• This page, Technical Refresh – Key Concepts, is   offered by
  • MassHealth

Technical Refresh – Key Concepts

The Technical Refresh project will enable MassHealth to replace back-end technology. MassHealth will fully implement phase II of the technical refresh initiative in March 2020. MassHealth intends to minimize the impact of this transition to its trading partners and will limit the number of required systems changes to the extent possible. The key concepts of this project are noted below. The following Questions and Answers provide additional information about the technical refresh project and implementation and testing timelines.

Table of Contents

What is the Technical Refresh?

The Technical Refresh project requires that MassHealth replace its “end of life” HIPAA compliance and translator tool. The tool is used to validate HIPAA compliance and translate the HIPAA compliant transactions to an XML format so that they can be processed within MassHealth’s Medicaid Management Information System (MMIS).  

What HIPAA Transactions are affected?

All HIPAA transactions (inbound/outbound) processed through MassHealth’s MMIS will be affected by the Technical Refresh.  Direct Data Entry (DDE) and paper submissions are not affected by the Technical Refresh.

To date, MassHealth has identified the initial impact of the translator on the HIPAA transactions.  Once the agency completes internal testing it will issue a final set of transaction impacts. Please review the current, known “Impact to MassHealth HIPAA Transactions” grid below for additional details.

When will the Technical Refresh be implemented?

MassHealth will implement the new HIPAA translator in two phases:

Phase 1 – October 2019 (270/271, 820, 834)

Phase 2 – March 2020 (837P, 837I, 835, 276/277)

Are pharmacy and dental, claims affected by the Technical Refresh?

No. Pharmacy and dental claims are processed by the Pharmacy Online Processing Systems (POPS) and DentaQuest respectively.  Transactions submitted to those systems are not affected by the MassHealth MMIS Technical Refresh.

Will MassHealth issue updated Companion Guides?

Yes. The initial draft of the updated MassHealth HIPAA Companion Guides for the specific transactions that require modification or trading partner awareness is available here for review. Once MassHealth’s technical team completes its internal testing of the new translator, MassHealth will confirm if additional modifications are required at that time. MassHealth will then issue the final draft of the affected Companion Guides within the following time frames: 

Phase 1:  June 2019

Phase 2:  November 2019

Will Trading Partners Have to make changes to their systems to accommodate the Technical Refresh?

Trading partners must determine if their systems comply with the updated Companion Guides.   MassHealth strongly encourages all trading partners that submit or receive transactions to/from MassHealth to review both iterations (see schedule) of the updated Companion Guides to determine if there is any impact to their systems.

Those trading partners should evaluate their systems immediately to confirm that they are aligned with modifications outlined in the initial version of the updated Companion Guides and ensure that systems are modified, as appropriate, to accommodate the changes. Do not wait until the final update of the Companion Guides is issued to begin to make any necessary changes.

If you utilize a billing intermediary, software vendor, or clearinghouse to process HIPAA transactions please outreach to them to confirm their awareness, and readiness plans.

Will the Technical Refresh impact file submission standards?

Yes. Please review the Technical Refresh Impact chart below and ensure that your systems comply with the changes outlined within the document. MassHealth strongly encourages all submitters to ensure that redundant or excessive transactions are not submitted for processing.  Transactions should only be submitted to MassHealth to directly support services that have or will be provided directly to MassHealth members.

How will MassHealth keep trading partners apprised of the status of the technical refresh project an

MassHealth will keep trading partners informed of the status of the Technical Refresh project and testing timelines and activities via provider bulletin, banner and broadcast messages, information sessions, provider association forums, and trading partner testing forums (providers, Billing Intermediaries, Software Vendors, and Clearinghouses).

Trading partners are strongly encouraged to monitor MassHealth communications for additional details.

If I have questions about the Technical Refresh, who should I contact

If you have any questions related to the technical refresh, please contact MassHealth Customer Services Center’s EDI team at (800) 841-2900 or edi@mahealth.net.

Implementation Schedule

The following table outlines the complete provider based testing and implementation schedule for the technical refresh project.

Implementation schedule

Phase

Affected Transactions

Updated CG Available
(after internal testing)

Trading Partner Testing

Implementation Date

1

270/271
820
834

June 2019

July 29 - October 26, 2019

October 27, 2019

2

276/277
835
837I
837P

November 2019

January 27 - March 27, 2020

March 30, 2020

Current Impact to MassHealth HIPAA Transactions

The chart linked below outlines the high-level impact to the HIPAA transaction. Please be sure to review the draft Companion Guide for detailed updates for each affected transaction.

Known Changes

To Date

Provider Impact

270

271

837P

837I

835

276

277

834

820

Files submitted to MassHealth must contain the same ISA/IEA and GS/GE values with the exception of the date/time and control # data elements or the file will fail pre-compliance.

Ensure that all ISA/IEA   and GS/GE values with the exception of the date/time and control # data elements in the same file are consistent or the transaction will be rejected.

 

X

 

X

X

 

X

 

 

 

A TA1 will be issued for each error within the Interchange envelope.

Ensure that no envelope in the file contains an error otherwise the specific envelope will reject.

X

 

X

X

 

X

 

 

 

A TA1 will no longer be issued for authorization failures.

MassHealth will outreach to the submitter to notify them of the failure; will provide file correction and resubmission instructions.

X

 

X

X

 

X

 

 

 

All Transaction Set Control Numbers (ST02) in transactions submitted to MassHealth must be unique across all envelopes within a file.

Ensure that all ST02 segments are unique or the transaction will be rejected.

X

 

X

X

 

X

 

 

 

ST/SE segments within transactions submitted to MassHealth must not contain more than 5,000 claims; segments that contain more than 5,000 claims will be rejected.

Large submitters, billing intermediaries, clearinghouses, and software vendors must ensure that transaction sets do not include more than 5,000 claims per ST/SE segment.

 

 

X

X

 

 

 

 

 

Any file submitted to MassHealth greater than 16MB will be rejected in accordance with MassHealth’s submission policy.

Continue to ensure that the files submitted to MassHealth are not larger than 16MB.

X

 

X

X

 

X

 

 

 

Updated MassHealth contact information (phone number, URL, etc.) that will be returned on applicable transactions. The coding of the PER segments has changed and one of the segments has been removed.

Please ensure that you update downstream systems that receive this information.

 

X

 

 

X

 

 

 

 

For Physician Claims, the Type of Bill (TOB) will no longer be returned on the Claim Status response.

Please update downstream system processes that utilize this information.

 

 

 

 

 

 

X

 

 

Additional Resources

Help Us Improve Mass.gov  with your feedback

Please do not include personal or contact information.
Feedback