Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	
	MassHealth
	Therapist Bulletin 12
	December 2004 

	TO:	Therapists Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director

	RE:	Prior Authorizations Submitted by Therapist Group Practices

Claim Denials for	This bulletin clarifies MassHealth requirements of therapist group 
Provider Number on	practices for requesting prior authorization (PA) for therapy services.
Claim and PA Mismatch	Therapist group practices requesting PA must submit a request
(Error Code 159)	under the individual independent therapist’s MassHealth servicing provider number, and not under the group practice number.  If you have requested a PA using the Automated Prior Authorization System (APAS), and received the PA approved under your group practice provider number, any claims for dates of service on and after April 15, 2004, may have been denied with error code 159, indicating that the provider number on the claim and the provider number on the PA do not match.

Correcting PAs	MassHealth has developed a process for correcting PAs that were submitted through APAS and authorized under the therapy group practice provider number (provider number beginning with 97).  If you have claims that have been denied with error code 159, with dates of service on or after April 15, 2004, you can contact the MassHealth Prior Authorization Unit at 617-451-7060 to request that a new PA be issued with the appropriate individual independent therapist provider number.  When you contact the PA Unit, you must provide: 
•	the original PA number of each PA that needs to be reissued; and 
•	the appropriate independent therapist’s provider number for each PA that needs to be reissued.  

	Once you receive notice that a new PA has been issued, you will be able to resubmit your otherwise payable claims using the new PA numbers on your claims.  You should follow MassHealth standard procedures for resubmitting claims, and make sure that you correct any other errors that may have caused the claim to deny.  If you have questions about how to resubmit claims, contact MassHealth Provider Services at the telephone number listed at the end of this bulletin.  

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Future PA Submissions	Submitting Requests Using APAS
	To ensure that PA requests for therapy services submitted through APAS  are authorized with the independent therapist’s provider number, group practice providers must contact the MassHealth APAS administrator, Ancillary Care Management (ACM), at 1‑866-378-3789, and give ACM a list of the MassHealth provider numbers for all independent therapists that work for the group.  Providers must remember to contact ACM any time a new independent provider is added to the group as a MassHealth provider.

	Submitting Requests on Paper	
	Therapy group practice providers who submit PA requests on paper must enter the independent therapist’s provider number in Item no. 3 of the Prior Authorization Request form.  

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