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
	All Provider Bulletin 114
	January 2002	

	TO:	All Providers Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	PAYMENT FOR THE MEDICARE PART B CROSSOVER CLAIMS REPRICING

	
Background	The purpose of this bulletin is to inform providers of the change in pricing for Medicare Part B crossover claims.

	The information in this bulletin supersedes information about the payment of Medicare Part B crossover claims contained in All Provider Bulletin 110, dated June 2000, and All Provider Bulletin 108, dated February 2000.

	The Division has been paying the full coinsurance and deductible for Medicare Part B crossover claims in accordance with restrictions set by the Legislature in November 1999.  In November 2001, the Legislature removed these restrictions; the Division is now authorized to limit payment of Medicare-MassHealth crossover claims to the Division’s maximum allowable amount less any Medicare payment, or the coinsurance and deductible amount, whichever is less.  The Balanced Budget Act of 1997, as well as the Division’s third-party-liability regulations at 130 CMR 450.318, also give the Division the authority to limit payment of Medicare-MassHealth crossover claims. 	 

New Policy	Effective January 1, 2002, the Division’s payment policy has changed for members who have Medicare coverage in addition to MassHealth.  For all claims received on or after January 1, 2002, 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.  

	

Claims Processing	Changes to the crossover processing system are being made to limit payment to the Division’s maximum allowable amount less any Medicare payment, or the coinsurance and deductible amount, whichever is less.   The Division anticipates that all system changes may not be fully implemented until February 1, 2002.  Any payments made under the Division’s earlier payment policy for claims received on or after January 1, 2002, will be considered overpayments and be subject to recovery by the Division.

Reminder	MassHealth members are not responsible for any Medicare coinsurance or deductible amount.

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