To ensure proper payment, hospitals must follow these special billing instructions. Failure to follow these special billing instructions could result in an overpayment that will be subject to recoupment and could subject the provider to sanctions for improper billing.
Overview
Under Appendix L, the current MassHealth Acute Hospital Request for Applications (as amended from time to time, the “Acute Hospital RFA”) and under Appendix G of the Psychiatric Hospital Request for Applications (as amended from time to time, the “Psych Hospital RFA”) applicable to in-state providers, and as applicable to out-of-state acute hospital providers under regulations at 130 CMR 450.233(D), participating in-state and out-of-state MassHealth acute hospital and psychiatric hospital providers will be paid for Specialty Inpatient Psychiatric Services for Children/Adolescents with Neurodevelopmental Disorders which are set forth in the Acute Hospital RFA and the Psych Hospital RFA.
Under Appendix H of the Psychiatric Hospital Request for Applications (as amended from time to time, the “Psych Hospital RFA”) applicable to in-state providers, and as applicable to out-of-state acute hospital providers under regulations at 130 CMR 450.233(D), participating in-state and out-of-state psychiatric hospital providers will be paid for Specialty Inpatient Psychiatric Services for Eating Disorders which are set forth the Psych Hospital RFA.
Children/Adolescents with Neurodevelopmental Disorders
The following billing instructions apply to inpatient claims for Specialty Inpatient Psychiatric Services for Children/Adolescents with Neurodevelopmental Disorders submitted by Acute Inpatient Hospitals (Provider Type 70) and Psychiatric Inpatient Hospitals (Provider Type 73), referred to as “Hospitals”:
- Costs, charges, and any other claims-based data must be excluded from any facility/institutional claim for general inpatient psychiatric services that the Hospital submits for the member’s stay.
- The Hospital must instead claim separate payment for by submitting a facility claim (837P) that includes MassHealth INPT (provider type 70) provider ID and service location (PIDSL).
- Along with the member’s name, date(s) of service, and other usual information, the separate DDE claim must also include:
- Occurrence code 47
- Except for the instructions above, all other applicable MassHealth billing instructions and conditions of payment continue to apply. MassHealth may, on a case-by-case basis, give additional or different instructions for submitting claims for the BH crisis evaluation service in certain circumstances.
Eating Disorders
The following billing instructions apply to inpatient claims for Specialty Inpatient Psychiatric Services for Eating Disorders submitted by Psychiatric Inpatient Hospitals (Provider Type 73), referred to as “Hospitals”:
- Costs, charges, and any other claims-based data must be excluded from any facility/institutional claim for general inpatient psychiatric services that the Hospital submits for the member’s stay.
- The hospital must instead claim separate payment by submitting a facility claim (837P) that includes MassHealth INPT (provider type 70) PIDSL.
- Along with the member’s name, date(s) of service, and other usual information, the separate DDE claim must also include:
- Occurrence code 73
- Except for the instructions set forth above, all other applicable MassHealth billing instructions and conditions of payment continue to apply. MassHealth may, on a case-by-case basis, provide additional or different instructions for submitting claims for BH crisis evaluation service in certain circumstances.
| Date published: | April 30, 2024 |
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