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 185 March 2009 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: NewMMIS Preparation, E-Learning, Trading Partner Testing, and NPI Readiness 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… ¡ Locate the Provider PIN Registration Letter and forward it to your organization’s designated primary user. ¡ Determine who on your staff will need access to the Provider Online Service Center (POSC) and what services they will perform. ¡ Visit and revisit any e-Learning courses that will help you transition your staff and systems to NewMMIS. ¡ Make sure all relevant staff familiarize themselves with new paper and electronic billing guidelines found online in the new companion and billing guides at www.mass.gov/masshealth/newwmmis. ¡ Coordinate your systems with applicable billing intermediaries and software vendors. ¡ Complete trading partner testing. ¡ Continue to check MassHealth’s NewMMIS Web site at www.mass.gov/masshealth/newmmis for critical and timely implementation updates. What you should have already done… ¡ Visited the NewMMIS Web site to learn about access steps to the Automated Voice Response system and the Provider Online Service Center—your two portals to eligibility verification in NewMMIS. ¡ Completed or scheduled trading partner testing to avoid any possible delays in payment at implementation. ¡ Confirmed Internet access for the designated staff and affiliated sources who will be accessing the Provider Online Service Center. ¡ Identified the functions and tasks those individuals will perform. ¡ Ensured that designated staff have completed any e?Learning courses pertinent to daily business and communications with MassHealth. Important Dates ¡ February 23, 2009: PIN registration letters mailed ¡ March 23, 2009: POSC opened for registration only ¡ May 26, 2009: NewMMIS Implementation · Preparation for NewMMIS Is Critical The implementation day for NewMMIS is May 26, 2009. See the announcement on the MassHealth Web site at www.mass.gov/masshealth/newmmis. MassHealth has been reviewing the participation statistics for training and testing for NewMMIS, and is concerned that many providers have not yet taken advantage of the tools and instructions that MassHealth has offered to help providers prepare for the changeover to NewMMIS. These preparation tools include * updated billing guides and companion guides; * trading partner testing; * provider trainings, including e-Learning, which is available 24 hours and day, seven days a week, and can be taken as often as you wish; and * a Web page dedicated to NewMMIS news and information. In addition, MassHealth has issued bulletins, remittance advice messages, and articles in the provider newsletter about NewMMIS. In spite of these efforts, MassHealth is concerned that many providers are not taking the steps necessary to ensure an easy transition to NewMMIS. Serious consequences to effective business operations, including claims processing and payment delays, could result if providers have not taken the necessary steps to prepare their organization for NewMMIS implementation. POSC Registration Update The NewMMIS Provider Online Service Center (POSC) lets MassHealth providers and other MassHealth business partners conduct virtually all of their day-to-day business with MassHealth in one central location from any computer with an Internet connection. The POSC is available 24 hours a day, seven days a week. Providers will be able to use the POSC to verify member eligibility, submit electronic claims, check claim status, request prior authorization and preadmission screening, request PCC referrals, inquire on PCC referrals, and review, print, or download remittance advices and PCC panel reports. Before your organization can use the POSC, you must register to receive your primary user identification (ID) and password. MassHealth mailed NewMMIS security access registration letters (“Provider PIN Registration Letter”) on February 23, 2009, to MassHealth providers and relationship entities who currently have a seven-digit MassHealth provider number. The letter, which was mailed to the providers’ “doing business as” (DBA) address, contains the 10-digit NewMMIS provider ID/service location number that your organization must use to perform transactions on the POSC. The letter also includes a provider identification number (PIN). Providers will need the PIN and their current seven-digit MassHealth ID number to register with the POSC. Since registration requires the PIN, it is imperative that the registration letter be forwarded to the individual who will be responsible for managing security access to the POSC for your organization. Upon receipt of the registration letter, you should perform the following activities before you register. * Identify your organization’s primary user and forward the Provider PIN Registration Letter to that person. * Identify office staff who will need access to the POSC and the services they will perform. * Identify any additional users affiliated with your organization, such as billing intermediaries, who may need access to your provider information on the POSC and the services they will perform. * Review the e-Learning courses and job aids for the POSC on the NewMMIS Web page at www.mass.gov/masshealth/newmmis. On March 23, 2009, MassHealth opened the POSC to providers for registration only. Please use the Step-by-Step Registration Instructions and the Provider Online Service Center Checklist to guide you through the registration process. Links to both of these documents, in addition to some registration scenarios, are available on the MassHealth Web page at www.mass.gov/masshealth/newmmis. Trading Partner Testing Be sure to complete trading partner testing. If you fail to modify and test your systems, there is no guarantee that your organization’s batch transactions will be accepted by NewMMIS for production processing. If you are unable to submit claims, you cannot get paid. MassHealth recently updated all HIPAA transactions for NewMMIS. Billing guides and HIPAA companion guides can be found at www.mass.gov/masshealth/newmmis. It is extremely important that all systems be modified to conform to the new billing procedures and HIPAA standards required to support NewMMIS claims processing. MassHealth has been conducting trading partner testing with providers since September 2008. Direct submitters to MassHealth have been contacted by MassHealth’s Electronic Data Interchange department but a number of trading partners have not submitted test files as scheduled. If you are one of the 300 providers who have been selected to conduct end-to-end, comprehensive testing with MassHealth and have not yet submitted your first test file, you must submit your test file no later than March 31, 2009. If we do not receive your first test file by then, MassHealth will not be able to test your file for comprehensive testing. Untested claim submissions are likely to fail, resulting in an interruption in your revenue stream or slower submission processing. If you cannot successfully submit batch transactions, you may need to bill on paper, use direct data entry (DDE) options, or even enlist the help of a billing intermediary. Please contact HIPAA Support for assistance at hipaasupport@mahealth.net. NPI Readiness Most providers must have their national provider identifier (NPI) on file with MassHealth and use only the NPI in the detail information when submitting claims to NewMMIS. Claims that require NPI and do not contain it will be denied. Providers billing Medicare and MassHealth should use the same NPI number. Providers that are not required to obtain an NPI (classified as “atypical providers”) are described in All Provider Bulletin 164 (May 2007). Atypical providers must use their provider ID/service location, provided in the PIN letter, when submitting their claims to NewMMIS. Special Instructions for Providers with a Single NPI That Corresponds to Multiple MassHealth IDs For providers with a single NPI that corresponds to multiple MassHealth IDs, MassHealth uses the following attributes from the submitted claim to determine the correct provider ID for claims processing and payment. * type of bill (for institutional claims) or place of service (for professional claims) * taxonomy * doing business as address and billing address (street, city, state, and zip) If you are a hospital provider with one NPI billing for both inpatient and outpatient services make sure to use the correct type of bill code to distinguish the services. If you are an organization with different physical locations, enter the doing business as address in Field 33 of the CMS-1500 claim form, or in the appropriate fields for the 837P and 837I HIPAA transactions, so that we can identify the correct location for claims processing and payment. Taxonomy is required on claims only when a single NPI corresponds to multiple provider IDs and other variables, such as type of bill and address, are not unique. We estimate only a small number of providers will need to submit taxonomy on claims. Providers who are not instructed by MassHealth to use taxonomy should not include it on claims. We strongly encourage any provider with a single NPI corresponding to multiple MassHealth numbers to participate in trading partner testing immediately. E-Learning Updates E-Learning courses provide valuable instruction for performing MassHealth provider tasks in NewMMIS. You can take e-Learning courses as many times as you’d like, any time you’d like, from any computer with an Internet connection. MassHealth has recently increased the response time of the enroll, update, and disenroll screens, which should improve the overall e-Learning course experience. In addition, MassHealth has added new job aids to supplement e-Learning courses. At a recent Provider Advisory Group (PAG) meeting, MassHealth received some feedback about why some providers may be reluctant to take advantage of e-Learning as a way of preparing for NewMMIS implementation. MassHealth has posted this feedback in the form of questions and answers on the NewMMIS Web page and hopes these responses may encourage reluctant providers to participate. Visit the NewMMIS Web page at www.mass.gov/masshealth/newmmis to review the feedback questions and answers and complete e-Learning courses. NewMMIS Readiness Requirement Chart MassHealth has developed a NewMMIS Readiness Requirement chart that details the consequences of completing and not completing critical implementation preparation activities. We urge you to review this readiness chart and follow the recommended steps to ensure that you are ready for NewMMIS implementation. The chart is published in the February Feature of the Month at www.mass.gov/masshealth. A link to the Feature of the Month is in the lower-right corner of the screen. 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.