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MassHealth Provider Training and Refreshers - Tips/Best Practices

This is part of the MassHealth Provider Handbook.

Table of Contents

General

Make sure that you know all provider MassHealth billing rules, resources,

and regulations and how to access them.

Make sure that you stay updated with the information resources.

Attend trainings, forums and related MassHealth association information when available.

  • Watch for MassHealth Trainings.
  • Attend MassHealth Training Forum (MTF) and Association meetings
  • For LTSS providers, attend all LTSS trainings available via the MassHealth LTSS portal.
  • For non-LTSS providers, register and take available classes on the MassHealth Provider Learning Management System for Non-LTSS Providers.

Keep your MassHealth contact information up to date.

  • Always make sure that MassHealth has the most updated information including addresses, emails, phone numbers, etc.
  • Use the POSC to regularly check and update provider information needed in order to receive any communication from MassHealth (Job aids and training is available to assist providers with using the POSC to update provider information).

Member Eligibility

MassHealth Card

Make sure you and all responsible staff understand how to check eligibility.

  • Many denials, delays and potential lost revenue are due to the lack of up-front eligibility checks.
  • Review the eligibility job aids available for POSC on Mass.gov.
  • Make sure you understand what type of benefit the member has in EVS.
  • Make sure you understand what services are covered for each member. Do not assume, check subchapters 1–3 of your provider manual.

Make sure that eligibility is checked every time prior to providing service to the member.

Make every effort to find out other primary insurer(s) during the eligibility verification process and make diligent efforts to bill all primary insurers first.

Submit any TPL corrections to MassHealth using the TPL indicator form.

Make sure that any vendor who is doing business on your behalf is also following these guidelines, ultimately the provider is responsible.

Claims

Claim graphic

Claims Submissions

  • Learn how to submit and manage claims through DDE. 
  • Understand how your facility is submitting claims to MassHealth
  • Make sure that any software or billing intermediary is set up according to MassHealth billing guidelines (MassHealth billing guide/companion guide) Note: make sure your software or billing intermediary is set up to submit Coordination of Benefit claims.
  • Once 837 batch claims are submitted, download the 999 to make sure that the file passed compliance.
  • Within 24 hours of submitting a batch of claims, always check claims status on two to three claims in the POSC to make sure that the claims are processing correctly. (For example, the file passed compliance, but the wrong month was submitted).

Claims Denials

  • Use the RA for detailed claim information including list of MassHealth EOB codes and adjustment information.
  • Correct fixable errors immediately using the POSC.

Claims-Related Reports

  • Download and save all RAs from the POSC (only six months is available and requests for additional copies have a cost).
  • Download and save monthly metric reports.
  • Compare monthly reports to check on progress or identify potential issues early.
Screenshot of Claim Templates section of the POSC
Date published: July 29, 2022

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