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 117
		December 2002

	TO:	All Providers Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	New Options for Claim Status Requests

New Claim Status 	This month the Division of Medical Assistance (Division) is
Request and Response 	scheduled to implement two new options for checking the status
Transaction Options 	of a MassHealth claim (except pharmacy claims):  a PC software method, and a Web-based application.  The new options were developed to meet the Health Insurance Portability and Accountability Act (HIPAA) standards for the Claim Status Request and Response transactions (also known as 276/277 transactions).  Providers may also continue to call MassHealth Provider Services to check claim status; however, all limitations on this method remain in place.

Please view these new claim status options as additional tools to provide you with information regarding the status of your claim, after it has been adjudicated.  Since HIPAA mandates that these transactions use a different and smaller set of edit codes than MassHealth, you will also want to refer to your MassHealth remittance advice when reconciling your accounts.
		
		Enclosed is a Specifications Addendum for the Claim Status
		Request and Response Transaction and a MassHealth Trading Partner Agreement (TPA).  This addendum applies immediately to the new software and Internet options.

Trading Partner	If you would like to start using the PC software and/or the Web-based 
Agreement	application, you must complete a MassHealth TPA, if you have not already done so, and return it to Electronic Data Systems (EDS) at the following address:

		EDS
		ATTN:  Provider Services
		155 Federal Street, 6th Floor
	Boston, MA  02110.

	

Trading Partner	Note that the MassHealth TPA has been revised.  If you already 
Agreement	submitted a signed TPA, you do not have to sign another one.  If you do 
(cont.)	want to sign this updated agreement, submit it to EDS.

The Trading Partner Agreement takes effect when it is signed by you and received by us.  A signature by the Division is not required to make the agreement binding on the Division.  If your facility uses more than one “Pay- to” provider number, a TPA must be signed for each provider number.

New Software for 	Also this month, the Division and EDS are releasing the updated
Eligibility Verification	Recipient Eligibility Verification System (REVS) PC software version 2.1
access method to generate a HIPAA-compliant Eligibility Inquiry and Response Transaction (also known as the 270/271 transactions).  The software allows you to save MassHealth member information, send batch eligibility inquiries, and store them for your records.  

Updated POS Device	MassHealth will soon be updating the eligibility verification Point-of-Service (POS) device access methods to comply with HIPAA standards.  This will be a gradual process that will begin sometime in December and continue throughout the winter of 2003.  Instructions for the new POS device log-in process will be distributed in the monthly report to POS users, and will be posted on the REVS Web site at:  https://www.massrevs.eds.com.

Updated AVR System	The Automated Voice Response (AVR) system will also be updated this winter to comply with HIPAA standards.  A log-in process will be required to gain access.  You will receive more information about this soon.

Eligibility Operator	The Eligibility Operator will also require that callers provide their user ID and password to access REVS data.  This transition will occur in December.  For those users of this emergency back-up option, the Eligibility Operator will inform you of the impending change in December, when you call to verify eligibility.

Summary of Transaction Options 

The table below lists some of the transaction options that have been developed or are being developed to meet the Health Insurance Portability and Accountability Act (HIPAA) standards.  The table includes options by transaction type, the date of availability for use, Trading Partner requirements, and documentation availability, indicated by a  as applicable.  If you have questions about the transactions or documents listed below, call the EDS HelpDesk at 
1-800-462-7738.

Transaction Type	
Transaction Option	
Date Available	
*Trading Partner Agreement Required	
DMA Documentation Available	
				User Guide	Companion Guide
	Instruction Guide	Specifications Addendum	
Eligibility 270/271
	WebREVS 	Aug. 2002	

N/A	
N/A	
	
Eligibility 270/271
	PC Software version 2.1	Dec. 2002	

	
N/A	
	
Eligibility 270/271
	POS	Dec. 2002	

N/A	

Eligibility 270/271
	AVR	Jan. 2003	
	
N/A
	
N/A	

Eligibility 270/271
	Eligibility Operator	Dec. 2002	
	
N/A
	
N/A	
N/A	
	
Claim Status 276/277
	WebREVS	Dec. 2002	

N/A	
N/A	
	
Claim Status 276/277
	PC Software version 2.1	Dec. 2002	

	
N/A	

*Only one Trading Partner Agreement (TPA) needs to be submitted to conduct any transaction. 

Send your completed MassHealth TPA to Electronic Data Systems (EDS) at the following address:

EDS
ATTN:  Provider Services
155 Federal Street, 6th Floor
Boston, MA  02110.