MassHealth Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth All Provider Bulletin 222 December 2011 TO: All Providers Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: 5010 Implementation Cutover Background On November 17, 2011, the Centers for Medicare & Medicaid Services Office of E-Health Standards and Services (OESS) announced a 90-day delay in enforcing the new 5010 HIPAA transaction standards. That is, CMS will not enforce the new standards until March 31, 2012. This applies to any HIPAA- covered entity and its compliance with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0), and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. Notwithstanding OESS’s discretionary enforcement, the compliance date for use of these new standards remains January 1, 2012. (Small health plans have until January 1, 2013, to comply with NCPDP 3.0.) Based upon this announcement, MassHealth will continue to work toward a January 1, 2012, implementation date in order to comply with the federal mandate. However, we are relaxing the previously communicated testing timelines to allow providers additional time to submit their initial and final test transactions before the implementation date. This means that all trading partners now have until December 16th to submit either their initial or final 5010 test file to MassHealth. Please Note: It is important to submit your test file before December 16, 2011, to ensure sufficient time to process any testing errors that may be encountered. Electronic submitters who cannot transition 5010 test files by January 1, 2012, may alternatively use direct data entry on the Provider Online Service Center (POSC) until they have completed testing. 5010 testing will resume on January 3, 2012. As previously noted, MassHealth will not accept or process any 4010 transactions once it converts to 5010 processing. (continued on next page) MassHealth All Provider Bulletin 222 December 2011 Page 2 Cutover to 5010 Processing MassHealth will cut over to 5010 transaction processing the weekend of December 31, 2011. During this time, most of the services on the POSC and Healthcare Transactions Services system-to-system testing (HTS) will be unavailable to users. To help ensure a smooth transition to the 5010 standards, MassHealth has outlined the following cutover schedule. This schedule includes all critical dates that providers must comply with in order to successfully transition to 5010 standards. Please ensure that your organization is fully aware of these dates, since they will affect a number of your day-to-day operations. Critical Date Affected Functions/Services 12/12/2011 5010 EVSpc software and installation instructions will be available on the MassHealth Web site (www.mass.gov/masshealth/5010). Please install the software on the PCs you use to submit eligibility inquiries when you are ready to transition to 5010 processing. Please work with your IT staff and read the directions carefully to ensure that you do not lose any data during this installation process. Please Note: 5010 EVSpc functionality will not be operational until 01/01/2012. 12/16/2011 This is the last day that MassHealth will accept an initial or final 5010 HIPAA test file from any trading partner before 5010 implementation. 12/29/2011 This is the last day that MassHealth will approve a test file for 5010 processing before 5010 implementation. 12/23/2011 This is the last day that MassHealth will accept any paper claim with 4010 data elements, including claims submitted with 90-day waiver requests. TPL claims received after 5:00 P.M. that do not include the updated 5010 TPL attachment will be returned to the provider. The updated TPL attachments can be found at www.mass.gov/masshealth/5010. 12/30/2011 This is the last day that MassHealth will accept an electronic batch transaction in the 4010 format (includes HTS). All 4010 batch submission services will be shut down at 9:00 P.M. Please ensure that you submit your final 4010 transactions before this date. 12/30/2011 This is the last day that the POSC will be fully operational in the 4010 environment. The POSC will shut down at 9:00 P.M. However, the following functions will be available until 10:00 A.M. on January 1, 2012. • Eligibility inquiry via direct data entry (DDE) and integrated voice response (IVR) • Notification (for example, remittance advices and letters) User security • Reports (top 10 denials, turn around time, etc.) Please ensure that you submit your final 4010 transactions for those affected services before this date. (continued on next page) MassHealth All Provider Bulletin 222 December 2011 Page 3 Cutover to 5010 Processing (cont.) Critical Date Affected Functions/Services 01/01/2012 All POSC services will be unavailable between 10:00 A.M and 6:00 P.M. MassHealth will extend its standard Sunday down time and start it earlier in the day. Please ensure that you execute eligibility transactions before the shutdown. 01/01/2012 This is the first day MassHealth will accept 5010 batch transactions, and support DDE transactions in the 5010 format. Providers may begin to access the POSC and HTS at 6:01 P.M. 01/02/2012 This is the official New Year’s Day holiday for MassHealth. All offices will be closed. It is important that you plan ahead for this holiday closure. If you plan to conduct MassHealth business on this day, please ensure that your offices are prepared to function without call center support services. . All POSC services will be available (including HTS). . Ensure that your staff are prepared to support 5010 processes. . Review job aids to assist with 5010 DDE. . Review billing instructions to assist with paper billing issues. . Review companion guides and other electronic submission requirements to assist with batch transactions. Review all relevant 5010 documentation at www.mass.gov/masshealth/5010. 1/3/2012 This is the first day that MassHealth will process paper claims with the new 5010 data elements. Paper claims will be accepted only from providers who have applied for and have received a paper claims submission waiver from MassHealth. See All Provider Bulletin 217, dated September 2011, for additional information on paper claims submission waivers. 1/3/2012 5010 trading partner testing resumes. It is imperative that you adhere to these dates and make the proper adjustments to your business operations in order to successfully transition to 5010 processing with MassHealth. (continued on next page) MassHealth All Provider Bulletin 222 December 2011 Page 4 Very Important Reminders MassHealth has communicated important 5010 information in all-provider bulletins, information sessions, remittance advice messages, POSC messages, and other media and venues. However, as the 5010 implementation date draws near, it is important to repeat this information to ensure that providers have the details needed to effectively prepare for the MassHealth cutover to 5010 processing. The following is a list of key points to keep in mind. . MassHealth will not process any transactions in the 4010 format after the 5010 standards have been implemented. . As of January 1, 2011, MassHealth will require all claims (including coordination of benefits (COB)) to be submitted in an electronic format, unless the provider has received an approved electronic claims submission waiver. If you currently have difficulty submitting claims electronically, and meet the criteria for a waiver outlined in All Provider Bulletin 217, dated September 2011, please be sure to submit your request for a waiver to: MassHealth Customer Service P.O. Box 9118 Hingham, MA 02043 Additionally, you may fax your request to 617-988-8910, or e-mail providersupport@mahealth.net to ensure that you have the necessary approvals in place before January 1, 2012. • MassHealth strongly encourages electronic claims submitters who currently submit COB claims on paper to submit them via DDE or batch transactions starting January 1, 2012. If you have not yet converted to any of the electronic options noted above, please contact MassHealth immediately to discuss your billing transition. For DDE call 1-800-8412900. For batch transaction processing contact the EDI team at 1-855-2537717 or via email at edi@mahealth.net . If you are an electronic submitter and have not completed trading partner testing, it is imperative that you adhere to the testing timelines in the cutover schedule beginning on page 1 of this bulletin. If you do not submit test files in accordance with the above-listed schedule, there is no guarantee that you will receive approval in time to submit files to MassHealth as of January 1, 2012. Additionally, if you do not complete trading partner testing before the deadline it may affect your cash flow, since MassHealth will not accept any 4010 transactions after it cuts over to 5010 transaction processing on January 1, 2012. (continued on next page) MassHealth All Provider Bulletin 222 December 2011 Page 5 Very Important Reminders (cont.) • If you use EVSpc, please be sure to download the 5010 version of the software since the 4010 version of the software will not be operational after the cutover. Please Note: The software is supported only on Windows XP and Windows Vista. MassHealth strongly discourages providers from using Windows 7 to run EVSpc software. EVSpc software may not function correctly on Windows 7, and MassHealth cannot provide technical support for the product when used with the Windows 7 operating system. . Providers must install EVSpc on the PCs they plan to use to submit eligibility inquiries to MassHealth before implementation to ensure that they can submit transactions on the first day of 5010 processing. Please see All Provider Bulletin 219a for important information about the EVSpc upgrade. . 5010 DDE training sessions are currently being held across the state. If you are interested in attending any of these sessions, contact MassHealth Customer Service at 1-800-841-2900, or e-mail providersupport@mahealth.net for information on how to register for the DDE training sessions. . Please visit the 5010 Web page at www.mass.gov/masshealth/5010 to view job aids and other 5010-related implementation preparation materials. Questions If you have any questions about the information in this bulletin, please contact the MassHealth EDI team at 1-855-253-7717 or via e-mail at edi@mahealth.net.