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 121
	May 2003

	TO:	All Providers Participating in MassHealth

	FROM:	Douglas S. Brown, Acting Commissioner

	RE:	Updated Appendix C and New Carrier Code

Updated Appendix C	The Division has updated Appendix C, Third-Party Liability Carrier Codes, 
on DMA Web Site	for all provider manuals.  Appendix C is listed on the Division’s Web site at www.mass.gov/dma.  Click on “DMA Publications,” then on “Provider Manual Appendices” to view, print, or download this updated appendix.  

	Carrier codes are reported by the Recipient Eligibility Verification System (REVS) to indicate the name and address of the member’s other insurance.  As the Division becomes aware of a member’s potential other insurance, the Division researches the information, and updates the member’s file with the appropriate carrier code as soon as the insurance is verified.  
	
	Providers should use Appendix C to determine the insurance information based on the code reported by REVS.  

New Carrier Code for 	For members who have reported that they have a comprehensive 
Self-Reported Insurance	insurance policy, REVS will indicate Carrier Code 920-00 as preliminary information about a member’s health insurance.  The narrative for Carrier Code 920-00 is “Self-reported insurance.  Ask member for a copy of the insurance card.”  Once the Division verifies the member’s insurance and policy number, the Division will change the carrier code from the temporary code 920-00 to the carrier code and policy number that matches the member’s other insurance.

	For members listed with Carrier Code 920-00, providers must ask to see the member’s other health insurance card, and use the information on the card to bill the other insurance.  If a provider tries to bill MassHealth for a service provided to a member with Carrier Code 920-00, the claim will be denied.  If you are unable to get the other health insurance card from the member, continue to check REVS for the other insurance information.  Once the member’s health insurance information is verified, the Division will change the temporary code 920-00 to the new code.  If the information is not verified within 60 days, Carrier Code 920-00 will be deleted.   

continued on back

Members with Less Than	The Division will now allow MassHealth members who have less than 
Comprehensive Health	comprehensive health insurance policies, for example, dental, vision, or 
Insurance Can Be 	pharmacy-only policies, to enroll in a MassHealth Managed Care 
Enrolled in an MCO	Organization (MCO).  Accordingly, REVS will occasionally report that a member has both a coverage type indicating that he or she is enrolled with a managed care provider and a coverage type and carrier code indicating a less than comprehensive policy. 

	A sample REVS message indicating enrollment in an MCO and dental benefits through a separate policy appears below.

sample:  

Restrictive Message:
Network Health member. Call MCO for approval for all services except routine dental, glasses, family planning. 1-800-257-1985.

Third-Party Liability Information:
     Carrier      policy/HIC          benefits          carrier      policy/HIC         benefits 
     10601       111111111        13                   90356      111111111       19 

Paper Copies of 	The Division will update Appendix C as needed.  The Division will not 
Appendix C 	inform providers when the appendix has been updated.  Providers should check the Web site periodically to determine if they are using the most up-to-date version of Appendix C.  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 9101	
Somerville, MA 02145 
Fax:  617-576-4487
E-mail:  mapublications@unisys.com

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