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 128
		November 2003

	TO:	All Providers Participating in MassHealth

	FROM:	Beth Waldman, Acting Commissioner

	RE:	Implementation of the HIPAA-Compliant Electronic Prior Authorization Request and Response Transaction 

New Electronic	On October 16, 2003, the Division of Medical Assistance (Division) 
Prior Authorization	implemented the HIPAA-compliant 278-Health Care Services Review 
Request and Response	and Response transaction.  
Option
The Division’s solution to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations was to implement an Automated Prior Authorization System (APAS), which enables providers to both submit and receive a response to a prior authorization (PA) request for a medical service or product that requires PA via the Internet, or to submit requests and receive responses in a batch mode via a secure File Transfer Protocol (FTP) method.  APAS also allows providers to attach additional documentation to their request electronically.  When the attachments needed to determine medical necessity cannot be submitted electronically (for example, photographs and X-rays), providers will be instructed by APAS to identify any mailed attachments, which will then be re-associated with the PA request that was submitted through APAS.

Effective December 15, 2003, providers can begin to submit prior authorization requests via APAS.
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Paper Requests	Providers may continue to submit PA requests on paper as they do today.  However, the Division encourages all providers who routinely request prior authorizations to explore the use of this new automated business solution.      
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Transportation and Retail	Providers cannot request authorization for retail pharmacy or
Pharmacy Authorizations	transportation services via APAS. The existing methods for requesting
	authorization for these services remain in place.  
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Requirements 	All MassHealth trading partners must sign a Trading Partner Agreement
	(TPA) before submitting a 278 transaction.  Providers must complete a MassHealth TPA (attached), only if you have not already done so, and return it to the address below.

			MassHealth		
		ATTN:  HIPAA Support Center
		P.O. Box 9101
		Somerville, MA  02145 
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Trading Partner	Providers will also be asked to complete a Trading Partner Profile (TPP) 
Profile (TPP) Form	if you have not already done so.  The purpose of this form is to collect additional data about which HIPAA transactions you will conduct with MassHealth, and to verify contact information for your facility.
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Privacy 	Since APAS employs HIPAA-compliant security for the browser, software and Internet layers, you must log on with a user name and password before submitting or retrieving information.  This information will be supplied to you upon completing APAS training.
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Testing, Training,	Testing is not required for providers who choose to submit prior
and Support	authorization requests via the Internet.  However, providers must contact the MassHealth APAS Support Center to schedule a Web-based conference training session.

	The Division will provide assistance to trading partners who would like to 
	participate in testing activities for the batch transaction. Providers who would like to test, can contact the MassHealth APAS Support Center at the telephone number or e-mail address shown below.
	
MassHealth APAS Training and Support Center
Toll-free Phone:  1-866-378-3789 
Press “1” for the Training and Support Center or “2” for assistance with batch transaction testing. You can also send an email to: support@masshealth-apas.com.
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Questions	If you have any questions about APAS, please contact the MassHealth APAS Support Center at the above telephone number or e-mail address, or visit www.masshealth-apas.com.