Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	
		MassHealth
		Dental Bulletin 28
		February 2003

	TO:	Dental Providers Participating in MassHealth

	FROM:	Douglas S. Brown, Acting Commissioner

	RE:	Implementation of HIPAA-Compliant Electronic Claim Format 

New Electronic Claim 	Beginning March 3, 2003, the Division of Medical Assistance 
Format and 	will begin testing its implementation of the 837 Dental Health Care 
Specifications 	electronic claim format.  The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates implementation of this format by all MassHealth dental providers who submit electronic claims no later than October 16, 2003.

	It is essential that affected dental providers complete testing and     achieve compliance as far in advance of that date as possible.  Our Companion Guide, which should be used in conjunction with the Implementation Guide for 837D, contains MassHealth-specific technical and data-element requirements.  The Companion Guide can be downloaded now from the MassHealth Provider Services Web site at www.mahealthweb.com.  Click on “HIPAA,” then “Testing.” 

Prior to Testing	You must successfully complete the testing process before you can submit claims for processing in the 837 format.  Providers are encouraged to contact their software vendor or billing intermediary to prepare test submissions for MassHealth, if applicable.  A signed Trading Partner Agreement (TPA) is required to be on file before you submit test claims.  You must complete a MassHealth TPA (attached), only if you have not already done so, and return it to MassHealth at the address below.

MassHealth
ATTN:  HIPAA Support Center
P.O. Box 9101
Somerville, MA  02145

Providers who have already completed a MassHealth TPA and returned it to Electronic Data Systems (EDS) do not need to complete a new form.  

	

Testing and Support	Once your TPA is acknowledged and you are ready to begin testing, contact the MassHealth HIPAA Support Center either by telephone at 617-576-4030, or by e-mail at mahipaasupport@unisys.com.  The MassHealth HIPAA Support Center will verify the transactions you will conduct and your readiness dates, and provide you with additional information about the testing process, requirements, and schedule.

Trading Partner	All electronic submitters, including billing intermediaries and
Profile Form	clearinghouses, must complete a MassHealth Trading Partner Profile (TPP) form.  The purpose of this form is to collect additional data about the HIPAA transactions you will conduct with MassHealth, and to verify the contact information for your facility.
		
If you have not already completed the TPP form, contact the MassHealth HIPAA Support Center for assistance. 

Production Claims	Test claims in the 837 Dental format will not be adjudicated in the weekly pay cycle.  You must continue to submit claims for processing in the existing format during the testing period, until you are approved to submit production claims in the 837 format. 

Providers who submit paper claim forms can continue to do so; there are no changes in this process.  However, all providers are encouraged to bill electronically.

Questions	If you have any questions about this, or other HIPAA-related information, contact the MassHealth HIPAA Support Center at 617-576-4030 or by e-mail at mahipaasupport@unisys.com.