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 181 October 2008 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: NewMMIS Important Events and Activities Scheduled for November Preparation for NewMMIS What you need to do now… ¡ Determine which staff will need access to the Provider Online Service Center and what functions they will perform. ¡ Determine which entities should have access to your provider information within the Provider Online Service Center. ¡ If you plan to test your HIPAA batch transactions before NewMMIS implementation, submit your tests according to the testing schedule published in this bulletin. ¡ Check out the MassHealth e-Learning tools on the NewMMIS Web page. ¡ Begin to collect new member numbers. What you should have already done… ¡ Review HIPAA companion guides. ¡ Review the MassHealth CMS-1500 and UB-04 billing guides. ¡ Prepare your system for billing paper and electronic claims. ¡ Coordinate with billing intermediaries and software vendors. ¡ Prepare your operations for implementation. ¡ Establish Internet access for your practice, if you do not already have it. ¡ Attend NewMMIS information and training sessions. ¡ Apply for a national provider identifier (NPI), if required to do so. Important Dates… ¡ November 5, 2008 – Mailing of registration letters containing provider ID/service location and PIN begins ¡ November 14, 2008 – Last day MassHealth will approve HIPAA test files in the current system ¡ December 8, 2008 – Registration for the Provider Online Service Center opens ¡ December 24, 2008 – Last day MassHealth will approve HIPAA test files in NewMMIS before implementation. ¡ January 5, 2009 – Implementation day This bulletin describes the activities that will occur in November 2008, and the tasks providers must perform in preparation for the implementation of NewMMIS. This bulletin applies to all providers, except dental providers who are not oral or maxillofacial surgeons. Dental providers who are not oral or maxillofacial surgeons must contact the MassHealth Dental Customer Service Center at 1-800-207-5019 if they have any questions about MassHealth. continued on next page) Registration for Provider Online Service Center Registration Letters On November 5, 2008, MassHealth will begin mailing NewMMIS registration letters to providers and vendors (known in NewMMIS as “relationship entities”), such as billing intermediaries, who are currently assigned a MassHealth provider or submitter number. The letters will be mailed to active providers at their doing business as (DBA) address. The letter will contain your new provider number, which is a 10-character provider ID/service location that you must use to access services on the NewMMIS Provider Online Service Center. The letter will also contain a personal identification number (PIN) that you must use to register for the Provider Online Service Center. Registration for the Provider Online Service Center opens on December 8, 2008. As suggested at the recent Provider Association Group (PAG) meeting, the following message will be printed in red across the bottom of the envelope containing this important registration letter: MassHealth NewMMIS – Critical Information Enclosed. Please Read! Provider Online Service Center The Web-based Provider Online Service Center will be your primary means for conducting business with MassHealth. Among other services, you will be able to submit claims, request service authorization, download your remittance advices, and if you are a Primary Care Clinician (PCC), download your PCC Panel reports through the Provider Online Service Center. In addition, you will be able to view and request updates to your provider file information online at your convenience, 24 hours a day, seven days a week. In order to use the Provider Online Service Center, you will need a valid user identification (ID) number and password. The PIN, which will be provided in the NewMMIS registration letter, is required for you to register in the Provider Online Service Center the first time the primary user from your organization logs in. After a successful initial login, the primary user will be prompted to change the password. Since the primary user will need the PIN to register, it is imperative that the registration letter be forwarded to the individual who will be responsible for managing security access to the Provider Online Service Center for the organization. A sample registration letter is attached for your reference. MassHealth will explain in a future communication what you should do if the registration letter is misplaced or you do not receive the letter by December 1, 2008. (continued on next page) Registration for Provider Online Service Center (cont.) Additional User Access Upon receipt of the registration letter, you must determine who in your organization will require access to the Provider Online Service Center and what functions they will perform. All services available in the Provider Online Service Center will be listed in the registration letter. You must also determine which entities (for example, group practices, affiliations, and billing intermediaries), if any, should be linked to your account for purposes of sharing data or delegating tasks to be performed by the entity on your behalf. Please coordinate these decisions with internal staff and others before security registration for the Provider Online Service Center opens on December 8, 2008. All additional users in your organization or affiliated with your organization must be assigned subordinate IDs (created by the designated primary user in your organization) in order to gain access to your organization’s information within the Provider Online Service Center. MassHealth has posted some registration scenarios at www.mass.gov/masshealth/newmmis to guide you through the registration process. Once registration opens, please register and begin to set up access to the Provider Online Service Center and coordinate linkages with other organizations as soon as possible. Registering for the Provider Online Service Center and assigning security permissions as soon as possible ensures that you will be prepared to begin using these new services upon implementation. MassHealth has developed a Web-based “Subordinate ID” e-Learning module to walk providers through registration and security for the Provider Online Service Center. This module, which is now available on the MassHealth Web site, is a step-by-step tutorial that providers can view at any time and as often as they want. Before assigning your subordinate IDs, it is important to review the “Subordinate ID” e-Learning module. After completing the “Subordinate ID” e-Learning module, you will have all the necessary information to successfully register in the Provider Online Service Center and set up subordinate IDs according to your organization’s needs. See page 5 of this bulletin for more information about e-Learning. (continued on next page) Trading Partner Testing MassHealth is currently testing Health Insurance Portability and Accountability Act (HIPAA) batch transactions with 300 MassHealth trading partners in preparation for January 2009 implementation. While MassHealth has selected these trading partners to conduct comprehensive testing, the remaining 900+ MassHealth trading partners who want to validate that they have correctly modified their HIPAA batch transactions in accordance with the updated MassHealth companion guides may submit compliance tests to the HIPAA Support Center. To ensure that trading partner transactions are tested before implementation in a timely and efficient manner, MassHealth has developed the following testing schedule. Date 11/14/08 Event Last day MassHealth will approve HIPAA test files in the current system Date 12/24/08 Event Last day MassHealth will approve HIPAA test files in NewMMIS (before implementation) In January 2009, after implementation, MassHealth will resume HIPAA testing. If you currently submit claims on paper or via Provider Claims Submission Software (PCSS) and would like to begin submitting HIPAA batch transactions, please schedule testing after the implementation of NewMMIS. This will ensure that existing HIPAA batch submitters have sufficient access to complete their trading partner testing before implementation. If you are interested in submitting test files to NewMMIS, contact HIPAA Support at hipaasupport@mahealth.net. MassHealth providers who intend to submit HIPAA batch transactions after NewMMIS implementation must coordinate with their software vendors, billing intermediaries, or their own internal technical staff to modify their systems to submit HIPAA transactions in accordance with the NewMMIS companion guides. These companion guides are available on the MassHealth Web site. Go to www.mass.gov/masshealth/newmmis. Updated instructions for paper claims can also be found in the MassHealth Provider Library at www.mass.gov/masshealth. (continued on next page) National Provider Identifier Currently, most MassHealth providers use both a national provider identifier (NPI) and a MassHealth provider number on HIPAA batch transactions. Providers that are not required to obtain an NPI (classified as “atypical providers”) are described in All Provider Bulletin 164 (May 2007). For 837 transactions, the MassHealth provider number is used as the submitter number in the claim header information, and the NPI is used in the body of the claim. The NPI is sometimes used in conjunction with the MassHealth provider number for claims processing and cross-walking in the current system. While you will still be required to include both the NPI and the newly issued provider ID/service location number (submitter number) on all transactions as noted above, the NPI will be the primary identifier in determining which provider is requesting payment for the service. NewMMIS will also rely on taxonomy to assist with the identification of the correct provider ID/service location, when applicable for certain provider types. Atypical providers must use the NewMMIS provider ID/service location in all HIPAA transactions, as this will serve as both the submitter ID number and pay-to provider ID. If you are not classified as an atypical provider and have not yet applied for your NPI, you must do so immediately. For information about applying for an NPI, visit the CMS Web site at http://www.cms.hhs.gov. You may apply at https://nppes.cms.hhs.gov/NPPES/. Once you receive your NPI, you must report it to MassHealth and begin using it on all claims submissions. If you currently have an NPI, but are not actively using it, you must enter your NPI on all current claims. This will ensure that if there is an issue in cross-walking your NPI to your MassHealth provider number, it is identified before NewMMIS implementation. Introducing E-Learning Along with offering various provider outreach implementation trainings, MassHealth will also offer online training opportunities through e- Learning. This training tool will give you the convenience and flexibility to learn about NewMMIS whenever you want and from any location with Internet access. This new tool will play an important role in helping your office prepare for NewMMIS. To ensure an easy transition to NewMMIS, all office staff conducting business with MassHealth must take the appropriate e-Learning courses. The e-Learning tool is now available through the MassHealth Web site at www.mass.gov/masshealth/newmmis by selecting the Register link under the Current MassHealth NewMMIS Provider Training section. More information about the e-Learning tool will be covered in future provider communications and NewMMIS Provider Outreach training sessions. (continued on next page) NewMMIS Web Page and Preparation Activities Checklist 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. MassHealth has posted a NewMMIS Preparation Activities Checklist on the NewMMIS Web page. This simple and efficient checklist gives providers all the steps they can take now to prepare their business for the changes ahead. Providers should continue to check this Web page regularly, as all NewMMIS-related publications and communications will be posted at this location. 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. MassHealth All Provider Bulletin 181 October 2008 Attachment PROVIDER PIN REGISTRATION LETTER Provider Name Address line 1 Address line 2 Provider Identification Number (PIN): NewMMIS Provider ID/Service Location: Current Provider # (first 5 digits only): RE: NewMMIS Provider Registration – Attention: Please forward this memo to the person in your organization who is responsible for managing fiscal affairs or billing, and will administer access to MassHealth’s Provider On-Line Service Center. Dear Provider/Billing entity: Soon MassHealth will implement its Provider On-Line Service Center (POSC). The POSC will allow you to conduct your day-to-day business with MassHealth electronically. You will have the ability to perform the following transactions (as applicable) on the POSC: * Submit & Receive HIPAA batch transactions: 270/271, 276/277, 820, 834, 835, 837P&I and 997 * Professional Claim Direct Data Entry (DDE) * Institutional Claim DDE * Claim Status DDE * Eligibility Verification DDE * PACE/SCO Enrollment * MMQ DDE (Management Minute Questionnaire) * Provider Enrollment and Profile Maintenance * Prior Authorization Request DDE * Pre-Admission Screening Request DDE * Referrals DDE * View Contracts * View Letters/Notifications * View Financial Data * View Metrics & Reports (Remittance advices, PCC Panel reports, etc..) * Submit Feedback (to Customer Services – CST) * Receive Broadcast Messages * Links (to other Mass.gov materials, training registration, form requests) * Security/Administer Account (set up & maintain access to the application for staff & link to other organizations) Please remember that you must submit your NPI on the HIPAA batch transactions once the POSC is implemented. If you are an atypical provider and are not required to use the NPI, please input your NewMMIS PID/SL on your batch transactions. To access the POSC, you need to acquire a user ID & password and use a provider ID & service location number (PID/SL). The provider ID and service location number replaces your current MMIS provider number. While using the POSC you will need to know and utilize this number when performing transactions on the POSC (i.e. view reports, remittance advices, letters, DDE & HIPAA transactions). To get ready to use the POSC you should do the following before implementation: * You should immediately begin to identify those staff members who will require access to the POSC and the function they will perform within POSC. Additionally, it is important that you decide which providers or entities you will link to in order to share data or have them perform services on your behalf (i.e. group practices, affiliations, billing intermediaries). It is important that you coordinate this activity before the Security Registration functionality becomes available. * Establish a POSC primary user ID and password. This primary user ID should be assigned to the person who will be responsible for managing the access to the POSC for your organization. On 12/8/08 use the URL: www.mass.gov/masshealth/providerservicecenter and click Set-Up Security Access to begin the registration process to obtain the primary user ID and password. You will need the PIN number located at the top of this letter to complete the registration process. The person who you selected to be the primary user for your organization must be the person who completes the registration process using the PIN, he/she will be assigned a user ID at the person level. * Change the password. Once the primary user has registered, he/she must go to the Virtual Gateway at https://gateway.hhs.state.ma.us/authn/index.jsp to change his/her password. A series of “I forgot my password” questions under the “Manage My Profile- Authentication Questions” tab must be answered. * Go to the POSC to set up access for your staff and give permission to share data with other entities who conduct business on your behalf. Select the “Administer Account” link to begin this process. * Attention Primary Care Clinician (PCC) Providers: PCC Plan providers can follow the standard PIN registration process to register their sites (Office Locations). However PCCs with more than one site (Office Location) will not have the ability to link all of the Sites until after our final conversion in late December. For those PCC provider offices impacted by this, we, MassHealth, will link those sites manually and will mail the NewMMIS Provider ID/Service Location numbers for those PCC sites to you under separate cover. Additional information on how to set up your access to the POSC is available in the Administer Account e-Learning. It can be accessed at www.mass.gov/masshealth/newmmis/providertraining. If you have any questions about this registration process, please contact the CST at: MassHealth Customer Support 1-800-841-2900 or via email at providersupport@mahealth.net Thank you.