Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111	
	MassHealth
	Chronic-Disease and Rehabilitation 
	Inpatient Hospital Bulletin 82
	June 1999

	TO:	Chronic-Disease and Rehabilitation Inpatient Hospitals Participating in MassHealth

	FROM:	Bruce M. Bullen, Commissioner

	RE:	INPATIENT CLAIMS SUBMISSION FOR DUALLY ENTITLED MEMBERS

Background	This bulletin revises procedures for the submission of inpatient claims for dually entitled members (MassHealth members who are also Medicare beneficiaries) for:
			noncovered Medicare Part A services; and
			covered Medicare Part B ancillary services.

Acceptable	Claims for dually entitled members for dates of service on or after 
Attachments	July 1, 1999, must be submitted to Unisys on the UB-92 claim form with an acceptable Medicare Part A and Part B attachment.  

	Acceptable Medicare Part A and B attachments are:
			the Medicare remittance advice; and 
			the Medicare determination letter. 

The hospital Utilization Review (UR) letter is no longer acceptable. 

MassHealth payment of the Medicare Part B coinsurance and deductible will continue to be processed automatically via crossover tape submitted to MassHealth by the Medicare intermediary.  

Billing				You must follow the billing guidelines below when Medicare Part A 
Guidelines			benefits are no longer covered.

		In Item 39 of the UB-92 claim form, enter the appropriate value code 
		(Rate ID) that corresponds to the member’s level of care.

		Enter all charges including Medicare Part B ancillary services and 
		physician services in Items 42 through 47 on the UB-92 claim form.

	

Billing		You must enter in Item 54 (prior payments) on the UB-92 claim
Guidelines		form the sum of the Medicare Part B payment plus the coinsurance 
(cont.)		and deductible amount.  This amount will be deducted from the 
		MassHealth payment. 

		If you are billing for physical, occupational, or speech therapy 
deemed by Medicare to be “maintenance” therapy, enter M in Item 43 (description field) on the UB-92 claim form.  These charges should be indicated on the claim form but should not be indicated in the prior payment field as the facility is not receiving Medicare reimbursement for these services.

Questions		If you have any questions about the billing process, please call the Unisys 
Provider Services Department at (617) 628-4141 or 1-800-325-5231.