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 184 February 2009 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: NewMMIS Member Eligibility Verification System and Discontinuation of Eligibility Operator 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… ˇ Determine which staff will need access to the Provider Online Service Center and what functions they will perform. ˇ Determine which entities should have access to your provider information within the Provider Online Service Center. ˇ Begin to collect new member numbers. What you should have already done… ˇ Prepare your operations for implementation. ˇ Establish Internet access for your staff who will use the Provider Online Service Center, if you have not done so already. Important Dates… ˇ March 31, 2009 – Last day for eligibility operator Background With the implementation of MassHealth’s new Medicaid Management Information System (NewMMIS), you will be able to perform most MassHealth activities online 24 hours a day, seven days a week, including eligibility verification. This bulletin describes the changes related to member eligibility verification activities that providers will see leading up to, and including the implementation of NewMMIS. Eligibility Verification System (EVS) As part of the transition to NewMMIS, the Recipient Eligibility Verification will be shut down and replaced by the NewMMIS Eligibility Verification System (EVS), which will be available through the Web-based Provider Online Service Center. The consolidation of MassHealth’s various systems, such as REVS, into NewMMIS will eliminate the possibility of discrepancies among systems and will decrease the number of user ID and password combinations that you will need to keep track of to conduct business with MassHealth. (continued on next page) Internet Access To take full advantage of the benefits of the Provider Online Service Center, including the ability to verify member eligibility, providers will need access to the Internet. MassHealth strongly recommends that you arrange for Internet access for all staff who will need to use the Provider Online Service Center. EVS Features With EVS, providers will be able to verify member eligibility using direct data entry (DDE) and batch submissions through a simple interface available through the MassHealth Web site. The table below compares the eligibility verification features of the current system (REVS) with the features of EVS under NewMMIS. Eligibility Verification Features REVS Today EVS Under NewMMIS History 13 months of eligibility history from the current date of service Search methods Search by * member ID * name * other EOHHS agency ID (for example, IDs beginning with ZZ, X, or Y) Verifying dates of eligibility Verify eligibility one day at a time. Payment responsibility information Limited information available Other insurance information Basic insurance information displayed History Up to four years of eligibility history from the current date of service Search methods Search by * member ID * name (expanded searching capabilities added) * SSN * other EOHHS agency ID (for example, IDs beginning with X or Y) Verifying dates of eligibility Verify eligibility in one- month date ranges (except for the Automated Voice Response (AVR)). Payment responsibility information Expanded member payment responsibility displayed Other insurance information Expanded other insurance information displayed Elimination of Eligibility Operator Effective April 1, 2009, the option of verifying member eligibility via the eligibility operator option will be discontinued. The last day that the eligibility operator will be available will be March 31, 2009. (continued on next page) WebREVS With the implementation of NewMMIS, WebREVS will be replaced with online eligibility verification through the NewMMIS Provider Online Service Center. You will need to register to use the Provider Online Service Center. Information about registration will be sent with the provider PIN (personal identification number) letters and other communications. Once NewMMIS is implemented, the user ID and password you use for REVS will no longer be valid. REVSpc MassHealth is modifying REVSpc so it can support the new system requirements for NewMMIS. Approximately 30 days before NewMMIS implementation, MassHealth will call MassHealth providers who currently use REVSpc to give instructions on how to download the new software. The new software will not work in the current REVS, but you should install it before implementation to ensure that there are no installation issues for your organization. Due to the extent of the changes, any data in the existing version of REVSpc will need to be updated by the provider. The name of REVSpc will be changed to EVSpc to reflect the new version of the software. Automated Voice Response MassHealth is modifying the current AVR system so that it can support the new system requirements for NewMMIS. Unlike the Provider Online Service Center and the EVSpc, providers using the AVR will be able to verify only one day at a time, as they do today, due to the length of the response on the telephone. The phone number for the AVR after NewMMIS implementation will remain 1-800-554-0042. Point-of-Service Devices As described in All Provider Bulletin 178, MassHealth has discontinued the use of point-of-sale devices. System-to-System Verifications Direct system communication (without manual intervention) to verify eligibility will continue to be available, but through a new Web service called Healthcare Transaction Service (HTS). If you currently use an automated verification method today, call the REVS Help Desk at 1-800-462-7738 to learn about the new Web-based eligibility verification service. This feature requires technical staff at your site who understand how to communicate using a Web service and understand Simple Object Access Protocol (SOAP). (continued on back) Access Methods The following table compares the access methods under REVS (the current system) with the access methods under NewMMIS. Eligibility Verification Access Methods REVS Today WebREVS REVSpc Automated Voice Response System Point-of-Service (POS) devices (discontinued) Eligibility Operator (through March 31, 2009, only) System-to-System Verification – Direct communication system to system EVS Under NewMMIS WebREVS will be replaced with the Provider Online Service Center. Enhanced EVSpc Enhanced Automated Voice Response System Enhanced features can be accessed using the Provider Online Service Center. Increased search features in NewMMIS will allow for necessary information to be accessed using the Provider Online Service Center. Healthcare Transaction Web Service (HTS) – Direct communication system to system Help Desk Upon NewMMIS implementation, the existing REVS Help Desk phone number 1-800-462-7738 will no longer be available for use. All questions about eligibility verification after NewMMIS implementation should be directed to MassHealth Customer Service at 1-800-841-2900. 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.