Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
All Provider Bulletin 104
March 1999

TO:      All Providers Participating in MassHealth

FROM:      Bruce M. Bullen, Commissioner

RE:      PAYMENT FOR THE MEDICARE PART B COINSURANCE AND DEDUCTIBLE

Background                       The information in this bulletin supercedes information about payment of the Medicare Part B coinsurance and deductible contained in All Provider Bulletin 94, dated February 1996.

The Balanced Budget Act of 1997 gives the Division of Medical Assistance the authority to limit payment of Medicare/MassHealth crossover claims up to the Division’s maximum allowable amount.  The Division’s third-party-liability regulations at 130 CMR 450.318 support this payment change.

New Policy                        Effective immediately, the Division’s payment policy has changed both for members who have Medicare coverage in addition to MassHealth, and for Qualified Medicare Beneficiaries who have Medicare coverage only.  The Division will pay Medicare Part B crossover claims up to the Division’s maximum allowable amount less any Medicare payment, or the coinsurance and deductible amount, whichever is less.

Questions                         If you have any questions sbout the information in this bulletin, please contact the Unisys Provider Services Department at (617) 628-4141 or
1-800-325-5231.