Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	

MASSHEALTH
TRANSMITTAL LETTER ALL-134 
July 2005

	TO:	All Providers Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director

	RE:	All Provider Manuals (Revised Appendix A)

Effective July 1, 2005, MassHealth has expanded and integrated MassHealth customer services for both providers and members.  These expanded services, which include a range of new Web-based self-service options and a consolidated MassHealth Customer Service Center, will dramatically improve the delivery of administrative services to both providers and members.

This letter transmits a revised Appendix A for all provider manuals.  Appendix A is a directory of MassHealth-related addresses, phone numbers, fax numbers, and e-mail addresses.  The updated appendix provides the revised contact information for many MassHealth functions.  

Appendix A is also available on the MassHealth Web site at www.mass.gov/masshealthpubs.  Click on “Provider Library,” then on “Provider Manual Appendices.”  

If you have any questions about the information in this transmittal letter 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.  

NEW MATERIAL
(The pages listed here contain new or revised language.)

All Provider Manuals

Pages A-1 through A-16

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(The pages listed here are no longer in effect.)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-120

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 MassHealth.  This appendix is also available on the MassHealth Web site at www.mass.gov/masshealthpubs.  Click on “Provider Library,” then on “Provider Manual Appendices.”

This directory is organized alphabetically by function.  
Contents

Benefit Plans and Utilization Management
Claims Submission and Resolution
Hearings
Member Eligibility
Payments
Prior Authorization (pharmacy services)
Prior Authorization (non-pharmacy services)
Provider Enrollment and Credentialing
Provider Training
Publications
Third-Party Liability
Vision Care Materials

Benefit Plans and Utilization Management
MassHealth 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)	

Claims Submission and Resolution

MassHealth has contracted with MAXIMUS to receive MassHealth claims, except for pharmacy claims, and to answer providers' questions about the payment of services covered by MassHealth.

MassHealth Customer Services:

If you have questions about claims or MassHealth policy,
or want to request a replacement remittance advice:
	MassHealth
Customer Service
P.O. Box 9118
Hingham, MA  02043
1-800-841-2900
Hours:  Mon. – Fri., excluding holidays
8:00 A.M. – 5:00 P.M.
providersupport@mahealth.net  
	
If you have a question about the status of a claim 	1-800-841-2900
Hours:  Mon. – Fri., excluding holidays
8:00 A.M. – 5:00 P.M.
www.massrevs.eds.com 
	
If you have questions about policies and procedures for 
submitting electronic claims, technical support, or testing 
for HIPAA claims transactions:  	1-800-841-2900
Hours:  Mon. – Fri., excluding holidays
hipaasupport@mahealth.net 
	
After you are approved to submit claims electronically,
upload your HIPAA-compliant electronic claims to the 
Web-Based Transactions page at:	www.mass.gov/masshealth 	
If you have questions about Provider Claim Submission 
Software (PCSS):	1-800-841-2900	
Send original paper claims to:	MassHealth
ATTN:  Originals
P.O. Box 9118
Hingham, MA  02043	
Send paper adjustments of all paid claims to:	MassHealth
ATTN:  Adjustments
P.O. Box 9118
Hingham, MA  02043	

Send paper resubmittals of all denied claims to:	MassHealth
ATTN:  Resubmittals
P.O. Box 9118
Hingham, MA  02043	

Send voids of all claims paid in error to:	MassHealth
ATTN:  Voids
P.O. Box 9118
Hingham, MA  02043	

If you have Medicare/MassHealth claims that do not
cross over systematically, send paper crossover claims to:	MassHealth
ATTN:  Crossover Claims
P.O. Box 9118
Hingham, MA  02043	
Send 90-day waiver requests
for inpatient UB-92 hospital claims only:	MassHealth
ATTN:  90-Day Waivers, Inpatient
600 Washington Street
Boston, MA  02111	
Send 90-day waiver requests for all other claims:	MassHealth
ATTN:  90-Day Waivers
P.O. Box 9118
Hingham, MA  02043	
If you have questions about final deadline appeals before
the Final Deadline Appeals Unit:	MassHealth
ATTN:  Final Deadline Appeals
600 Washington Street
Boston, MA  02111
617-210-5538
fdeappeals@state.ma.us 	

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

ACS Help Desk:	1-866-246-8503
24 hours a day, seven days a week
	
If you have questions about 90-day waiver requests for 
pharmacy claims:

Send the completed form and any pertinent documentation 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)

Send written questions related to claims, MassHealth 
policy, registration for electronic remittance advices, or replacement of a remittance advice to:	
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:	MassHealth
ATTN:  Final Deadline Appeals 
Unit
600 Washington Street
Boston, MA  02111
617-210-5538
fdeappeals@ state.ma.us  	

Hearings

If you have questions about a fair hearing or an 
adjudicatory hearing:	MassHealth
Board of Hearings
2 Boylston Street
Boston, MA  02116
617-210-5800
1-800-655-0338
617-210-5820 (fax)	

Member Eligibility
MassHealth 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 Online 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.
WebREVS
Automated Voice Response (AVR):
	www.massrevs.eds.com 

1-800-554-0042	
Eligibility Operator (24-hour eligibility operator):	1-800-833-7582	
REVS Help Desk:
Answers questions about:
•	REVS access methods (WebREVS, point-of-service, PC software, and automated-voice-response systems)
•	MassHealth cards
•	REVS Provider Manual
•	availability of REVS
•	how to verify eligibility	1-800-462-7738
Hours:  Mon.– Fri., excluding holidays
8:00 A.M. – 5:00 P.M.

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

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:	MassHealth
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
all other changes:	MassHealth
Provider Enrollment and Credentialing
P.O. Box 9118
Hingham, MA  02043
1-800-841-2900
617-988-8974 (fax)
providersupport@mahealth.net	
For replacement of a lost or damaged check:	617-210-5072	

MassHealth payment information is available online.  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.

Prior Authorization (pharmacy services)

Claims for certain drugs submitted through the Pharmacy Online Processing System (POPS) require prior authorization (PA).  Please see Subchapter 4 of your provider manual and the MassHealth Drug List on the MassHealth Web site at www.mass.gov/masshealth.  Click 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:

Note:  Telephone requests for PA will be accepted only in the case of a medical emergency.	MassHealth Drug Utilization Review Program 
P.O. Box 2586
Worcester, MA  01613-2586
1-800-745-7318
1-877-208-7428 (fax)	

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:	MassHealth
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 MassHealth 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): 	617-451-7000
1-800-862-8341
	
PA for independent nurse (after 14 days):	617-451-7176
	
PA for skilled nursing for MassHealth Basic members 
(after 21 days):
	617-451-7132	
MCB PA Unit (after 14 to 21 days, depending on the 
service):	617-727-5550	

Provider Enrollment and Credentialing

MassHealth has contracted with MAXIMUS 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.
You may 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.	MassHealth
Provider Enrollment and Credentialing
P.O. Box 9118
Hingham, MA  02043
1-800-841-2900
Hours:  Mon. – Fri., excluding holidays
8:00 A.M.-5:00 P.M.
617-988-8974 (fax)
providersupport@mahealth.net	
You must 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 9118
Hingham, MA  02043
1-800-841-2900
Hours:  Mon. – Fri., excluding
holidays
8:00 A.M.-5:00 P.M.
617-988-8974 (fax)
providersupport@mahealth.net	

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 9118
Hingham, MA  02043
1-800-841-2900
617-988-8974 (fax)
Hours:  Mon. –  Fri., excluding holidays
8:00 A.M. – 5:00 P.M.
providersupport@mahealth.net	

To apply for managed care or to change your managed 
care information:	MassHealth
Provider Enrollment and Credentialing
P.O. Box 9118
Hingham, MA  02043
1-800-841-2900
617-988-8974 (fax)
Hours:  Mon. – Fri., excluding holidays
8:45 A.M. – 5:00 P.M.
providersupport@mahealth.net	
Provider Training
For all providers, except pharmacy providers, MassHealth has contracted with MAXIMUS 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 9118
Hingham, MA  02043
617-988-8974 (fax)
providersupport@mahealth.net	

For pharmacy providers, MassHealth 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	

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 MassHealth regulations, Subchapter 6 (service codes) of provider manuals that have them, and bulletins are available on the MassHealth Web site at www.mass.gov/masshealthpubs.  

Provider manuals

	MassHealth
Provider Enrollment and Credentialing
P.O. Box 9118
Hingham, MA  02043
1-800-841-2900
617-988-8974 (fax)
Hours:  Mon.– Fri., excluding holidays 
8:00 A.M.-5:00 P.M.
providersupport@mahealth.net
	
REVS provider manuals	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	

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.	MassHealth
Publications
P.O. Box 9118
Hingham, MA 02043
617-988-8974  (fax)
providersupport@mahealth.net	

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.
	
MassHealth
Forms Distribution
P.O. Box 9118
Hingham, MA  02043
617-988-8974 (fax)
	
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.	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	

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.)	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)	

Third-Party Liability

Medicare/Senior Plan Updates

MassHealth’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, 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:
  Please enclose copies of written evidence, if possible.	
MassHealth
Medicare Unit
600 Washington Street
Boston, MA  02111
617-210-5080 (fax)	

Other Health Insurance
MassHealth’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, 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:
Please enclose copies of written evidence, if possible.	MassHealth
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 MassHealth 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 MassHealth 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:	MassHealth
Benefit Coordination and Recovery
Home Health Claims
600 Washington Street
Boston, MA  02111
617-210-5080 (fax)	

Vision Care Materials

If you are a vision-care provider and need to check the 
status of an order for vision-care materials:	MassCor Optical Labs
P.O. Box 466
Gardner, MA  01440
1-888-482-7331
1-888-420-2047 (fax)

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