Message Text – April 2025

MassHealth Provider Remittance Advice

The messages listed below may be general All Provider messages, applicable to several provider types or services, or provider specific. 

You can request a copy of a prior message by:

• Emailing [e-mail]
• Sending a letter to

  MassHealth Customer Service
  P.O. Box 278
  Quincy, MA 02171

• Calling MassHealth Customer Services at [phone],
  Hours: Monday through Friday 8 a.m. to 5 p.m.

04/29/2025

RETROACTIVE MEDICARE RECOVERY PROJECT (RMRP) FOR DURABLE MEDICAL EQUIPMENT (DME)

Effective May 1, 2025, and in accordance with MassHealth regulations 130 CMR 450.316(A)(6) and 130 CMR 450.316(F), the Retroactive Medicare Recovery Project (RMRP) will recover MassHealth claim payments for services provided by Durable Medical Equipment (DME) providers that meet the following criteria:

• MassHealth was the primary claims payor at the time services were rendered,
• Medicare coverage is identified retroactively after the date MassHealth paid the claim, but no more than 36 months after such claim’s date of service, and
• The service rendered is a Medicare-covered service.

A summary of the RMRP process is described in MassHealth All Provider Bulletin 329 which was issued to all MassHealth providers in November 2021.

MassHealth will send the RMRP Notice outlining the provider process instructions with the accompanying paid claims report to the provider’s Doing Business As (DBA) address on file with MassHealth.

It is important to note that Medicare allows for a timely filing exception for claims that have been identified for recoupment by MassHealth due to retroactive Medicare coverage. Providers must follow Medicare’s billing instructions for submitting claims for these members and should refer to the Noridian site and direct any questions regarding Medicare requirements to Noridian at [phone].

Additional provider resources may be found at the following:

• Medicare Learning Network (MLN) Bulletin - Processing Claims Affected by Retroactive Entitlement
• Beneficiaries Entering Medicare

Providers may direct any questions about the RMRP notice to the RMRP mailbox at [e-mail] or call [phone].

04/22/2025

CLAIMS REPROCESSED FOR 2025 HCPCS/CPT CODE UPDATES

The Centers for Medicare & Medicaid Services (CMS) have revised the HCPCS codes for 2025. MassHealth is updating the Service Codes and Descriptions (Subchapter 6) of the Physician Manual to incorporate those 2025 HCPCS/Current Procedural Terminology (CPT) service code updates, as applicable.

MassHealth updated its system to reflect the 2025 HCPCS/CPT coding changes effective for dates of service on or after January 1, 2025. All affected claims will be reprocessed and will appear on a future remittance advice.

If you have questions, please contact MassHealth at [e-mail] or [phone].

SERVICES PROVIDED BY NON-INDEPENDENT NURSE PRACTITIONER (SA MODIFIER) FOR DATES OF SERVICE 01/01/2020 - 06/30/2023

As instructed in the provider notice dated November 20, 2024, MassHealth will begin voiding claims for Group Practice Paid for Services Provided by Non-Independent Nurse Practitioner for Dates of Service on April 24, 2025, and will have completed voided claims by April 30, 2025. MassHealth will only void impacted claims as instructed by providers.

Process Reminder:

Direct Data Entry (DDE) Resubmission:

Any such claim must be resubmitted electronically via DDE on the Provider Online Service Center (POSC) using Delay Reason Code 3. Providers must scan and submit the Waiver form, the remittance advice depicting the denied claim, and any other documentation in support of the request for review. If you are submitting multiple claims for the same member you must submit each claim separately with a copy of the Waiver form, the remittance advice for the voided claim, and supporting documentation.

These documents must be scanned and included with a DDE claim submission. Use the Attachment Tab on the POSC to upload the document(s). Once resubmitted into the POSC, these claims will appear in a suspense status on your remittance advice with Edit 826 (SPECIAL HANDLING PAPER WAIVER PROVIDER). A final decision will be reflected on a subsequent remittance advice once the Waiver form is reviewed.

Electronic Data Interchange (EDI) Resubmission:

To begin the claims resubmittal process, email the 90-day waiver request to the EDI email box at [e-mail]. That initial email must include:

1. Completed 90 Day Waiver Request Form; For an EDI batch submission, only one form is required.
2. A letter, on the provider’s letterhead, with the details of the request; The letter must include the date of service range, claim count and dollar value, and the reason the claims were not submitted within 90 days of the date of service. The letter must also be signed with a typed/printed name with a date.
3. Any supporting documentation; and
4. A copy of this Provider Notice.

If the 90-day waiver request is approved, the EDI team will notify the provider of the approval and request the claim file. The claim file must contain only those claims to be considered for the 90 Day Waiver.

If the 90-day waiver is denied or additional information is needed, the EDI team will notify the provider.

The claim file must be in an ANSI X12 format and 5010 compliant. We request that you send only one claim file.

When the claim file is ready to be emailed, send the email securely or send the file as a password protected file and send the password in a separate email.

After the EDI team receives the file, they will review it and let the provider know if there are any claim file formatting issues or if it is missing any required documentation. The provider will have up to 30 days from the approval date to submit the batch claim files.

For further information on 90-day waivers, please go to the following link: Billing timelines and appeal procedures. The 90-Day Waiver Request form is located at the following link: Submit a 90-day Claim Waiver Request Form.

If providers have any questions about resubmitting claims, please contact MassHealth at [phone] or [e-mail].

Please note, MassHealth may conduct an audit of the adjusted claims to confirm the identity of the actual servicing provider, that the servicing provider was fully enrolled in MassHealth and was enrolled and approved by MassHealth as a member of the group practice on the applicable date(s) of service.

DELAY REASON CODE REQUIREMENTS ON 90-DAY WAIVER SUBMISSIONS FOR MEDICARE CROSSOVER CLAIMS

In April 2024, providers were notified that the standard process of submitting 90-day waiver requests using delay reason codes 1, 4 and 8 was causing denials for Medicare Crossover requests instead of suspending the claims for review as intended. As a temporary solution, providers were instructed to use delay reason code 10 while the MMIS issue was being addressed. The MMIS system change has now been implemented effective 4/20/2025 therefore, providers should immediately return to the standard submission process using delay reason codes 1, 4, and 8 for 90-day waiver requests for all crossover claims.

For all 90-day waiver requests including crossover claims, providers are instructed to use the delay reason codes 1, 4 and 8 per the original requirements noted on All Provider Bulletin 220.

If you have questions regarding this message, please contact MassHealth at [phone] or [e-mail]. LTSS providers should contact the LTSS Provider Service Center at [phone] or [e-mail].

04/15/2025

MASSHEALTH EOB CODES APEARING ON THE REMITTANCE ADVICE

MassHealth Independent Nurses (INs) may encounter an Explanation of Benefits (EOB) code on their Remittance Advice that prevents claims from paying. To understand what these EOB codes mean, INs may use the MassHealth List of EOB Codes.

If an IN needs further assistance understanding their Remittance Advice or EOB codes appearing on their Remittance Advice, INs should contact the LTSS Provider Service Center at [phone] or [e-mail].

Date published:	April 14, 2025
Last updated:	April 22, 2025