Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth All Provider Bulletin 217 September 2011 TO: All Providers Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: Waiver Policy for Claim Submissions Background MassHealth issued All Provider Bulletin 212 (May 2011) to announce an important change in claims submission policy. Beginning January 1, 2012, all MassHealth claims must be submitted electronically unless a provider has an approved waiver. MassHealth billing regulations are being revised to reflect this policy and related waiver provisions. Please note that this does not apply to claims submitted on the American Dental Association claim form. Electronic Waiver Providers must submit all claims electronically unless they have been approved for an electronic claim submission waiver. The MassHealth waiver policy is designed for providers who * have submitted an average of less than 20 claims per month over the previous 12 months; * are experiencing temporary technical difficulties related to upgrading their current billing system or installing a new one; * are experiencing temporary technical difficulties related to testing or interfacing with the MassHealth claims processing system; * do not have Internet access or a computer; * are experiencing a temporary disruption in service, of at least five business days, caused by a natural disaster or utility work; * attest in writing to MassHealth that they employ staff responsible for claims submission who have a disability preventing the submission of electronic claims that cannot be easily mitigated with reasonable accommodation; or * have an extenuating circumstance in which submitting electronic claims would impede their ability to participate in MassHealth. Providers meeting at least one of these criteria can apply for a waiver beginning in November. Providers will be notified on the status of their waiver application within 30 days. Effective January 1, 2012, paper claims may be submitted only if a request for a waiver to the electronic submission policy has been approved by MassHealth. Electronic Waiver Waiver application forms will be available for download from the MassHealth Web site in the fall. Go to www.mass.gov/masshealth and click on the link for MassHealth Provider Forms in the lower right panel of the home page. Providers can also request an application by e-mail at providersupport@mahealth.net, by fax at 617-988-8974, or by calling MassHealth Customer Service at 1-800-841-2900. Reminder You can use our direct data entry (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. If you need a vendor to support your electronic submissions, a complete list of vendors who are submitting 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. Provider Outreach and Training MassHealth understands that the transition to an all-electronic claims policy may require modifying your internal billing processes and procedures. Four outreach and training sessions on DDE claims submission were completed in July. Additional training sessions are being planned, tentatively starting in October. Check the Massachusetts Healthcare Training Forum Web site at www.masshealthmtf.org and sign up for e-mail updates. After training sessions are scheduled, MassHealth Customer Service will also have specific training content, logistics, and registration details. 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.