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-158 
June 2008

	TO:	All Providers Participating in MassHealth

	FROM:	Tom Dehner, Medicaid Director 

	RE:	All Provider Manuals (Revised Appendix Y)

Appendix Y has been updated to include new and modified messages that impact members with MassHealth, Commonwealth Care, and Health Safety Net (HSN) coverage. Effective June 2008, these changes will appear on REVS.

Some additional changes have also occurred with regard to copayment requirements for members with HSN coverage. The Division of Health Care Finance and Policy (DHCFP) is temporarily suspending the copayment requirements for medical services described in 114.6 CMR 13.04(6)(a)(2)(b). These include the $5 copayment for an outpatient visit, the $50 copayment for an inpatient admission, and the $50 copayment for an emergency room visit. This policy is necessitated by provider messaging system limitations and is effective immediately. Low-Income patients continue to be responsible for pharmacy copayments in accordance with the regulation. MassHealth anticipates that copayments for medical visits will be implemented in the future. As a result, restrictive messages stating these copayments have been modified to reflect this policy.

Health Safety Net providers should immediately stop charging for and collecting the medical copayments listed above from low income patients. The DHCFP will offer further guidance on processes to address any copayments that may have been collected to date. 

Message No.	Current Message	New Message	What the new Message  means	
186	EXEMPT FROM COPAY ON NON-PHARMACY SERVICES UNDER 130  CMR 450.130(D).
	EXEMPT FROM MASSHEALTH COPAY ON NON-PHARMACY SERVICES UNDER 130  CMR 450.130(D).
	“MassHealth” was inserted to clarify that this is a MassHealth copay, not an HSN copay.	
246	EXEMPT FROM COPAY ON PHARMACY SERVICES UNDER 130  CMR 450.130(D).
	EXEMPT FROM MASSHEALTH COPAY ON PHARMACY SERVICES UNDER 130  CMR 450.130(D).
	“MassHealth” was inserted to clarify that this is a MassHealth copay, not an HSN copay.

	
Message No.	Current Message	New Message	What the new Message  means	
616	NETWORK HEALTH MEMBER. FOR DENTAL SERVICES CALL 1-800-341-8478.  	NETWORK HEALTH MEMBER. FOR DENTAL SERVICES CALL 1-800-341-8478.  FOR VISION SERVICES CALL 1-888-257-1985.	Phone number has been added.	
617	NHP MEMBER. FOR DENTAL SERVICES CALL 1-800-685-9971. FOR VISION SERVICES CALL 1-800-462-5449.	NHP MEMBER. FOR DENTAL SERVICES CALL 1-800-341-8478. FOR VISION SERVICES CALL 1-800-638-3120.	Phone numbers have been updated.	
619	FALLON COMMUNITY HEALTH PLAN MEMBER. FOR DENTAL SERVICES CALL 1-800-868-5200. FOR VISION SERVICES CALL 1-800-868-5200.	FALLON COMMUNITY HEALTH PLAN MEMBER. FOR DENTAL SERVICES CALL 1-800-822-5353. FOR VISION SERVICES CALL 1-800-868-5200.	Phone number has been updated.	
623	NHP MEMBER. FOR VISION SERVICES CALL 1-800-462-5449.	NHP MEMBER. FOR VISION SERVICES CALL 1-800-638-3120.	Phone number has been updated.	
642	PARTIAL HSN DENTAL AVAILABLE. MEMBER WITH 200-250 PERCENT FPL. HSN DEDUCTIBLE IS $41.	PARTIAL HSN DENTAL AVAILABLE. HSN DEDUCTIBLE IS $41.	Modification of text related to FPL.	
643	PARTIAL HSN DENTAL AVAILABLE. MEMBER WITH 250-300 PERCENT FPL. HSN DEDUCTIBLE IS $2,083.	PARTIAL HSN DENTAL AVAILABLE. HSN DEDUCTIBLE IS $2,083	Modification of text related to FPL.	
646	COPAY MAY BE APPLICABLE. FPL IS XXX.X.	COPAY MAY BE APPLICABLE.	Modification of text related to FPL.	
647	HSN MEDICAL AND PHARMACY COPAYS MAY BE APPLICABLE.  FPL IS XXX.X. 	HSN PHARMACY COPAYS MAY BE APPLICABLE.	Modification of text related to FPL and reference to medical copays.	
648	HSN PHARMACY COPAYS MAY BE APPLICABLE. FPL IS XXX.X.	HSN PHARMACY COPAYS MAY BE APPLICABLE.	Modification of text related to FPL. 
	
Message No.	Current Message	New Message	What the new Message  means	
650	N/A	MEMBER ALSO ELIGIBLE FOR COMMCARE: MEMBER MUST ENROLL TO RECEIVE THESE BENEFITS. CALL 1-877-MA-ENROLL (1-877-623-6765).  	Member’s coverage type is MassHealth Limited, but member qualifies for more comprehensive benefits if enrolled with Commonwealth Care.	
651	N/A	NEW MMIS MEMBER ID - 123456789012	Used in REVS to show NewMMIS member ID	

As always, check REVS before performing services.

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.  

More information about Commonwealth Care is available on the MassHealth Web site at 
www.mass.gov/masshealth and on the Connector Web site at www.mass.gov/connector.

More information about Health Safety Net is available on the Division of Health Care Finance and Policy Web site at www.mass.gov/dhcfp. 

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

All Provider Manuals

Pages Y-1 through Y-6

OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)

All Provider Manuals

Pages Y-1 through Y-6 — transmitted by Transmittal Letter ALL-156

REVS Codes and Messages
Important Note: This appendix is available online at www.mass.gov/masshealthpubs. MassHealth will update Appendix Y as needed. Paper copies of this appendix will not be mailed automatically, but can be requested by mailing, faxing, or e-mailing a request to:
MassHealth Publications
P.O. Box 9118
Hingham, MA  02043
Fax:  617-988-8973
E-mail:  publications@mahealth.net
This appendix lists the active Recipient Eligibility Verification System (REVS) 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. 
This appendix also lists other messages that do not have a code associated with them, but are important to be aware of, as they are returned on REVS.
Code	Message
006		NHP MEMBER. FOR MEDICAL SERVICES CALL 1-800-462-5449. FOR BEHAVIORAL HEALTH SERVICES CALL 1-800-414-2820.
011		NHP MEMBER. FOR MEDICAL SERVICES CALL 1-800-462-5449. FOR BEHAVIORAL HEALTH SERVICES CALL 1-800-414-2820.
021		BMC HEALTHNET MEMBER. FOR MEDICAL SERVICES CALL 1-888-566-0010. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-217-3501.
031		PRIOR AUTH REQUIRED ON ALL CARE EXCEPT EMERGENCIES. ESP NORTH SHORE. CALL 781-581-3900 FOR LYNN CLIENTS, 978-837-9479 FOR BEVERLY CLIENTS.
035		DMH CLIENT.
036		PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR EMERGENCIES. CALL ESP OF THE CAMBRIDGE HOSPITAL AT 617-868-6323.
041		PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR EMERGENCIES. CALL ESP AT FALLON AT 508-852-2026.
046		PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR EMERGENCIES. CALL ESP OF UPHAM’S CORNER AT 617-288-0970.
051		PRIOR AUTHORIZATION MANDATORY FOR ALL CARE EXCEPT FOR EMERGENCIES. 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 
1-888-566-0010. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-217-3501.
066		NETWORK HEALTH MEMBER. FOR MEDICAL SERVICES CALL 1-888‑257-1985. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-257-1986.
071		MEMBER ENROLLED IN PROGRAM THAT LIMITS HIM/HER TO 1 PHARMACY. FOR INFORMATION, MEMBER MAY CALL 1-800-841-2900, 8AM-5PM MON-FRI.

Code		Message
075		MEMBER ID MAY HAVE BEEN USED IN THE PAST BY MORE THAN ONE MASSHEALTH MEMBER. VERIFY MEMBER NAME AND BIRTHDATE ON RESPONSE.
096		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.
116	EAEDC (CAT. 04). SERVICES RESTRICTED. SEE 130 CMR 450.106. FOR QUESTIONS, CALL PROVIDER SERVICES AT 1-800-841-2900.
121	DIRECT ALL INQUIRIES ABOUT ELIGIBILITY TO SOCIAL SERVICE WORKER.
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 EXCEPT FOR EMERGENCIES. CALL ESP OF EAST BOSTON AT 617-568-6416.
186		EXEMPT FROM MASSHEALTH COPAY ON NON-PHARMACY SERVICES UNDER 130 CMR 450.130(D).
201	SENIOR CARE OPTIONS. PAYMENT LIMITED TO SCO. AUTHORIZATION NEEDED FOR ALL SERVICES EXCEPT EMERGENCIES. CALL CCA: 1-866-610-2273. 
231	SENIOR CARE OPTIONS. PAYMENT LIMITED TO SCO. AUTHORIZATION NEEDED FOR ALL SERVICES EXCEPT EMERGENCIES. CALL SWH: 1-888-794-7268.
246	EXEMPT FROM MASSHEALTH COPAY ON PHARMACY SERVICES UNDER 130 CMR 450.130(D).
271		MET CAP ON NON-PHARMACY SERVICES UNDER 130 CMR 450.130(C).
281		UNCOMPENSATED CARE POOL IS FOR CERTAIN HOSPITAL AND CHC SERVICES ONLY. FOR MORE INFORMATION, CALL 1-877-910-2100.
306		INDIVIDUAL HAS SUBMITTED AN MBR AND IS NOT ELIGIBLE FOR MASSHEALTH. FOR MORE INFORMATION, CALL 1-800-462-7738.
311	FALLON MEMBER. FOR MEDICAL SERVICES CALL 1-800-868-5200. FOR BEHAVIORAL HEALTH SERVICES CALL 1-888-421-8861. 
366		MET CAP ON PHARMACY SERVICES UNDER 130 CMR 450.130(C).
386		MEDICARE-COVERED SERVICES ONLY.
391	SENIOR CARE OPTIONS. PAYMENT LIMITED TO SCO. AUTHORIZATION NEEDED FOR ALL SERVICES EXCEPT EMERGENCIES. CALL EVERCARE: 1-888-867-5511.
461		PRIMARY CARE CLINICIAN (PCC) PLAN MEMBER. CALL PCC FOR AUTHORIZATION FOR ALL SERVICES EXCEPT THOSE LISTED IN 130 CMR 450.118(J). 

Code		Message
480		BILL MEMBER’S PRIVATE HEALTH INSURANCE. SEE 130 CMR 450.316-317 FOR INFO ON TPL REQS AND PAYMENT LIMITATIONS ON CLAIM SUBMISSIONS.
485		BILL MEMBER’S PRIVATE HEALTH INSURANCE. MASSHEALTH PAYS ONLY FOR COPAYS AND DEDUCTIBLES FOR WELL-CHILD VISITS.
490		DMH CLIENT. NOT ELIGIBLE FOR MASSHEALTH.  
495		Eligible for Premium Assistance only. BILL member's private health insurance. 
500		SPECIAL NHP PROGRAM. CALL NHP AT 1-888-816-6000 FOR AUTHORIZATION FOR ALL SERVICES EXCEPT FAMILY PLANNING, GLASSES, AND MOST DENTAL. 
505		MASSHEALTH COMMONHEALTH MEMBER. FOR QUESTIONS, CALL 
1-800-841-2900. 
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.
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.
595	ELIGIBLE BUT NOT ENROLLED IN MANAGED CARE. SERVICE CANNOT BE BILLED TO MASSHEALTH. MEMBER MUST ENROLL. HSN COVERAGE AVAILABLE.
596	MEMBER ALSO ELIGIBLE FOR ESSENTIAL. MEMBER MUST ENROLL IN MANAGED CARE TO RECEIVE THESE BENEFITS. MEMBER MUST CALL 
800-841-2900.
597	MEMBER ALSO ELIGIBLE FOR BASIC. MEMBER MUST ENROLL IN MANAGED CARE TO RECEIVE THESE BENEFITS. MEMBER MUST CALL 800-841-2900.
601		ELIGIBLE FOR EMERGENCY SERVICES, INCLUDING LABOR AND DELIVERY, UNDER LIMITED WITHOUT COPAY UNDER 130 CMR 450.130(D).
602		FOR ELIGIBILITY DATES AND PAYMENT FOR ALL OTHER PREGNANCY-RELATED SERVICES UNDER HEALTHY START, CALL 1-888-488-9161.
603		ELIGIBLE FOR EMERGENCY SERVICES UNDER LIMITED WITHOUT COPAY UNDER 130 CMR 450.130(D).
604		FOR ELIGIBILITY DATES AND PAYMENT FOR PRIMARY AND PREVENTIVE CARE SERVICES CALL CMSP AT 1-800-909-2677.

Code		Message
605		FOR ELIGIBILITY DATES AND PAYMENT FOR PRIMARY AND PREVENTIVE CARE SERVICES CALL CMSP AT 1-800-909-2677.
606		REIMBURSEMENT FROM THE UNCOMPENSATED CARE POOL NOT ALLOWABLE FOR THIS PATIENT. FOR INFORMATION CALL 617-988-3222 OR 
1-877-910-2100.
608		MEMBER ELIGIBLE FOR MEDICARE PART D. FOR MEMBER ENROLLMENT STATUS OR OTHER INFORMATION CALL 1-800-MEDICARE (1-800-633-4227).
609		YES. MEMBER HAS FULL MEDICAID BENEFITS.
610		NO. MEMBER DOES NOT HAVE FULL MEDICAID BENEFITS.
611		MEMBER IS QUALIFIED MEDICARE BENEFICIARY. SEE 130 CMR 519.010.
612		MEMBER IS SPECIFIED LOW INCOME MEDICARE BENEFICIARY. SEE 130 CMR 		519.011(A).
613	MEMBER IS QUALIFIED INDIVIDUAL BENEFICIARY. SEE 130 CMR 519.011(B).
614	BILL HOSPICE PROVIDER IF SERVICE IS RELATED TO TERMINAL ILLNESS.
615		BMC HEALTHNET PLAN MEMBER. FOR MEDICAL SERVICES CALL 
1-888-566-0008. FOR BEHAVIORAL HEALTH SERVICES CALL 1-866-444-5155.
616		NETWORK HEALTH MEMBER. FOR DENTAL SERVICES CALL 1-800-341-8478. FOR VISION SERVICES CALL 1-888-257-1985.
617		NHP MEMBER. FOR DENTAL SERVICES CALL 1-800-341-8478. FOR VISION SERVICES CALL 1-800-638-3120. 
618		BMC HEALTHNET PLAN MEMBER. FOR DENTAL SERVICES CALL 
1-800-685-9971. FOR VISION SERVICES CALL 1-800-615-1883.
619		FALLON COMMUNITY HEALTH PLAN MEMBER. FOR DENTAL SERVICES CALL 1-800-822-5353. FOR VISION SERVICES CALL 1-800-868-5200.
620		MEMBER ALSO ELIGIBLE FOR COMMONWEALTH CARE. MEMBER MUST ENROLL IN MANAGED CARE TO RECEIVE THESE BENEFITS. CALL 
1-877-MA-ENROLL.
621		MEMBER ENROLLED WITH <Commonwealth Care MCO> PLAN. COVERAGE TO BEGIN <Mon 06>.
622		NETWORK HEALTH MEMBER. FOR VISION SERVICES CALL 1-888-257-1985.
623		NHP MEMBER. FOR VISION SERVICES CALL 1-800-638-3120.
624		BMC HEALTHNET PLAN MEMBER. FOR VISION SERVICES CALL 1-800-615-1883.
625		FALLON COMMUNITY HEALTH PLAN MEMBER. FOR VISION SERVICES CALL 
1-800-868-5200. 
628		COMMONWEALTH CARE PLAN TYPE I. MEMBER DOES NOT HAVE TO PAY A MONTHLY PREMIUM. MEMBER MUST PAY COPAYMENTS FOR PRESCRIPTION DRUGS.

Code		Message
629		COMMONWEALTH CARE PLAN TYPE II. MEMBER DOES NOT HAVE TO PAY A MONTHLY PREMIUM. MEMBER MUST PAY COPAYMENTS FOR SOME SERVICES.
630		COMMONWEALTH CARE PLAN TYPE II. MEMBER MUST PAY A MONTHLY PREMIUM AND COPAYMENTS FOR SOME SERVICES.
631		COMMONWEALTH CARE PLAN TYPE III. MEMBER MUST PAY A MONTHLY PREMIUM AND COPAYMENTS FOR SOME SERVICES.
632		COMMONWEALTH CARE PLAN TYPE IV. MEMBER MUST PAY A MONTHLY PREMIUM AND COPAYMENTS FOR SOME SERVICES.
633		HSN IS FOR CERTAIN HOSPITAL AND CHC SERVICES ONLY. MEMBER HAS SUBMITTED AN MBR AND IS NOT ELIG FOR MASSHEALTH. CALL 
1-877-910-2100.
634		MEMBER MUST ENROLL IN COMMCARE TO RECEIVE THESE BENEFITS. MEMBER MUST CALL 1-877-MA-ENROLL (1-877-623-6765).
635		HSN AVAILABLE.
636		MEMBER IS ALSO ELIGIBLE FOR HSN SECONDARY. SEE 114.6 CMR 13.00 FOR INFO ON HSN REQS.
637 		MEMBER IS HSN SECONDARY. BILL MEMBER’S PRIVATE HEALTH INSURANCE. SEE 130 CMR 450.316-317 FOR INFO ON TPL REQS.
638		PARTIAL HSN AVAILABLE. MEMBER WITH 200-250 PERCENT FPL. HSN DEDUCTIBLE IS $41.
639		PARTIAL HSN AVAILABLE. MEMBER WITH 250-300 PERCENT FPL. HSN DEDUCTIBLE IS $2,083. 
640		HSN NOT AVAILABLE.
641		PARTIAL HSN AVAILABLE.
642		PARTIAL HSN DENTAL AVAILABLE. HSN DEDUCTIBLE IS $41.
643		PARTIAL HSN DENTAL AVAILABLE. HSN DEDUCTIBLE IS $2,083. 
644		HSN DENTAL AVAILABLE
645		PARTIAL HSN DENTAL AVAILABLE
646		COPAY MAY BE APPLICABLE
647	HSN PHARMACY COPAYS MAY BE APPLICABLE. 
648	HSN PHARMACY COPAYS MAY BE APPLICABLE. 
650	MEMBER ALSO ELIGIBLE FOR COMMCARE: MEMBER MUST ENROLL TO RECEIVE THESE BENEFITS. CALL 1-877-MA-ENROLL (1-877-623-6765).
651	NEW MMIS MEMBER ID - 123456789012

Other Messages
This section lists messages returned from REVS that do not have a code associated with them. While they do not have an associated code, these messages are still important when providing services.
Member is Eligible	Member is eligible based on the services and restrictions indicated for the date of service inquired upon.	
Member is Eligible – RID has changed	Member is eligible based on the services and restrictions indicated for the date of service inquired upon. The member ID inquired upon for this member has changed. The new member ID is displayed and should be used for billing purposes.	
Member is Not Eligible	Member is not eligible on date of service inquired upon. Member was eligible for benefits at some time in the 13 months prior to the date of inquiry.	
Member Not Found	Member is not known to REVS.	
Member is Eligible - Use this RID for this Date of Service Only	Member is eligible based on the services and restrictions for the date of service inquired upon. However, the member ID that you need to submit on the claim for payment differs from the member ID that you entered in REVS. Submit the claim with the member ID returned but use the member ID you entered in REVS for future eligibility inquiries.	
PCC Member.  Call (corporate & site name, if applicable) (phone number) for approval. For exceptions see 130 CMR 450.118(J). 	Member is enrolled with a primary care clinician (PCC). The corporate PCC and site PCC (if applicable) names will be displayed. The site PCC phone number will be displayed.	
Duplicate RID. Call 1-800-833-7582 for assistance. 	The member ID entered has been linked to more than one member on REVS. Call the eligibility operator to determine the appropriate member ID to check eligibility.