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 172 February 2008 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: NewMMIS Key Concepts and Provider Preparation Guidelines Introduction 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 questions about MassHealth. Information about NewMMIS for dental providers will be forthcoming from Doral. MassHealth is hosting a series of upcoming provider trainings to prepare providers for the implementation of MassHealth’s new Medicaid Management Information System (NewMMIS). The new system is scheduled to go live this summer. It is important that you are aware of the changes ahead so that you can better understand and plan for the impact NewMMIS will have on your business. This bulletin outlines the significant changes that providers will experience during the transition to the new system. MassHealth is excited to be rolling out a state-of-the-art system and looks forward to your participation in the training sessions. Upcoming Provider Trainings During the last week in January, MassHealth began conducting the first phase of a statewide training program to prepare providers for the NewMMIS implementation. MassHealth strongly recommends that providers attend trainings offered to ensure that you receive the information necessary to conduct business with MassHealth and understand how best to take advantage of the benefits that NewMMIS will provide. The first training sessions offered will focus on awareness and preparation for the new system. The key concepts described later in this bulletin will be explained comprehensively and other critical preparation recommendations will be provided during these sessions. The second series of trainings, currently scheduled to begin in the spring, will focus on the specific details you will need for member eligibility verification, prior authorization, claims submission, and other important transactions that you conduct with MassHealth. The current dates, times, and locations for these trainings are posted on the MassHealth Web site. Providers may register for the trainings online at www.mass.gov/masshealth. In the Online Services box on the MassHealth home page, click on Register for Provider Training, then on Current Course Offerings. In addition, all providers will receive invitations to the training approximately one month before each series of training sessions. Impact on Your Business NewMMIS will impact the way you currently store and use data within your practice-management systems, software, or databases, and the way you send information to, and receive information from, MassHealth. This bulletin introduces these key concepts. NewMMIS Key Concepts New Provider ID Numbers All current MassHealth provider numbers will be replaced with new system-generated 10-character provider IDs consisting of nine digits and an alpha character to denote the provider’s service location. Example: * John Doe Clinic, 452 Maple Avenue – 123456789A * John Doe Clinic, 65 Elm Street – 123456789B While most providers will use a national provider identifier (NPI) to submit claims and other HIPAA transactions to MassHealth, providers should still become familiar with the NewMMIS ID, as this number will appear on reports produced by MassHealth and the MassHealth remittance advice. In addition, providers will need this number to access the Provider Online Service Center. NPIs will be required for submission of all HIPAA transactions to MassHealth. Providers who are not required to obtain an NPI, for example, some transportation providers, will be required to use the NewMMIS 10-character provider ID number/service location for all interactions with MassHealth. NewMMIS provider IDs will be sent to providers several months in advance of NewMMIS implementation. Detailed instructions about the use of the new provider ID will be provided in future publications and at NewMMIS training sessions. New Member ID Numbers All MassHealth members will receive a new 12-digit MassHealth ID number and a MassHealth ID card before the implementation of NewMMIS. The new member ID numbers will not be based on the member’s social security number. The new member ID number will remain the same, regardless of how many times the member receives a replacement card, moves to another residence, has a change in marital status, or has a gap in MassHealth coverage. MassHealth cards will no longer be issued at the head-of-household level. Each MassHealth member will receive his or her own card. Consolidation of Services With NewMMIS, MassHealth will launch a new Provider Online Service Center that will consolidate Web services available to providers. In addition, PCSS (the MMIS Provider Claims Submission Software), APAS (Automated Prior Authorization System), and REVS (Recipient Eligibility Verification System) will be retired, and their functions will be consolidated into NewMMIS. The consolidation of MassHealth’s various systems will eliminate the possibility of discrepancies among systems and will decrease the number of user ID and password combinations that you need to keep track of to do business with MassHealth. You will need just one user ID and password to verify member eligibility, request prior authorization, and submit claims. You will continue to use a separate user ID and password for the services supported by MassHealth Customer Service, including registering for training, ordering supplies of forms, and requesting nonemergency transportation. Industry-Standard Claims With the implementation of NewMMIS, MassHealth will adopt many industry-standard claim-processing rules. MassHealth will accept for processing only standard UB-04 and CMS-1500 claim forms; it is eliminating its use of all MassHealth-proprietary forms (claim form nos. 4, 5, 7, 9, and 10). Additionally, claims will be processed at the claim level rather than the individual claim line level. NewMMIS will also feature real-time claims processing of non-batch direct data entry (DDE) claims. You will be able to get the status of a claim within minutes after submitting them. As stated above, PCSS will be eliminated and replaced by functionality that will allow providers to submit claims directly via the Provider Online Service Center. The ability to “copy” a claim with DDE as in the current PCSS will be a feature of NewMMIS. Finally, NewMMIS will replace the current 12-digit transaction control number (TCN) with a 13-digit interchange control number (ICN). The ICN will be used the same way that the TCN is used today (that is, as a claim identifier) and is similar in structure. Service-Authorization Numbers NewMMIS will issue 10-character identifiers for service authorizations, but you will no longer need to indicate the number on your claims as NewMMIS features “look-up” functionality. Electronic Attachments NewMMIS will allow electronic attachments. This functionality will replace the claims attachment form (CAF) process and will allow providers to submit electronic attachments with most DDE submissions, including prior (service) authorization requests and claims. What You Can Do Now To ensure that you are ready for the implementation of NewMMIS and are able to take advantage of the system’s new features, you should take the following actions: * register for and attend NewMMIS provider training sessions; * assess your office business procedures and technology to identify how your business office and management system and vendor software may be impacted by the changes outlined in this bulletin; and * ensure that your office and all appropriate staff have access to the Internet. NewMMIS Web Page MassHealth has begun posting information on its Web site about NewMMIS. As additional information and material become available, MassHealth will update the Web page to provide a single source for all information that providers will need for the implementation. You can visit the page directly at www.mass.gov/masshealth/newmmis. Consider bookmarking this page for ease of future reference. Questions If you have any questions about the information in this bulletin, please 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.