Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Community Health Center Bulletin 57 December 2005 TO: Community Health Centers Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: Changes in REVS Display for Uncompensated Care Pool (UCP) Patients Change MassHealth has changed the way the Recipient Eligibility Verification System (REVS) displays information for UCP patients. Effective immediately, you will see UCP patient information displayed as follows. 1. UCP coverage type changes: * Full Free Care has been changed to Full UCP. * Partial FC has been changed to Partial UCP. 2. UCP helpline phone number change: We have changed the UCP helpline phone number shown in the restrictive message from the local Boston-area number to the statewide toll-free number. The restrictive message will now read: “Uncompensated Care Pool is for certain hospital and CHC services only. For more information, call 877-910-2100.” Please Note: Providers may continue to use the Boston area helpline number, 6179883222, or they may use the toll-free number. Both telephone numbers connect with the UCP helpline, but there is space for only one phone number in the restrictive message. Addition of Six-Month Retroactive UCP Eligibility to REVS Based on feedback from the provider community, MassHealth has enhanced REVS to include information on the six-month retroactive UCP eligibility period for all eligible MassHealth members whose eligibility determination occurred on or after October 1, 2004. Previously, the six-month retroactive period was included only for UCP patients, and not patients who were eligible for both MassHealth and UCP. This enhancement adds the retroactive period for all MassHealth members eligible for “retroactive” coverage by the Pool. The improvement is meant to help UCP providers identify and submit claims to the UCP for Permissible Services, as described in the following regulation: (continued on back) MassHealth Community Health Center Bulletin 57 December 2005 Page 2 Addition of Six-Month Retroactive UCP Eligibility to REVS (cont.) “Providers may submit claims for Permissible Services for the period beginning six months prior to (1) the date that MassHealth eligibility begins as determined by the Office of Medicaid, or (2) if the Provider is processing the application pursuant to 114.6 CMR 12.03(4)(b), the date the Provider determines that the applicant is a Low Income Patient” (114.6 CMR 12.03(5)). The six-month retroactive period is indicated as a new Coverage Type in the REVS display: “RETRO FULL UCP” or “RETRO PARTL UCP.” * Retro Full UCP – This coverage type will be displayed for any date of service that falls within the six months before the eligibility determination date for all full UCP patients and all eligible MassHealth members. Services that occurred on these dates can be billed to the UCP. * Retro Partl UCP – This coverage type will be displayed for any date of service falling within the six months before the determination date for partial UCP patients. Services that occurred on these dates can be billed to the UCP once the patient has met his or her deductible amount. (Please note that due to system limitations, “Partial” was abbreviated to “Partl.”) If a date of service falls before the retroactive billing period, REVS will indicate that the patient is “ineligible” for services. Providers will no longer have to estimate whether a date of service falls within a retroactive period, but can rely on REVS to indicate whether a service can be billed to the UCP. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 6179888974.