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 175 July 2008 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: NewMMIS Service Authorization, Eligibility Verification, and Claims Status Inquiry Introduction As announced in All Provider Bulletin 173, the planned implementation date for the new Medicaid Management Information System (NewMMIS) is September 29, 2008. To prepare providers for this implementation, MassHealth will issue information over the coming months about NewMMIS, its functionality, and how it will improve the efficiency of conducting business with MassHealth. Providers are strongly encouraged to access information about NewMMIS at www.mass.gov/masshealth/newmmis, which will include information about upcoming training opportunities as they become available. MassHealth recommends that providers check this page regularly for new information. This bulletin addresses operational changes and transition activities for service authorizations (including prior authorizations (PA), preadmission screenings, and referrals), eligibility verification (including all current Recipient Eligibility Verification System (REVS) services), and claims- status inquiries. MassHealth hopes the timelines provided in this bulletin will assist you in preparing for NewMMIS implementation. Providers are encouraged to develop internal schedules to complement the timelines announced in this bulletin, to further ease their transition to NewMMIS. (continued on next page) Timeline The events and activities described in this bulletin are general time frames counting down toward NewMMIS implementation. 130 - 170 Days Before Implementation MassHealth has issued All Provider Bulletin 176 to announce that members will begin to receive new MassHealth cards along with instructions about its use. 60 - 90 Days Before Implementation * REVS will begin to display the new 12-digit member ID number in addition to the current 10-character member ID number within the eligibility-verification response. This return of both numbers will allow providers to begin to build a crosswalk of MassHealth member IDs in preparation for NewMMIS implementation. Please note: Providers cannot use the new member ID number for claim submission until implementation. * WebREVS and batch REVSpc (also known as REVScall) will accept inquiries by the new 12-digit member ID number. * MassHealth will begin to issue new ID cards to active MassHealth members along with a letter explaining why they have received a new card and that they can begin using it right away. The new card will contain the 12-digit NewMMIS member identification number. All active MassHealth members will receive their own card. * MassHealth will make available for download the upgraded REVSpc software. Although this software cannot be used until the NewMMIS implementation, this advance availability will allow providers time to access the software and become familiar with the new functions. * REVS point-of-service (POS) devices will be discontinued and providers will no longer be able to use them to verify eligibility. Providers should dispose of the defunct POS devices the same way that they dispose of televisions and computer monitors. Providers who previously used this option should use the Provider Online Service Center once it has been implemented or call MassHealth Customer Service at 1-800-841-2900 to review other options for verifying eligibility. * MassHealth will begin assigning NewMMIS provider and submitter IDs to active providers and billing intermediaries. These IDs will allow providers to register as a primary user for the Provider Online Service Center and allow the primary user to create subordinate IDs and access privileges. (continued on next page) 10 to 20 Days Before Implementation * MassHealth will process the last PA requests using the existing Automated Prior Authorization System (APAS). MassHealth will also stop issuing PA numbers from APAS. APAS will be replaced by a service-authorization function in the NewMMIS Provider Online Service Center. Please Note: The PA process for medications and DME products that are processed by the Pharmacy Online Processing System (POPS) will remain unchanged. * All paper PA requests received 17 days before implementation will be processed in the current PA system (APAS). Providers will not be able to make direct entries into APAS after the close of business on the 18th day before implementation. Seven Days Before Implementation * MassHealth will process the last preadmission-screening (PAS) requests into MassPRO. MassHealth will stop issuing preadmission- screening numbers from the current system. On the next business day, MassHealth will resume online processing of PA requests via the Provider Online Service Center. * PA Requests received 10 to 17 days before implementation will be held and directly data-entered into NewMMIS on the seventh day before implementation. * MassHealth will process the first NewMMIS Eligibility Verification System (EVS) Direct Data Entry (DDE) requests through the Provider Online Service Center. * MassHealth will process the last eligibility requests submitted through REVS. * MassHealth will process the last REVS 270 batch transactions through REVS. * MassHealth will process the first 270 batch transactions through the Provider Online Service Center and system-to-system Healthcare Transaction Service (HTS). * MassHealth will process the last 276 batch transactions through REVS. * MassHealth will accept the first 276 batch transactions for processing through the Provider Online Service Center. * REVS will no longer accept claims-status requests through WebREVS and REVSpc. * MassHealth will accept the first claims-status requests for processing through the Provider Online Service Center via DDE. * MassHealth will process the last interactive voice recognition (IVR) requests through REVS. * MassHealth will process the first IVR requests through the NewMMIS IVR system. * MassHealth will process the first eligibility requests and claims-status requests through the upgraded REVSpc software. (continued on next page) Implementation Day * The REVS Help Desk will no longer be supported. All REVS-related questions will be directed to MassHealth Customer Service at 1-800-841-2900. * MassHealth will accept the first referrals into NewMMIS via the Provider Online Service Center. Seven to 14 Days After Implementation MassHealth will accept DDE claims submissions through the Provider Online Service Center. Implementation Day Through Six Months After Implementation Day To ease transition, MassHealth will continue to accept the PCC’s seven- digit provider number for referrals issued before NewMMIS implementation, for six months after implementation. NewMMIS Web Page MassHealth posts information about NewMMIS on its Web site. As additional information and material become available, MassHealth updates the NewMMIS Web page. The MassHealth NewMMIS Web page provides 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. Please add this page to your favorites (“bookmark” this page) on your Web browser. NewMMIS Training Implementation training information will be forthcoming. Please access training information at www.mass.gov/masshealth and select MassHealth Training Registration under “News and Updates” in the right column. You can download NewMMIS preparation training materials at www.mass.gov/masshealth/newmmis. 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.