Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA 02111 www.state.ma.us/dma
MassHealth
Nurse Practitioner Bulletin 11
November 2001
TO:       Nurse Practitioners Participating in MassHealth FROM:       Wendy E. Warring, Commissioner
RE:       Elimination of PCC Referral Requirement for Clinical Laboratory Tests

Background

Currently, when a primary care clinician (PCC) refers a plan member to a specialist who then orders clinical laboratory tests, the laboratory must include the member's PCC referral number on the MassHealth claim. This requirement has been a problem for laboratories.

Reduction of
Administrative
Burden

As part of the Division's efforts to reduce administrative burdens for MassHealth providers, the Division has reviewed the PCC referral policy and has determined that PCC referrals will no longer be required for clinical laboratory services.

Elimination of
Referral
Requirement

Effective for dates of service beginning December 1, 2001, the Division will no longer require a PCC referral number on claims for payment of clinical laboratory services provided to MassHealth members enrolled in the PCC Plan.

Questions

If you have any questions about this bulletin, please contact the MassHealth Provider Services Department at 617-628-4141 or 1-800-325-5231.