Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MASSHEALTH TRANSMITTAL LETTER ALL-138 May 2006 TO: All Providers Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: All Provider Manuals (Revised Appendix A) This letter transmits a revised Appendix A for all provider manuals. Appendix A is a directory of MassHealth-related addresses, phone numbers, fax numbers, and e-mail addresses. MassHealth has revised the address and fax number to which home health agencies must send explanations of benefits (EOB) when a member’s services have been denied by a commercial insurer. This revision is located on page A-19 of the attached directory, under the heading entitled Commercial Explanation of Benefits (EOB). In addition, MassHealth has added a new section entitled Clinical Screenings (Long-Term-Care Services). This section begins on page A-5 and lists the contact information and service areas for the Aging Service Access Points (ASAPs) that perform clinical assessment activities on behalf of MassHealth. Appendix A is also available on the MassHealth Web site at www.mass.gov/masshealthpubs. Click on Provider Library, then on MassHealth Provider Manual Appendices. If you have any questions about the information in this transmittal letter please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) All Provider Manuals Pages A-1 through A-20 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) All Provider Manuals Pages A-1 through A-16 — transmitted by Transmittal Letter ALL-136 This appendix contains the names, addresses, and telephone numbers of units, agencies, and contractors that you may need to contact in the course of doing business with MassHealth. This appendix is also available on the MassHealth Web site at www.mass.gov/masshealthpubs. Click on Provider Library, then on MassHealth Provider Manual Appendices. This directory is organized alphabetically by function. Contents Benefit Plans and Utilization Management A-2 Claims Submission and Resolution A-3 Clinical Screenings for Long-Term-Care Services A-5 Final Deadline Appeals A-10 Hearings A-10 Member Eligibility A-11 Payments A-12 Prior Authorization (pharmacy services) A-13 Prior Authorization (non-pharmacy services) A-14 Provider Enrollment and Credentialing A-15 Provider Training A-16 Publications A-17 Third-Party Liability A-19 Vision-Care Materials A-20 Benefit Plans and Utilization Management MassHealth has entered into agreements with various entities to manage and review the quality and appropriateness of care. If you have questions about the PCC Plan, PCC Plan Network Management Services, or referral requirements: PCC Plan Hotline 1-800-495-0086 (TTY: 617-790-4130 for people with partial or total hearing loss) 617-790-4138 (fax) If you have questions about service authorization or claims for members enrolled in the Behavioral Health Program: 1-800-495-0086 617-790-4185 (fax) If you have questions about the Acute Hospital Utilization Management Program, including: * admission screening; * prepayment review; * OPD PCC review; and * postpayment review: MassPRO 235 Wyman Street Waltham, MA 02451-1231 781-890-0011 and 781-419-2700 For admission screening only: 1-800-732-7337 1-800-752-6334 (fax) For prepayment review only: 781-290-5784 (fax) If you have questions about the Chronic Disease and Rehabilitation Hospital Utilization Management Program, including: * admission screening; * prepayment review; and * postpayment review: For preadmission screening, conversion screening, and concurrent review: MassPRO 235 Wyman Street Waltham, MA 02451-1231 781-890-0011 and 781-419-2700 1-800-554-5127 1-800-752-6334 (fax) Claims Submission and Resolution MassHealth has contracted with MAXIMUS to receive MassHealth claims, except for pharmacy claims, and to answer providers' questions about the payment of services covered by MassHealth. MassHealth Customer Service: If you have questions about claims or MassHealth policy, or want to request a replacement remittance advice: MassHealth ATTN: Customer Service P.O. Box 9118 Hingham, MA 02043 1-800-841-2900 Hours: Mon. – Fri., excluding holidays 8:00 A.M. – 5:00 P.M. providersupport@mahealth.net If you have a question about the status of a claim: 1-800-841-2900 Hours: Mon. – Fri., excluding holidays 8:00 A.M. – 5:00 P.M. www.massrevs.eds.com If you have questions about policies and procedures for submitting electronic claims, technical support, or testing for HIPAA claims transactions: 1-800-841-2900 Hours: Mon. – Fri., excluding holidays hipaasupport@mahealth.net After you are approved to submit claims electronically, upload your HIPAA-compliant electronic claims to the Web-Based Transactions page at: www.mass.gov/masshealth If you have questions about Provider Claim Submission Software (PCSS): 1-800-841-2900 Hours: Mon. – Fri., excluding holidays 8:00 A.M. – 5:00 P.M. providersupport@masshealth.net Send original paper claims to: MassHealth ATTN: Originals P.O. Box 9118 Hingham, MA 02043 Send paper adjustments of all paid claims to: MassHealth ATTN: Adjustments P.O. Box 9118 Hingham, MA 02043 Send paper resubmittals of all denied claims to: MassHealth ATTN: Resubmittals P.O. Box 9118 Hingham, MA 02043 Send voids of all claims paid in error to: MassHealth ATTN: Voids P.O. Box 9118 Hingham, MA 02043 If you have Medicare/MassHealth claims that do not cross over systematically, send paper crossover claims to: MassHealth ATTN: Crossover Claims P.O. Box 9118 Hingham, MA 02043 Send all 90-day waiver requests (except pharmacy claims) to: MassHealth ATTN: 90-Day Waivers P.O. Box 9118 Hingham, MA 02043 If you have questions about final deadline appeals, contact the Final Deadline Appeals Unit at: MassHealth ATTN: Final Deadline Appeals 600 Washington Street Boston, MA 02111 617-210-5538 fdeappeals@state.ma.us MassHealth has contracted with ACS State Healthcare (ACS) to receive MassHealth pharmacy claims and answer providers’ questions about the Pharmacy Online Processing System (POPS). ACS Help Desk: 1-866-246-8503 24 hours a day, seven days a week If you have questions about 90-day waiver requests for pharmacy claims: Fax the completed 90-day waiver form and any pertinent documentation to: ACS Help Desk 1-866-246-8503 1-866-556-9315 (fax) Send written questions related to claims, MassHealth policy, registration for electronic remittance advices, or replacement of a remittance advice to: ACS State Healthcare ATTN: MassHealth 260 Franklin St., Suite 1020 Boston, MA 02110 masshealth.providerrelations@acs-inc.com Clinical Screenings for Long-Term-Care Services The following Aging Service Access Points (ASAPs) perform clinical eligibility screening activities for certain long-term-care services and programs (adult day health, home health, nursing facility, and Program of All-inclusive Care for the Elderly (PACE)) and review prior-authorization (PA) requests for personal emergency response systems (PERS) for MassHealth members of all ages. Please send the applicable clinical documentation or PA request to the ASAP serving the town in which the member lives. Clinical eligibility screening requests must be reviewed by the applicable ASAP before a MassHealth member can be served by the community long-term-care programs identified above. Clinical approval is a prerequisite for MassHealth payment. ASAP Service Area BayPath Elder Services, Inc. 354 Waverly Street Framingham, MA 01702 1-800-287-7284 or 508-872-1866 Fax: 508-872-3325 Ashland, Dover, Framingham, Holliston, Hopkinton, Hudson, Marlborough, Natick, Northborough, Sherborn, Southborough, Sudbury, Wayland, Westborough Boston Senior Home Care 110 Chauncy Street Boston, MA 02111 617-451-6400 Fax: 617-451-6631 Beacon Hill (West End), Charlestown, Chinatown, Columbia Point, Dorchester, East Boston, East Mattapan, North End, South Boston Bristol Elder Services, Inc. 182 North Main Street Fall River, MA 02720 508-675-2105 Fax: 508-679-0320 Attleboro, Berkley, Dighton, Fall River, Freetown, Mansfield, Norton, Raynham, Rehobeth, Seekonk, Somerset, Swansea, Taunton, Westport Central Boston Elder Services 2315 Washington Street Boston, MA 02119 617-277-4641 Fax: 617-277-2005 Allston, Back Bay, Brighton, Fenway, Jamaica Plain, North Dorchester, Parker Hill, Roxbury Chelsea/Revere/Winthrop Elder Services 100 Everett Ave, #10 Chelsea, MA 02150 617-884-2500 Fax: 617-884-7988 Chelsea, Revere, Winthrop Coastline Elderly Services 1646 Purchase Street New Bedford, MA 02740 508-999-6400 Fax: 508-993-6510 Acushnet, Dartmouth, Fairhaven, Gosnold, Marion, Mattapoisett, New Bedford, North Dartmouth, Rochester ASAP Service Area Elder Services of Berkshire County, Inc. 66 Wendell Avenue Pittsfield, MA 01201 413-499-0524 Fax: 413-442-6443 Adams, Alford, Becket, Cheshire, Clarksburg, Dalton, Egremont, Florida, Great Barrington, Hancock, Hinsdale, Lanesborough, Lee, Lenox, Monterey, Mount Washington, New Ashford, New Marlborough, North Adams, Otis, Peru, Pittsfield, Richmond, Sandisfield, Savoy, Sheffield, Stockbridge, Tyingham, Washington, West Stockbridge Elder Services of Cape Cod & the Islands 68 Route 134 South Dennis, MA 02660 1-800-244-4630 (on Cape Cod) 1-800-442-4492 (off Cape Cod) 508-394-4630 Fax: 508-394-3712 Barnstable, Bourne, Brewster, Buzzards Bay, Centerville, Chatham, Chilmark, Dennis, Eastham, Edgartown, Falmouth, Gay Head, Harwich, Hyannis, Mashpee, Nantucket, Oak Bluffs, Orleans, Provincetown, Sandwich, Tisbury, Truro, Vineyard Haven, Wellfleet, West Tisbury, Yarmouth Elder Services of Merrimack Valley, Inc. 360 Merrimack Street Building 5 Lawrence, MA 01843-1740 1-800-892-0890 or 978-683-7747 Fax: 978-687-1067 Amesbury, Andover, Billerica, Boxford, Chelmsford, Dracut, Dunstable, Georgetown, Groveland, Haverhill, Lawrence, Lowell, Merrimack, Methuen, Newbury, Rowley, Salisbury, Tewksbury, Tyngsborough, Westford, West Newbury Elder Services of Worcester Area, Inc. 411 Chandler Street Worcester, MA 01602 1-800-243-5111 or 508-756-1545 Fax: 508-754-7771 Auburn, Barre, Boylston, Grafton, Hardwick, Holden, Leicester, New Braintree, Oakham, Paxton, Rutland Shrewsbury, West Boylston, Worcester ETHOS 555 Amory Street Jamaica Plain, MA 02130-2672 617-522-6700 Fax: 617-524-2899 Hyde Park, Roslindale, South Jamaica Plain, West Mattapan, West Roxbury Franklin Country Home Care Corporation 330 Montague City Road, Suite 1 Turners Falls, MA 01376-2530 1-800-732-4636 or 413-773-5555 Fax: 413-772-1084 Ashfield, Athol, Benardston, Buckland, Charlemont, Colrain, Conway, Deerfield, Erving, Gill, Greenfield, Hawley, Heath, Leverett, Leyden, Monroe, Montague, New Salem, Northfield, Orange, Petersham, Phillipston, Rowe, Royalston, Shelburn, Warwick, Wendell, Whately Greater Lynn Senior Services 8 Silbee Street Lynn, MA 01901 1-800-594-5164 or 781-599-0110 Fax: 781-592-7540 Lynnfield, Lynn, Nahant, Saugus, Swampscott ASAP Service Area Greater Springfield Senior Services, Inc. 66 Industry Avenue Springfield, MA 01104-4243 1-800-649-3641 or 413-781-0632 Fax: 413-781-0632 Agawam, Brimfield, East Longmeadow, Hampden, Holland, Longmeadow, Monson, Palmer, Springfield, Wales, West Springfield, Wilbraham HESSCO Elder Services One Merchant Street Sharon, MA 02067-1662 781-784-4944 Fax: 781-784-4922 Canton, Dedham, Foxborough, Medfield, Millis, Norfolk, Norwood, Plainville, Sharon, Walpole, Westwood, Wrentham Highland Valley Elder Services, Inc. 320 Riverside Drive, Suite B Florence, MA 01062 1-800-322-0551 or 413-586-2000 Fax: 413-584-7076 Amherst, Blandford, Chesterfield, Chester, Cummington, Easthampton, Goshen, Granville, Hadley, Hatfield, Huntington, Middlefield, Montgomery, Northampton, Pelham, Plainfield, Russell, Southampton, Southwick, Tolland, Westfield, Westhampton, Williamsburg, Worthington Minuteman Senior Services 24 Third Avenue Burlington, MA 01803 781-272-7177 Fax: 781-229-6190 Acton, Arlington, Bedford, Boxborough, Burlington, Carlisle, Concord, Harvard, Lexington, Lincoln, Littleton, Maynard, Stow, Wilmington, Winchester, Woburn Montachusett Home Care Corporation 680 Mechanic Street, S-120 Leominster, MA 01453-4402 1-800-734-7312 or 978-537-7411 Fax: 978-537-9843 Ashburnham, Ashby, Ayer, Berlin, Bolton, Clinton, Fitchburg, Gardner, Groton, Hubbardston, Lancaster, Leominster, Lunenberg, Pepperell, Princeton, Shirley, Sterling, Templeton, Townsend, Westminster, Winchendon Mystic Valley Elder Services 19 Riverview Business Park 300 Commercial Street Malden, MA 02148-7312 781-324-7705 Fax: 781-324-1369 Everett, Malden, Medford, Melrose, North Reading, Reading Stoneham North Shore Elder Services 152 Sylvan Street Danvers, MA 01923 978-750-4540 Fax: 978-750-8053 Danvers, Marblehead, Middleton, Peabody, Salem ASAP Service Area Old Colony Elderly Services, Inc. 144 Main Street Brockton, MA 02301-4099 1-800-242-0246 or 508-584-1561 Fax: 508-584-6005 Abington, Avon, Bridgewater, Brockton, Carver, Duxbury, East Bridgewater, Easton, Halifax, Kingston, Pembroke, Hanover, Hanson, Lakeville, Marshfield, Middleborough, North Easton, Plymouth, Plympton, Rockland, Stoughton, Wareham, West Bridgewater, Whitman Senior Care, Inc. 5 Blackburn Center Gloucester, MA 01930-2259 978-281-1750 Fax: 978-281-1753 Beverly, Essex, Gloucester, Hamilton, Ipswich, Manchester, Rockport, Topsfield, Wenham Somerville-Cambridge Elder Services 61 Medford Street Somerville, MA 02143-3429 617-628-2601 Fax: 617-628-1085 Cambridge, Somerville South Shore Elder Services 159 Bay State Drive Braintree, MA 02184 781-848-3910 or 718-749-6832 Fax: 617-843-8279 Braintree, Cohasset, Hingham, Holbrook, Hull, Milton, Norwell, Quincy, Randolph, Scituate, Weymouth Springwell 125 Walnut Street Watertown, MA 02472 617-926-4100 Fax: 617-926-9897 Belmont, Brookline, Needham, Newton, Weston, Waltham, Watertown, Wellesley Tri-Valley Elder Services, Inc. 10 Mill Street Dudley, MA 01571 1-800-286-6640 Fax: 508-949-6651 Bellingham, Blackstone, Brookfield, Charlton, Douglas, Dudley, East Brookfield, East Douglas, Franklin, Hopedale, Medway, Mendon, Milford, Millville, Northbridge, North Brookfield, Oxford, Southbridge, Spencer, Sturbridge, Sutton, Upton, Uxbridge, Warren, Webster, West Brookfield, Whitinsville WestMass Elder Care, Inc. 4 Valley Mill Road Holyoke, MA 01040 1-800-462-2301 or 413-538-9020 Fax: 413-538-6258 Belchertown, Chicopee, Granby, Holyoke, Ludlow, South Hadley, Ware Adult Foster Care and Group Adult Foster Care Services The following ASAP performs clinical eligibility screening activities for the Adult Foster Care (AFC) and Group Adult Foster Care (GAFC) programs. Please send the applicable clinical documentation for all members seeking these services to: Coastline Elderly Services 1646 Purchase Street New Bedford, MA 02740 508-999-6400 Fax: 508-993-6510 Clinical eligibility screening requests must be reviewed by Coastline Elderly Services before a MassHealth member can be served by an AFC or GAFC program. Clinical approval is a prerequisite for MassHealth payment. Nursing Facility Services For all individuals seeking admission to a nursing facility, regardless of payor, who have a diagnosis of, or are suspected of having, mental illness, mental retardation, and/or development disability, a Level II Preadmission Screening (PAS) is required before admission to a nursing facility. For MassHealth members or applicants who have a mental illness and are seeking admission to a nursing facility call the Department of Mental Health’s designee, HES at: HES 978-745-2440, Ext. 126 For MassHealth members or applicants who have mental retardation and/or developmental disabilities, and are seeking admission to a nursing facility, contact the Department of Mental Retardation for the Level II Preadmission Screening and Annual Resident Review (PASARR): Referrals: 1-800-649-9378 To report admission: 617-624-7796 (Must be done on day of admission.) Fax page 1 of Level II PAS to: 617-624-7557 (Must be done within 48 hours of admission.) Final Deadline Appeals If the service date on the claim exceeds 12 months (or 18 months, if another insurer is involved), and has received a final deadline exceeded error code (888), submit your appeal to: MassHealth ATTN: Final Deadline Appeals 600 Washington Street Boston, MA 02111 617-210-5538 fdeappeals@state.ma.us Hearings Applicants, members, and/or appeal representatives with questions about a fair hearing, and providers with questions about an adjudicatory hearing, should contact: Board of Hearings MassHealth 2 Boylston Street Boston, MA 02116 617-210-5800 1-800-655-0338 617-210-5820 (fax) Member Eligibility MassHealth has contracted with Electronic Data Systems (EDS) to maintain and monitor the MassHealth Recipient Eligibility Verification System (REVS). This system provides 24-hour access to member eligibility information for the previous 12 months. Be sure to have the member’s card, MassHealth identification number, or name and date of birth when making eligibility inquiries. REVS access methods require a user ID and password. If you have not submitted a Trading Partner Agreement, you cannot access REVS. ACS, the contractor responsible for operating the Pharmacy Online Processing System (POPS), receives the same MassHealth member eligibility information as EDS. The pharmacy claim-adjudication process at ACS includes the same eligibility verification that is available through REVS. Therefore, it is not necessary for retail pharmacists to separately validate member eligibility for pharmacy claims through REVS. WebREVS Automated Voice Response (AVR): www.massrevs.eds.com 1-800-554-0042 Eligibility Operator (24-hour eligibility operator): 1-800-833-7582 REVS Help Desk: Answers questions about: * REVS access methods (WebREVS, point-of-service, PC software, and automated-voice-response systems) * MassHealth cards * REVS User Guides * availability of REVS * how to verify eligibility 1-800-462-7738 Hours: Mon. – Fri., excluding holidays 8:00 A.M. – 5:00 P.M. REVSHelpDesk@eds.com Send correspondence to: EDS MassHealth 155 Federal Street, 6th Floor Boston, MA 02110 617-350-8180 (fax) If members have questions about MassHealth, they should call MassHealth Customer Service at: 1-800-841-2900 (TTY: 1-800-497-4648 for people with partial or total hearing loss) Payments Providers are encouraged to receive MassHealth payments by electronic funds transfer (EFT). To receive payments by EFT, you must complete the Authorization for Electronic Funds Transfer (EFT) of MassHealth Payments form. The authorization form is available for download from our Web site at www.mass.gov/masshealth. Click on Information for MassHealth Providers, and then MassHealth Provider Forms. Your EFT request will not be approved unless you have a W-9 form on file. The W-9 form can also be downloaded from the Web according to the above guidelines. Send the completed EFT form (and W-9 form, if applicable) to: If you have questions about W9 or EFT form completion: MassHealth Provider Enrollment and Credentialing P.O. Box 9118 Hingham, MA 02043 1-800-841-2900 617-988-8974 (fax) providersupport@mahealth.net For replacement of a lost or damaged check: 617-210-5072 MassHealth payment information is available online. You may access the amount of your check or EFT by going to the Office of the State Comptroller’s Web site at www.mass.gov/massfinance. Go to VendorWeb and follow the instructions. Prior Authorization (pharmacy services) Claims for certain drugs submitted through the Pharmacy Online Processing System (POPS) require prior authorization (PA). Please see Subchapter 4 of your provider manual and the MassHealth Drug List on the MassHealth Web site at www.mass.gov/masshealth. Click on MassHealth Drug List. Other claims will be denied because of certain drug utilization review (DUR) edits. When appropriate, the pharmacist should discuss the medical necessity of prescribing such drugs with the prescriber before calling for DUR certification. Use the following telephone and fax numbers to request DUR certification or to check on the status of your pharmacy PA request if you have not received a response within 24 hours. If you have not received a response within 24 hours, the pharmacist may provide a 72-hour supply of a requested covered drug. University of Massachusetts Medical Center: 1-800-745-7318 1-877-208-7428 (fax) Send requests for all drugs that require PA to: Note: Telephone requests for PA will be accepted only in the case of a medical emergency. MassHealth Drug Utilization Review Program P.O. Box 2586 Worcester, MA 01613-2586 1-800-745-7318 1-877-208-7428 (fax) Prior Authorization (non-pharmacy services) Some services need prior authorization (PA). These items are identified in Subchapters 4 and 6 of your provider manual. Submit electronic PA requests using the Automated Prior Authorization System (APAS) at: www.masshealth-apas.com APAS technical support and training: 1-866-378-3789 Mail all paper PA requests, except those for personal emergency response systems (PERS) and those listed below for Massachusetts Commission for the Blind (MCB) and Community Case Management (CCM) members to: MassHealth ATTN: Prior Authorization Unit (include name of program area) 600 Washington Street Boston, MA 02111 Mail PA requests for MCB members for durable medical equipment, personal care attendant, private duty nursing (unless member is aged 22 or over), and oxygen and respiratory therapy services to: Massachusetts Commission for the Blind 48 Boylston Street Boston, MA 02116 Mail PA requests for PERS to: The member’s local Aging Service Access Point (ASAP). See Page A-5 of this appendix. Mail PA requests for CCM members for nursing, home health aide, physical therapy, occupational therapy, speech therapy, personal care attendant, durable medical equipment, and oxygen and respiratory therapy equipment to: Community Case Management P.O. Box 2586 100 Century Drive Worcester, MA 01613-2586 You may call the MassHealth PA Unit, CCM, ASAP, or MCB, as applicable, to ask about the status of a PA request sent to one of the above addresses. Please wait the times specified in 130 CMR 450.303 before calling. PA requests not sent to CCM or MCB: 617-451-7000 1-800-862-8341 CCM: 1-800-863-6068 PA for home health skilled nursing visits for MassHealth Basic members: 617-451-7132 MCB PA Unit: 617-727-5550 Provider Enrollment and Credentialing MassHealth has contracted with MAXIMUS to manage provider enrollment and credentialing activities. Provider Enrollment and Credentialing establishes and maintains a file on every MassHealth provider. You must contact Provider Enrollment and Credentialing to report any changes in: * your licensure and certification; * Medicare provider status; * ownership information; or * any other qualifications that may affect your participation in MassHealth. You may contact Provider Enrollment and Credentialing by telephone to: * request a provider application; * ask about the status of your provider application; * verify your participation status; or verify the information in your provider file. You must write to Provider Enrollment and Credentialing on your letterhead stationery and include your MassHealth provider number and tax identification number to: * report changes in information, such as your provider name and address; * change or add your Medicare provider number to your MassHealth provider file; or report a change in ownership. To notify Provider Enrollment and Credentialing of any change in licensure, certifications, and qualifications or data that may affect participation in MassHealth, or to participate in the Primary Care Clinician Plan (PCCP), you must request a PCC Plan enrollment and credentialing application from: MassHealth Provider Enrollment and Credentialing P.O. Box 9118 Hingham, MA 02043 1-800-841-2900 617-988-8974 (fax) Hours: Mon. – Fri., excluding holidays 8:00 A.M. – 5:00 P.M. providersupport@mahealth.net Provider Training For all providers, except pharmacy providers, MassHealth has contracted with MAXIMUS to perform provider services, including training. To schedule a training or an individual consultation about billing for MassHealth services: MassHealth Provider Training P.O. Box 9118 Hingham, MA 02043 617-988-8974 (fax) providersupport@mahealth.net For pharmacy providers, MassHealth has contracted with ACS to perform provider services, including training. To schedule a training or individual consultation about billing for MassHealth pharmacy services: ACS State Healthcare ATTN: MassHealth 131 Tremont Street, 4th Floor Boston, MA 02111 617-423-1237 617-423-9846 (fax) masshealth.providerrelations@acs-inc.com Publications The following is a list of sources where requests can be directed for various MassHealth publications. Please submit a written request on your company letterhead and include your provider number, tax identification number, and street address. Please note that the first replacement copy of a provider manual is provided free of charge. There will be a charge for additional copies. All current MassHealth regulations and bulletins are available for viewing on the MassHealth Web site at www.mass.gov/masshealthpubs. Provider manuals Available online at www.mass.gov/masshealth or by contacting: MassHealth Provider Enrollment and Credentialing P.O. Box 9118 Hingham, MA 02043 1-800-841-2900 617-988-8973 (fax) Hours: Mon. - Fri., excluding holidays 8:00 A.M. - 5:00 P.M. providersupport@mahealth.net REVS user guides Available online at www.mass.gov/masshealth or by contacting: REVS Helpdesk 1-800-462-7738 Hours: Mon. - Fri., excluding holidays 8:00 A.M. - 5:00 P.M. REVSHelpdesk@eds.com POPS payer sheets ACS State Healthcare ATTN: MassHealth 365 Northridge Center 1 Suite 400 Atlanta, GA 30350 Transmittal letters and provider bulletins Requests must be made in writing. Include your provider number, address, telephone number, the exact title of the publication, and the date of the issuance. Available online at www.mass.gov/masshealth or by writing to: MassHealth ATTN: Publications P.O. Box 9118 Hingham, MA 02043 617-988-8973 (fax) providersupport@mahealth.net Claim forms, prior authorization forms (including pharmacy), and other forms and publications Requests must be made in writing. Include your provider number, address, telephone number, and the exact title of the form. MassHealth ATTN: Forms Distribution P.O. Box 9118 Hingham, MA 02043 617-988-8973 (fax) Fee schedules It is helpful if you know the Code of Massachusetts Regulations (CMR) citation that applies to your provider type. There is a charge for each publication. DHCFP also has the regulations available on disk. Please write to the State Bookstore address if you cannot access the Internet. Division of Health Care Finance and Policy (DHCFP) 2 Boylston Street Boston, MA 02116 617-988-3100 www.mass.gov/dhcfp State Bookstore State House, Room 116 Boston, MA 02133 617-727-2834 ICD-9-CM, CPT, and HCPCS Code Books are available from the following sources: (Have your credit card ready. In addition, ICD-9-CM Code Books are available from some bookstores.) Ingenix 13931 Willard Road Chantilly, VA 20151 1-800-765-6588 801-536-1009 (fax) American Medical Association Order Department P.O. Box 930876 Atlanta, GA 31193-0876 1-800-771-7199 863-582-6845 (fax) Third-Party Liability Other Health Insurance MassHealth’s TPL Unit maintains the file that identifies other health insurance that a member may have. Other insurance information comes from various sources. If you receive written evidence (such as an explanation of benefits or a letter from an employer) that a member has other health insurance, different insurance than what is listed on the file, or no longer has health insurance coverage, please send the information to the TPL Unit. Mail or fax the insurance information to: (Please enclose copies of written evidence, if possible.) MassHealth TPL Unit P.O. Box 9209 Boston, MA 02209 617-357-7604 (fax) Medicare/Senior Plan Updates MassHealth’s Medicare Unit maintains the file that identifies Medicare or a third-party liability (TPL) senior plan that a member may have. If you receive written evidence (such as a health insurance card) that a member has Medicare or a senior plan/Medicare replacement policy, has a different insurance than what is listed on the file, or no longer has insurance coverage, please send the information to the Medicare Unit. This does not apply to a member whose benefits have been exhausted. It applies only to members who have terminated their enrollment, or transferred to another senior plan. Mail or fax the insurance information to: (Please enclose copies of written evidence, if possible.) MassHealth Medicare Unit The Schraffts Center 529 Main Street, 3rd Floor Charlestown, MA 02129 617-886-8133 (fax) Home Health Services Home health agency providers must obtain and send an EOB whenever a member with commercial health insurance has a change in medical condition or health-insurance-coverage status. Providers may not send MassHealth a single annual EOB for services denied by a commercial insurer. Providers must submit the EOB to MassHealth within 10 days of receiving notification of denial from the insurer. The EOB must include the member’s MassHealth identification number. Mail or fax a copy of the EOB to: MassHealth Home Health Claims The Schraffts Center 529 Main Street 3rd Floor Charlestown, MA 02129 617-210-5080 (fax) Vision-Care Materials If you are a vision-care provider and need to check the status of an order for vision-care materials: MassCor Optical Labs P.O. Box 466 Gardner, MA 01440 1-888-323-5995 1-888-698-2020 (fax) Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title Appendix A. Directory Page A-1 All Provider Manuals Transmittal Letter ALL-138 Date 05/01/06