Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth All Provider Bulletin 170 October 2007 TO: All Providers (Except Dental Providers) Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: A New Medicaid Management Information System Is Coming Important Note: This bulletin does not apply to dental providers. Dental providers should contact the MassHealth Dental Customer Service Center at 1-800-207-5019 if they have any questions about MassHealth. NewMMIS with Increased Flexibility MassHealth is pleased to announce plans to implement its new Medicaid Management Information System (“NewMMIS”) in the late summer of 2008. NewMMIS will provide MassHealth with increased flexibility to establish and manage effective benefit-plan structures, implement new payment methodologies, and support the timely delivery of services to MassHealth members. Real-time claims processing and online services will serve to reduce administrative burdens on the provider community. NewMMIS will make a sophisticated array of self-service options available to our providers. As Massachusetts implements a historic expansion of health-insurance options for citizens of the Commonwealth, this new Medicaid system will put MassHealth at the forefront of information technology that supports the health-care industry. As the implementation draws closer, MassHealth will provide more detailed information about NewMMIS through a variety of means, including provider bulletins, the MassHealth Web site, and the MassHealth provider newsletter, Update. NewMMIS will enable both the provider community and MassHealth to shift from a paper-based operation to an electronic-based business model through a variety of e-business tools available through the Web-based NewMMIS Provider Online Service Center. Web-Based NewMMIS Provider Online Service Center To take full advantage of the benefits of the Provider Online Service Center, providers will need access to the Internet. Most functions that will be available through the Provider Online Service Center will have alternate methods for those who do not have access to the Internet. However, one important and commonly used product, remittance advices (RAs), that MassHealth currently provides in a paper format will not be available on paper after the implementation of NewMMIS. In addition, providers should expect that a second commonly used product that is currently available in paper format, the Primary Care Clinician panel report, will not be available on paper. If there is a method developed to provide the PCC panel report on paper, MassHealth will notify providers in a subsequent bulletin. The following services will be available to MassHealth providers through the Provider Online Service Center. Function Enroll as a MassHealth provider and update your MassHealth provider information Description Direct data entry (DDE) and submission of provider enrollment and profile updates Other Methods Available Submit applications and updates on paper. Contact MassHealth Customer Service. Function View your provider contract and related documents (such as the Request for Applications (RFA)) Description View your contract and related provider documents online. Other Methods Available Contact MassHealth Customer Service. Function Verify member eligibility Description Validate eligibility for MassHealth members via DDE or batch transactions. The Recipient Eligibility Verification System (REVS) will be retired. Other Methods Available Verify eligibility via: * PC Eligibility Verification System (EVS); * Interactive Voice Response System (IVR); or * Eligibility Operator. Function Submit claims Description Submit 837 transactions and DDE claims over the Web. PCSS (Provider Claims Submission Software) will be retired. Other Methods Available Submit claims on paper. Function Correct claims Description Edit and resubmit single DDE claims. Other Methods Available Resubmit claims on paper. Function Test claims Description Submit a batch of 837 transaction test claims to verify that they will pass HIPAA compliance and adjudicate correctly. Other Methods Available Submit a disk or electronic file containing test claims. Function Check the status of your claims Description DDE and batch inquiries of claims status Other Methods Available None Function Submit referrals for your MassHealth patients Description DDE submission of provider referrals for members Other Methods Available Submit referrals via PC EVS. Function Request prior authorization Description DDE and batch submission of prior authorization of services for a member Other Methods Available Request prior authorization on paper. Function Request preadmission screening Description DDE submission of a provider’s preadmission screening request Other Methods Available Request preadmission screening on paper. Function Submit Management Minutes Questionnaires (MMQ) Description DDE and batch submission of MMQs Other Methods Available None Function Enroll members in Senior Care Options (SCO) or Program of All-Inclusive Care for the Elderly (PACE) Description DDE and batch submission of a member’s SCO and PACE enrollments Other Methods Available None Function Submit feedback about the Provider Online Service Center Description Submit an e-mail to MassHealth Customer Service with your comments about the Provider Online Service Center. Other Methods Available Call MassHealth Customer Service. Function View broadcast messages Description Read systems messages sent to all providers. Other Methods Available None Function View notices Description Read your specific MassHealth provider letters. Other Methods Available Providers can opt to receive notices via paper or electronic means. Function View metrics and reports Description View your report (for example, top 10 denials, claims volume, PCC panel reports, and remittance advices) online. Other Methods Available None Function View financial data Description View your financial information for a specific period of time (for example, inquire on claims paid and denied amounts by month/year). Other Methods Available None Function View publications Description View MassHealth publications via a link to the MassHealth Web site. Other Methods Available Providers will continue to receive notification of publications according to their preferred method: via e-mail, postcard, or a paper copy of the publication. Function Display FAQs Description Access frequently asked questions about the services on the Provider Online Service Center. Other Methods Available None MassHealth Fall 2007 Provider Forums MassHealth conducted a series of provider forums in September and October 2007, to introduce the benefits and new options that will be available to providers with NewMMIS. Providers who attended the forums learned how they can prepare for the 2008 implementation of NewMMIS and take advantage of the current MassHealth self-service solutions and information sources to prepare for the transition. Materials from the provider forums are posted on the MassHealth Web site at www.mass.gov/masshealth. Click on Information for MassHealth Providers, then on MassHealth Provider Trainings. Future Communications This is just the first of a number of communications that will be issued about NewMMIS. MassHealth will provide additional details, instructions, and assistance over the coming months through its Web site, bulletins, the MassHealth provider newsletter Update, e-mail, and association meetings. Questions If you have any questions about the information in this bulletin, please attend one of the upcoming provider forums. You can also contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.