Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth All Provider Bulletin 212 May 2011 TO: All Providers Participating in MassHealth FROM: Terence G. Dougherty, Medicaid Director RE: Important Claims Submission Policy Changes Background In January 2011, MassHealth issued All Provider Bulletin 207 (Reduction of Paper Claim Forms), which introduced a paper claims reduction project. As part of this initiative, MassHealth is moving toward an all-electronic claims submission policy to achieve greater efficiency. Electronic Submission Mandate MassHealth intends to require electronic claim submission, unless the provider has an approved waiver, as of January 1, 2012. The related changes to MassHealth regulations will be described in a future transmittal letter. Electronic Submission MassHealth is developing a waiver process similar to the Medicare electronic claims submission waiver policy for those providers who meet certain criteria, such as submitting on average less than 20 paper claims per month. Details on this waiver process will be communicated in a future bulletin. Provider Outreach and Training MassHealth understands that this change may require modifying your internal billing processes and procedures. We will make every effort to assist Training you with this transition through outreach and training. MassHealth will host several information sessions and provider trainings to further assist providers’ transition to all electronic billing. The first four training sessions on direct data entry (DDE) claims submission will be held in the month of July, in Taunton, Holyoke, Tewksbury, and Somerville. Check the Massachusetts Healthcare Training Forum Web site at www.masshealthmtf.org for the latest information on training. Reminder You can use our DDE functionality on the Provider Online Service Center (POSC) to submit claims and attachments. Coordination of benefit claims may be submitted via 837 batch transaction or DDE through the POSC. (continued on next page) MassHealth All Provider Bulletin 212 May 2011 Page 2 Reminder (cont) If you need a vendor to support your electronic submissions, a complete list of vendors who have submitted claims electronically to MassHealth is available on the MassHealth Web site. From the home page, click on Information for MassHealth Providers. Click on MassHealth and HIPAA. Click on Electronic Data Interchange (EDI) and HIPAA Information for Providers. Then click on Vendor List. Questions If you have any questions about the information in this bulletin or need help getting started with electronic claims submission, 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.