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Message Text – April 2019

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 providersupport@mahealth.net
  • Sending a letter to

      MassHealth Customer Service
      P.O. Box 121205
      Boston, MA  02112-1205
     
  • Calling MassHealth Customer Services Center at (800) 841-2900,
    Hours: Monday – Friday 8 a.m. – 5 p.m.

04/30/19

Retro rate adjustments for hospice providers

Please be advised that the most recent remittance advice (RA) may contain rate adjustments resulting from the certification of revised FFY19 rates (October 1, 2018) by the Executive Office of Health and Human Services.  Please review this RA for accuracy.  Proposed corrections must be submitted to the MassHealth LTSS Provider Service Center within 60 days from the date of this RA at support@masshealthltss.com or by calling 1-844-368-5184. For more information, refer to the POSC job aid, View Remittance Advice Reports, on the Job aids for the Provider Online Service Center (POSC) web page at https://tinyurl.com/y95aaqjk.

For questions, please contact MassHealth LTSS Provider Service Center at support@masshealthltss.com  or call 1-844-368-5184.

 

04/23/19

Retroactive reprocessing for new HCPCS codes effective January 1, 2018

The attached Remittance Advice may contain adjusted and/or reprocessed claims for the new HCPCS codes that were added effective January 1, 2018. This Retroactive Reprocessing should correct any erroneous denials or payments.

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail providersupport@mahealth.net.

04/16/19

Prior authorization requirement update

Effective 4/15/19 the PA requirements for HCPCS codes A8000, A8001, A8003 and A8004 billed by orthotics providers will align with the PA requirements for DME providers and will change from Yes to Sometimes.

Please refer to the MassHealth Orthotics and Prosthetics Payment and Coverage Guideline Tool for updates.

If you have any questions regarding this change, please contact the LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

 

Changes to non-emergency transportation customer web portal (CWP)

The CWP changes that were outlined in All Provider Bulletin 280 scheduled to take effect in March 2019 are delayed.  Please continue to use the current version of the CWP. The new implementation date is May 31, 2019.

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail providersupport@mahealth.net.

 

To MassHealth providers

Effective May 31, 2019, updates to the Customer Web portal (CWP) will support the user experience related to the Recent Non-Emergency Transportation (PT-1) Policy Changes.

The CWP has been updated as a result of policy changes from February 1, 2019 related to authorizing and scheduling brokered non-emergency medical transportation. Please plan to attend one of the following webinars to review these changes.

  • April 30, 1:00 PM – 2:00 PM     
  • May 2, 1:00 PM – 2:00 PM     
  • May 9, 1:00 PM – 2:00 PM      
  • May 23, 1:00 PM – 2:00 PM         
  • May 30, 1:00 PM – 2:00 PM     
  • June 6, 1:00 PM – 2:00 PM     
  • June 13, 1:00 PM – 2:00 PM     

With an understanding of the new CWP you will be able to effectively comply with the policy changes detailed in the All Provider Bulletin 280 released in January at http://tinyurl.com/yyzlmjr5.

To enroll in a webinar session, please register at the MassHealth Learning Management System (LMS) via www.masshealthtraining.com. Once you are registered, select the preferred course date and time available.

If you have any questions, please contact the MassHealth Customer Service Center by email at providersupport@mahealth.net, or by phone at 1-800-841-2900.

 

Adult foster care prior authorization requirement as condition of payment

130 CMR 408.417 provides that, as a prerequisite for payment for Adult Foster Care (AFC), the AFC provider must obtain Prior Authorization (PA) from MassHealth or its designee before the first date of service delivery, and at various intervals thereafter. PA determines the medical necessity for AFC as described under 130 CMR 408.000 and in accordance with 130 CMR 450.204: Medical Necessity.

As explained in AFC Bulletin 13, MassHealth has been working to implement an approach for the PA process and transfer existing approval and referral responsibilities from Coastline to Optum. That process is now finalized. MassHealth has delivered numerous communications and trainings regarding PA implementation and deadlines to AFC providers and has also provided training materials.

Beginning April 16, 2019, as a prerequisite for payment of AFC, each MassHealth AFC provider must submit a PA request for each member who seeks admission to the MassHealth AFC program through that provider. In addition, and also as a condition for payment of AFC, each such provider must submit PA requests for their existing AFC members according to a schedule available in the AFC PA Provider Portal Training Guide. 

Providers must submit all requests for PA, whether for new or existing members, through the MassHealth LTSS Provider Portal at www.masshealthltss.com.

All materials, including all required PA forms and documentation, can be accessed through the LTSS Provider Portal at www.masshealthltss.com/s/article/AFC-Provider-Resources.

If you have any questions regarding this message, please contact the LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

 

04/02/19

Technical refresh update – MassHealth extends its technical refresh information sessions 

MassHealth will implement its technical refresh activities in 2 phases through March, 2020.   This initiative 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). This change will affect the submission of all HIPAA transactions supported by MassHealth:

  • Health Care Benefit Inquiry and Response (270/271),
  • Health Care Claim Status Request and Response (276/277),
  • Health Care Claim Payment/Advice (835),
  • Health Care Claim: Institutional (837I) and Professional (837P), and
  • HIPAA (999/TA1) Implementation Acknowledgment for Health Care Insurance.

MassHealth will conduct Trading Partner Testing (TPT) with providers and entities that directly send or receive transactions to/from MassHealth in the summer 2019 and early 2020.  MassHealth strongly recommends that all affected trading partners update their systems and conduct TPT with MassHealth to validate compliance. MassHealth has extended its series of 1 hour information sessions about TPT for an additional 4 weeks.  The sessions will be held on Thursdays from 2:00 – 3:00 pm through 05/09/2019.  Affected providers and vendors (Billing Intermediaries, Software Vendors, Clearinghouses) may sign up for either the vendor or provider sessions at www.masshealthtraining.com.

MassHealth will conduct compliance only testing of eligibility batch files (270/271) from 7/29/2019 – 9/20/2019 (phase I) and the claims, remittance advice files and claim status (837I, 837P, 835, 276/277) from 1/27/2020 – 3/27/2020 (phase II).  Please note that MassHealth requires that all trading partners modify their systems, where appropriate, and test compliance during the defined testing phases.

MassHealth made available a dedicated webpage for the Technical Refresh here: https://www.mass.gov/masshealth-technical-refresh.  It contains important information and updated Companion Guides for Phase I testing activities.  Phase II Companion Guides were posted at the end of March.  Please review the contents and check periodically for updates.

Please continue to monitor MassHealth communications regarding the technical refresh over the coming months.

If you have any questions regarding this message, please contact the MassHealth Customer Service Center at 1-800-841-2900 or edi@mahealth.net.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.

 

To therapy providers regarding limits on therapy service codes

In March 2019, the Medicaid National Correct Coding Initiative (NCCI) released edit files for Medically Unlikely Edits (MUEs).  MassHealth has updated the MMIS system and these edits will be effective on April 1, 2019. These MUEs will limit the maximum number of units per service code that a therapy provider is able to bill for a MassHealth member’s therapy visit. The addition of the MUE limits do not affect any other MassHealth authorization or billing rules. Please see below for the MUE values and service codes affected. 

  • Service code: 97010; MUE limit = 1; Service description: Application of a modality to one or more areas; hot or cold packs
  • Service code: 97012; MUE limit = 1; Service description: Application of a modality to one or more areas; traction, mechanical
  • Service code: 97014; MUE limit = 1; Service description: Application of a modality to one or more areas; electrical stimulation (unattended)
  • Service code: 97016; MUE limit = 1; Service description: Application of a modality to one or more areas; vasopneumatic devices
  • Service code: 97018; MUE limit = 1; Service description: Application of a modality to one or more areas; paraffin bath
  • Service code: 97024; MUE limit = 1; Service description: Application of a modality to one or more areas; diathermy (e.g., microwave)
  • Service code: 97026; MUE limit = 1; Service description: Application of a modality to one or more areas; infrared
  • Service code: 97028; MUE limit = 1; Service description: Application of a modality to one or more areas; ultraviolet
  • Service code: 97034; MUE limit = 2; Service description: Application of a modality to one or more areas contrast baths, each 15 minutes
  • Service code: 97035; MUE limit = 2; Service description: Application of a modality to one or more areas; ultrasound, each 15 minutes
  • Service code: 97150; MUE limit = 2; Service description: Therapeutic procedure(s), group (two or more individuals) (services delivered under an outpatient plan of care) (maximum one unit per visit)

If you have any questions regarding this message, please contact the LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.

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