Message Text – January 2024

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.

01/23/2024

INCORRECT PAYMENTS ON COMMUNITY BEHAVIORAL HEALTH CENTER (CBHC) CROSSOVER CLAIMS

MassHealth has identified a pricing issue affecting Medicare crossover claims that are billed with the CBHC per diem service code (T1040) and adjudicated on or after 11/19/23. Currently, MMIS is incorrectly paying these crossover claims the full MassHealth allowed amount for T1040 and is not deducting the Medicare payment(s) associated with other bundle services on the claim. MassHealth anticipates implementing a system fix for this issue in June 2024 and will subsequently adjust the affected claims once the correction is implemented.

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

MENTAL HEALTH CENTER (MHC) RATE AND PROGRAM REGULATIONS PROVIDER LISTENING SESSION 2/6/24 10:30am-12:00pm

MassHealth is beginning its review of rates and programs for services governed by 130 CMR 429 at http://tinyurl.com/bddrnnre and 101 CMR 306 at http://tinyurl.com/mren49b4. In anticipation of this review, MassHealth will host a virtual provider listening session on February 6, 2024, from 10:30 am-12:00 pm. A separate public hearing will be scheduled at a later date when providers can provide official testimony.

To register for the listening session, please use this Zoom link: https://zoom.us/meeting/register/tJ0uduGgrTgiE9RcCAX1hbEItp6iLbCbYQ_P

MassHealth invites all providers of these services to attend and provide information they would like MassHealth to consider during the rate and program review. If you are planning to attend and speak, please email [e-mail] by the end of the day on February 5, 2024. (There will also be time for comments from those who have not sent notification in advance.)

MassHealth also encourages written feedback from providers who cannot attend this session or who would like to provide more detailed information. Please email any written feedback to [e-mail] by the end of the day on February 6, 2024.

Comments provided at this session will not automatically be part of the official public hearing process. The public hearing will be held at a later date for this regulation when providers can submit official testimony.

COMMUNITY BEHAVIORAL HEALTH CENTER (CBHC) RATE AND PROGRAM REGULATIONS PROVIDER LISTENING SESSION: 2/13/24 11:30 AM-1:00 PM

MassHealth is beginning its review of rates and programs for services governed by 130 CMR 448 at http://tinyurl.com/3nyv8s4j and 101 CMR 305 at http://tinyurl.com/5bz5dr2j. In anticipation of this review, MassHealth will host a virtual provider listening session on February 13, 2024, from 11:30 am-1:00 pm. A separate public hearing will be scheduled at a later date when providers can provide official testimony.

To register for the listening session please use this Zoom link: https://zoom.us/meeting/register/tJAqdeChrz8vHtewlmU-Quk6lA4ZujJc2p5d

MassHealth invites all providers of these services to attend and provide information they would like MassHealth to consider during the rate and program review. If you are planning to attend and speak, please email [e-mail] by the end of the day on February 9, 2024. (There will also be time for comments from those who have not sent notification in advance.)

MassHealth also encourages written feedback from providers who cannot attend this session or who would like to provide more detailed information. Please email any written feedback to [e-mail] by the end of the day on February 9, 2024.

Comments provided at this session will not automatically be part of the official public hearing process. The public hearing will be held at a later date for this regulation when providers can submit official testimony.

IMPORTANT ALERT - MASSHEALTH POSC PRIMARY USER IDENTIFICATION NEEDED BY MARCH 31, 2024

In September 2023, the Executive Office of Health and Human Services published the MassHealth Provider Online Service Center (POSC) Primary User Policy and All Provider Bulletin 377: MassHealth POSC Primary User Policy. In an effort to ensure compliance, MassHealth has contacted the Primary Users within organizations that have more than the required number of Primary Users to update their Primary User designations to align with MassHealth’s Primary User policy (1 Primary User and 1 backup Primary User).

Non-compliant organizations have one final opportunity to update the primary user designations to align with MassHealth’s Primary User Policy by completing the survey below. This is a one-time opportunity for organizations to modify their primary user designations by completing the survey below no later than March 31, 2024:

https://forms.office.com/g/nYNPPSxAQp

It is imperative that organizations ensure that only the current designated Primary User and backup Primary User can manage access to the organization’s data. Additionally, as a one-time effort to assist all providers in making modifications to better align with the policy, all provider organizations can complete the aforementioned online survey no later than March 31, 2024.

Please review the policy here: http://tinyurl.com/4cysd32p

All Provider Bulletin 377 is available here: http://tinyurl.com/3j9pajtj

For additional questions or concerns:

Dental providers, please contact Dental Services at [phone]; TTY: [phone].

LTSS providers, please contact the LTSS Provider Service Center at [phone] or [e-mail].

All other providers, please contact MassHealth at [phone] or [e-mail].

01/16/2024

PROCESS UPDATE WHEN SUBMITTING A DATE OF DISCHARGE FOR MASSHEALTH MEMBERS RESIDING IN NURSING FACILITIES

MassHealth is communicating a process update for when hospice providers submit a date of discharge for MassHealth members residing in a Nursing Facility (NF).

Following this communication, for members who will continue residing in a NF upon discharge from hospice, the hospice provider should use the date of discharge. Hospice providers may use the “other” option located in the online Hospice Election Form. Hospice provider will select other discharge reason and note that the member is continuing to reside in the NF upon discharge.

Hospice providers must also alert the LTSS Service Center by email or via the LTSS Provider Online Inquiry Form found on the MassHealth LTSS Provider Portal. To submit an inquiry form, providers will need to have Provider Portal access (tutorial link provided below).

MassHealth LTSS Provider Service Center:

Phone: [phone]

Email: [e-mail]

MassHealth LTSS Provider Portal: http://tinyurl.com/bdd7wt76

Tutorial: http://tinyurl.com/2hphd62p

If you or your agency has questions regarding this guidance, please contact the LTSS Provider Service Center at [phone] or [e-mail].

PROVIDER REMINDER: ILLEGAL BILLING OF QUALIFIED MEDICARE BENEFICIARY MEMBERS

MassHealth providers are reminded that you may not bill MassHealth members, including Qualified Medicare Beneficiary (QMB) members.

For more information, go to the MassHealth All Provider Bulletin 386: MassHealth Medicare Savings Programs at http://tinyurl.com/2vf974um.

01/09/2024

RELEASE OF MENTAL HEALTH CENTER POLICY AND PAYMENT REFORM REQUEST FOR INFORMATION (RFI)

EOHHS has released a Mental Health Center Policy and Payment Reform Request for Information (RFI) form. You can find the RFI on the COMMBUYS website, Bid # BD-24-1039-EHS01-ASHWA-96104, at http://tinyurl.com/4j9p9vwn. All responses to this RFI are due no later than 01/31/2024 by 5pm and must be submitted by email to [e-mail] with “MHC RFI Response” in the subject line. EOHHS is asking that the RFI be shared with provider networks to try to increase the number of responses. Please refer to the RFI document for further instruction.

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

TIMELY FILING REGULATIONS FOR CLAIMS WITH OTHER HEALTH INSURANCE

Providers are reminded to adhere to the timely filing regulations when submitting claims for members with other health insurance per MassHealth regulation 130 CMR 450.313. For all claims submitted with other health insurance (Medicare, Medicare Advantage, supplemental ins, commercial ins, casualty payer), adjudication information must be received within 90 days from the date of the other insurer's explanation of benefits. All claims exceeding this requirement will be denied for edits 850 BILLING DEADLINE EXCEEDED DETAIL or 852 BILLING DEADLINE EXCEEDED HEADER. Providers may submit a 90-day waiver request if the requirements in 130 CMR 450.309 are met.

If MassHealth denies the initial claim which was submitted in a timely manner, providers may resubmit the corrected claim with other insurer adjudication information up to 18 months from the date(s) of service on the claim. Claims exceeding this requirement will be denied for edit 853 FINAL DEADLINE EXCEEDED DETAIL or 855 FINAL DEADLINE EXCEEDED HEADER. Providers may submit an appeal if the appeal requirements in 130 CMR 450.323 are met.

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

01/02/2024

IMPORTANT ALERT - MASSHEALTH POSC PRIMARY USER POLICY

In September 2023, the Executive Office of Health and Human Services published the MassHealth Provider Online Service Center (POSC) Primary User Policy and All Provider Bulletin 377: MassHealth POSC Primary User Policy. The policy outlines the responsibilities of an enrolled provider for management of the access to its information on the POSC. The policy also requires each organization to assign a single Primary User (system administrator) and a single backup Primary User for each Provider ID Service location (PID/SL) and outlines the responsibilities of the designated Primary User. The Primary User within each organization is the person responsible for managing access to the organization’s information on the POSC.

Ineffective management of this information could allow staff and affiliate organizations to continue to access the provider’s information and submit transactions on behalf of a provider after they have left employment or after the termination of contractual agreements. This could leave providers vulnerable to fraud as well as enabling persons or entities to leverage the organization’s information to benefit themselves or other organizations.

It is imperative that organizations ensure that only the designated Primary User and backup Primary User have the ability to manage access to the organization’s data. MassHealth has contacted the Primary Users within organizations that have more than the required number of Primary Users to update their Primary User designations to align with MassHealth’s Primary User policy. Additionally, as a one-time effort to assist providers in complying with the policy, MassHealth is collecting Primary User designations via an online survey. If you have not been contacted by MassHealth, but still want to re-align your Primary User designations to ensure the effective management of access to your information on the POSC, please complete the survey at your earliest convenience. The survey is available here: https://forms.office.com/g/s6qPKJTB1W.

Upon receipt of your updated Primary User designations, MassHealth will update the Primary User and backup Primary User designations and will remove the Primary User designation and the Manage Subordinates permission from any other user currently listed under your organization’s PID/SL(s) that has these permissions. This includes all linked users and those user IDs created by your organization.

Please review the policy here: http://tinyurl.com/4cysd32p

All Provider Bulletin 377 is available here: http://tinyurl.com/3j9pajtj\

For additional questions or concerns:

Dental providers, please contact Dental Services at [phone]; TTY: [phone].

LTSS providers, please contact the LTSS Provider Service Center at [phone] or [e-mail].

All other providers, please contact MassHealth at [phone] or [e-mail].

Date published:	January 2, 2024