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 182 February 2009 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Important Updates about 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. Preparation for NewMMIS What you need to do now… .. Prepare your systems for billing paper and electronic claims. .. Complete trading partner testing. .. Coordinate with billing intermediaries and software vendors. .. Prepare your operations for the provider registration process. .. Identify staff in your organization who will require access to the Provider Online Service Center and the functions they will perform. .. Identify other entities that you will share data with or act on your behalf. .. Attend NewMMIS information and education sessions, including e-Learning courses. .. Confirm Internet access for staff who will use the Provider Online Service Center. What you should have already done… .. Started e-Learning courses. .. Started trading partner testing. .. Reviewed billing guides for paper claims. MassHealth is pleased to report that significant progress has been made toward the implementation of the Provider Online Service Center. A new implementation date will be announced as soon as MassHealth is confident that the Provider Online Service Center will be functional when it is opened for you to conduct your day-to-day business with us. Please continue to .. Prepare your systems for billing paper and electronic claims; .. Complete trading partner testing; .. coordinate preparation and development activities with billing intermediaries and software vendors; .. prepare your operations for the provider registration letters; .. identify NewMMIS users and the functions they will perform; and .. attend NewMMIS information and education sessions, including e-Learning courses. Internet Access The Provider Online Service Center is a Web-based application that will require providers and entities (for example, group practices, affiliations, and billing intermediaries) to have access to the Internet in order to conduct business with MassHealth. Providers and entities must have Internet access to use the Provider Online Service Center to verify member eligibility, submit electronic claims, check claim status, request PCC referrals, inquire on PCC referrals, and review, print, or download remittance advices and PCC panel reports. MassHealth strongly recommends that you arrange for Internet access for all staff who will need access to the Provider Online Service Center. Provider Registration Letters Due to the delay in implementation, MassHealth did not mail the NewMMIS registration letters to providers, as described in All Provider Bulletin 181. MassHealth will notify providers when the letters will be mailed. It is imperative, when the registration letter arrives, that it be forwarded to the individual who will be responsible for managing security access to the Provider Online Service Center for your organization. Additional User Access As instructed in All Provider Bulletin 181, you should determine who in your organization will require access to the Provider Online Service Center and what functions they will perform. You should also determine which entities, if any, should be linked to your account to view data and perform functions on your behalf. Take the time now to identify the internal and external users of the Provider Online Service Center and the functions they will perform, so that you are ready when registration opens. You can view various registration scenarios that may help guide you through the registration process at www.mass.gov/masshealth/newmmis. Billing Claims Paper Claims With the implementation of NewMMIS, MassHealth will adopt many industry-standard claim-processing rules for paper claims and will accept only UB-04 and CMS-1500 claim forms. Providers should continue to prepare for the transition to these claim forms for the implementation. Until NewMMIS implementation, providers should continue to submit claims following the current billing guidelines using the current paper claim forms. Electronic Claims NewMMIS will continue to process electronic claims in the form of HIPAA (Health Insurance Portability and Accountability Act) transactions. Providers should continue to prepare for the transition to the NewMMIS Billing Claims specifications in the updated companion guides, which are available on (cont.) the MassHealth Web site at www.mass.gov/masshealthpubs. Click on Provider Library, then on MassHealth Companion Guides. Both the current (legacy) and NewMMIS versions of the companion guides are available on this page. Trading Partner Testing As outlined in All Provider Bulletin 181, MassHealth is currently testing HIPAA batch transactions with providers, software vendors, and billing intermediaries. Participating entities are encouraged to continue the trading partner testing to ensure that they are ready to submit updated HIPAA transactions in the NewMMIS environment. 835 Payment/Advice The NewMMIS 835 payment/advice transaction will be available to Transaction providers to download through the Provider Online Service Center or through Healthcare Transaction Services (HTS). HTS is also known as system-to-system processing. The 835 payment/advice transaction will display the national provider identifier (NPI), or in the case of atypical providers (providers who are not required to obtain an NPI), the 10-digit NewMMIS provider ID/service location number. The current (legacy) seven-digit MassHealth provider number will not be displayed on the 835 transaction. Please make the necessary preparations in your organization to accommodate this HIPAA-compliant 835 transaction. Coordinate with Billing Intermediaries and Software Vendors Providers should continue to communicate with their billing intermediaries and software vendors to be certain that they will be ready for the NewMMIS changes. E-Learning E-Learning (Web-based training courses that you can take as often as you want from any location where you have Internet access) continues to play an important role in helping providers prepare for NewMMIS. It is strongly recommended that all office staff who will conduct business with MassHealth take the appropriate e-Learning courses so that they are prepared for the implementation and the changes it will bring. By taking e-Learning courses now, your staff will be able to familiarize themselves with the Provider Online Service Center well before implementation. They will have sufficient time to practice and become comfortable with the features of NewMMIS. The e-Learning tool is available on the MassHealth Web site at www.mass.gov/masshealth/newmmis. More information about e-Learning is available in the October 2008 Feature of the Month on the MassHealth E-Learning Web site. Go to www.mass.gov/masshealth. Click on Information for MassHealth Providers, then on Feature of the Month. Eligibility Verifications The Provider Online Service Center will allow providers to submit member eligibility requests via direct data entry (DDE) or batch transactions. Providers will also be able to use the Interactive Voice Response System (IVR). MassHealth will discontinue the Eligibility Operator option before NewMMIS implementation. Providers must use one of the above automated solutions to determine member eligibility. New Member ID Numbers MassHealth began reissuing NewMMIS member ID cards this past October. Providers can use the new 12-digit member ID numbers to determine eligibility, but must use the current 10-digit member ID numbers for billing until NewMMIS implementation. Claims containing the new 12-digit member ID number that are billed before NewMMIS implementation will be denied. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at providersupport@mahealth.net, call 1-800-841-2900, or fax your inquiry to 617-988-8974.