
mamanagedcare@unisys.com
Provider Training
For all providers, except pharmacy providers, the Division has contracted with Unisys to perform provider services, including training.

To schedule a training or an individual consultation about billing for MassHealth services:
MassHealth
Provider Training
P.O. Box 9101
Somerville, MA 02145
617-576-4487 (fax) or 703-917-4942
(e-fax)
maproviders@unisys.com
For pharmacy providers, the Division has contracted with ACS to perform provider services, including training.

To schedule a training or individual consultation about billing for MassHealth pharmacy services:

ACS State Healthcare ATTN: MassHealth 131 Tremont Street, 4th Floor Boston, MA 02111 617-423-1237 617-423-9846 (fax) masshealth.providerrelations@acs-inc.com

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-11	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Publications
The following is a list of sources for publications you may need.
The first replacement of a provider manual is provided free of charge. You will be charged for all others. Submit your request in writing on your letterhead stationery. Include your provider number, tax identification number, and a street address.
All current Division regulations, Subchapters 6 (service codes) of provider manuals that have them, and bulletins are available on the Division’s Web site at www.mass.gov/dma. Additional publications and forms are available at www.mahealthweb.com.

Provider manuals
REVS provider manuals

MassHealth
Provider Enrollment and Credentialing
P.O. Box 9101
Somerville, MA 02145
617-576-4424
1-800-322-2909
703-917-4931 (fax)
Hours: Mon.-Fri.
8:45 A.M.-5:00 P.M.
maproviderenrollment@unisys.com
EDS MassHealth ATTN: Provider Services 155 Federal Street, 6th floor Boston, MA 02110

POPS payer sheets

ACS State Healthcare ATTN: MassHealth 365 Northridge Center 1 Suite 400 Atlanta, GA 30350

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-12	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	

Transmittal letters, provider bulletins, and billing instructions
Requests must be made in writing. Include your provider number, address, telephone number, the exact title of the publication, and the date of the issuance.
Claim forms, prior authorization forms (including pharmacy), and other forms and publications
Requests must be made in writing. Include your provider number, address, and telephone number, and the exact title of the form.
Fee schedules
It is helpful if you know the Code of Massachusetts Regulations (CMR) citation that applies to your provider type. There is a charge for each publication. DHCFP also has the regulations available on disk.
ICD-9-CM, CPT, and HCPCS Code Books are available from the following sources:
(Have your credit card ready. In addition, ICD-9-CM Code Books are available from some bookstores.)

MassHealth Publications P.O. Box 9101 Somerville, MA 02145 617-576-4487 (fax) 703-917-4943 (fax) mapublications@unisys.com
MassHealth Forms Distribution P.O. Box 9101 Somerville, MA 02145 617-576-4087 (fax) 703-917-4937 (fax)
State Bookstore State House, Room 116 Boston, MA 02133 617-727-2834
Division of Health Care Finance and
Policy (DHCFP) 2 Boylston Street Boston, MA 02116 617-988-3100 www.mass.gov/dhcfp
Ingenix
13931 Willard Road
Chantilly, VA 20151
1-800-765-6588
801-536-1009 (fax)

American Medical Association Order Department P.O. Box 930876 Atlanta, GA 31193-0876 1-800-771-7199 863-582-6845 (fax)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-13	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Third-Party Liability
Medicare/Senior Plan Updates
The Division’s Medicare Unit maintains the file that identifies Medicare or a Third-Party Liability (TPL) Senior Plan that a member may have. If you receive written evidence (such as a health insurance card) that a member has Medicare or a Senior Plan/Medicare Replacement Policy or has a different insurance than what is listed on the file or no longer has insurance coverage, please send the information to the Medicare Unit. This does not apply to a member whose benefits have been exhausted, only to members who have terminated their enrollment, or transferred to another senior plan.
Mail or fax the insurance information to:	Division of Medical Assistance
Please enclose copies of written evidence, if possible.	Medicare Unit
600 Washington Street Boston, MA 02111 617-210-5080 (fax)
Other Health Insurance
The Division’s TPL Unit maintains the file that identifies other health insurance that a member may have. Other insurance information comes from various sources. If you receive written evidence (such as an explanation of benefits or a letter from an employer) that a member has other health insurance or different insurance than what is listed on the file, or no longer has health insurance coverage, please send the information to the TPL Unit.
Mail or fax the insurance information to:	Division of Medical Assistance
Please enclose copies of written evidence, if possible.	TPL Unit
P.O. Box 9209 Boston, MA 02209 617-357-7604 (fax)
Commercial Explanation of Benefits (EOB)
Home health providers may no longer send the Division a single annual EOB for services denied by a commercial insurer. They must obtain and send an EOB whenever a member with commercial health insurance has a change in medical condition or health-insurance-coverage status. Providers must submit the EOB to the Division within 10 days of receiving notification of denial from the insurer. The EOB must include the member’s MassHealth identification number.
Mail or fax a copy of the EOB to:	Division of Medical Assistance
Benefit Coordination and Recovery Home Health Claims 600 Washington Street Boston, MA 02111 617-210-5080 (fax)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ALL PROVIDER MANUALS	SUBCHAPTER NUMBER AND TITLE
APPENDIX A: DIRECTORY	PAGE
A-14	

	TRANSMITTAL LETTER
ALL-120	DATE
10/01/03	
Vision Care Materials
If you are a vision-care provider and need to check the	MassCor Optical Labs
status of an order for vision-care materials:	P.O. Box 466
Gardner, MA 01440 1-888-482-7331 1-888-420-2047 (fax)