Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Dental Bulletin 40 December 2008 TO: Oral and Maxillofacial Surgeons Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: NewMMIS Preparation Activities and Rescheduling of NewMMIS Implementation MassHealth has reviewed the NewMMIS project’s status, and has determined that although significant progress has been made toward implementation goals, it is prudent to delay implementation until MassHealth can be more confident that NewMMIS will work correctly when it is implemented. MassHealth is currently evaluating the readiness of NewMMIS, and will realign the preparation and implementation dates based on its review. A new implementation date will be announced once MassHealth has completed its realignment activities. Important Note: This bulletin describes the events and changes that will affect oral and maxillofacial surgeons as a result of NewMMIS implementation. NewMMIS will have minimal impact on the way dental providers who are not oral and maxillofacial surgeons submit their claims. Dental providers who are not oral or maxillofacial surgeons must contact the MassHealth Dental Customer Service Center at 1-800-207-5019 if they have any questions about MassHealth. Billing Changes for NewMMIS To align MassHealth billing procedures with those of other insurers, beginning with the implementation of NewMMIS, MassHealth will revise its billing rules for oral and maxillofacial surgeons. Effective upon NewMMIS implementation, you must submit claims and prior-authorization requests that contain Current Procedural Terminology (CPT) codes to MassHealth, rather than Doral. (continued on next page) Billing Changes for NewMMIS(cont.) Claim Submissions After NewMMIS Implementation Claims to MassHealth (CPT Codes) With the implementation of NewMMIS, you must submit claims billed with CPT codes to MassHealth (not Doral as is the current practice) using any of the following methods: * paper submission using the CMS-1500 claim form; * electronic 837P transaction; or * direct data entry (DDE) using the Web-based Provider Online Service Center. Doral will not process 837P transactions or any claims billed on the CMS-1500 claim form after implementation of NewMMIS. Claims to Doral (CDT Codes) You must continue to submit claims billed with the Current Dental Terminology (CDT) codes to Doral using either of the following methods: * paper submission using the ADA-2006 claim form; or * electronic 837D transaction. MassHealth will not process any 837D transactions or ADA claim forms with CDT codes. Prior Authorization After NewMMIS Implementation Prior-Authorization Requests to MassHealth (CPT Codes) Upon implementation of NewMMIS, when requesting prior authorization for services that are billed with a CPT code, you must submit online through the NewMMIS Provider Online Service Center or via paper using the MassHealth Prior Authorization Request form (PA-1). Refer to Appendix A of your provider manual for the mailing address for prior-authorization forms. Refer to Subchapter 6 of the Dental Manual for prior-authorization requirements. Prior-Authorization Requests to Doral (CDT Codes) When requesting prior authorization for services that are billed with a CDT code, you must continue to submit prior-authorization requests to Doral electronically at www.masshealth-dental.net or on the ADA- 2006 claim form. Refer to the MassHealth Dental Program Office Reference Manual for instructions. (continued on next page) Billing Changes for NewMMIS (cont.) Online Remittance Advice – Internet Access Needed Effective upon implementation of NewMMIS, the MassHealth remittance advice for services that are billed with a CPT code will be available only through the Web-based MassHealth Provider Online Service Center. Remittance advices will not be mailed to providers after the implementation of NewMMIS. You will need Internet access so that you can log in to the Provider Online Service Center and download your remittance advices. NewMMIS Web Page The MassHealth NewMMIS Web page provides a single source for all information that providers will need for implementation. As additional information and materials become available, MassHealth updates the NewMMIS Web page. You can visit the page directly at www.mass.gov/masshealth/newmmis. Please add this page to your favorites (“bookmark” this page) on your Web browser. Questions If you have questions about NewMMIS implementation, contact MassHealth Customer Service at 1-800- 841-2900, or e-mail your inquiry to providersupport@mahealth.net.