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Certain messages are applicable to several provider types, and are identified below as "General Messages." Other sections are service specific and are identified by provider type or by provider topic.
You can request a copy of a prior message by:
In accordance with the Medicare Social Security Number Removal Initiative (SNNRI), effective April 1, 2018, MassHealth will begin to accept the new 11 digit Medicare Beneficiary Identifier (MBI) on all relevant transactions. This includes Direct Data Entry (DDE) via the POSC. The MBI will replace the 11 digit Health Insurance Claim Number (HICN). During Medicare’s transition period, between April 1, 2018 and December 31, 2019, MassHealth will accept either the MBI or HICN. Please note that if an HICN is submitted during this transition period, MassHealth will return the MBI on all response transactions if the new number is known to MassHealth.
Trading partners that exchange transactions directly with MassHealth should not need to make any systems changes to send or receive the 11 digit alpha-numeric number to/from MassHealth. Therefore, MassHealth does not intend to require trading partners to test the changes.
If you have any concerns about this approach or strongly believe that MassHealth should test with you, please contact the MassHealth EDI team immediately at 1-800-841-2900 or EDI@MAHealth.net, but no later than September 15, 2017.
Effective with dates of service on or after August 1, 2017, claims submitted with the HN modifier may have inappropriately denied. MassHealth is in the process of identifying the denied claims and will reprocess them within the next two weeks. Please do not resubmit your denied claims, MassHealth will re-adjudicate those that have denied due to the HN modifier issue.
If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail firstname.lastname@example.org.
Effective immediately, the Provider Contracts for Entities and Individuals have been updated to include the document number and the revision date on all pages. MassHealth has made this change as a result of receiving old versions of the contract signature pages along with new versions of the document itself. The contracts can be found on the MassHealth website on the MassHealth Provider Forms page: https://tinyurl.com/kxb82pd
Please discontinue use of any old versions immediately.
An upcoming provider bulletin, set to be released in the beginning of September 2017, will introduce two new Post Office (P.O.) boxes that must be used for mail correspondence for providers, including non-billing providers who order, refer, and prescribe services. The address changes do not apply to Long Term Services and Supports (LTSS) providers, with the exception of submitting paper claims. The full list of LTSS providers can found in All Provider Bulletin 270, with along with the address for LTSS correspondence.
The NEW MassHealth Provider Enrollment and Credentialing P.O. box address is the following:
Attn: Provider Enrollment and Credentialing
P.O. Box 121205
Boston, MA 02112-1205
The NEW MassHealth Claims P.O. box address is the following:
P.O. Box 120010
Boston, MA 02112-0010
For a limited time, MassHealth will continue to receive and process documentation mailed to the previous P.O. boxes in Canton, MA, but we encourage all providers to immediately use the new addresses.
Hearing aid providers are reminded that when requesting prior authorization (PA) for hearing aid services, the individual rendering provider number and service location or NPI number must be the same as the servicing/rendering provider number and service location or NPI number on the claim form. If these ID numbers do not match, the claim will deny.
As announced in MassHealth’s Transmittal Letter TRN-33, issued in June of 2017, MassHealth has updated the transportation manual and regulations (130 CMR 407.000); the new regulations are effective September 1, 2017. An important amendment (130 CMR 407.411) changes the locality restrictions on transportation. Locality is now defined as the town or city in which the member resides and the surrounding communities within 25 miles of that town or city. The Customer Web Portal (CWP) has been updated so that when a provider submits a PT-1 form (Provider Request for Transportation) the CWP will calculate the 25 mile radius and will notify the provider of the locality status. If the destination is outside of the member’s defined radius, the provider must choose another treating facility within locality or submit justification for the request.
On July 14, 2017, MassHealth promulgated 101 CMR 350.00: Home Health Services, which increased the reimbursement rates for the following codes:
Currently, MassHealth is experiencing IT issues and providers who submitted claims for services provided on or after July, 14, 2017 are being reimbursed at their previous rate. All claims submitted with the correct modifiers are not affected, and are being reimbursed at the correct rate.
MassHealth is working to correct this error, and will reprocess all affected claims so they are reimbursed at the correct rate.
If you have any questions regarding these changes, please contact LTSS Provider Service Center at email@example.com or call 1-844-368-5184.
Providers are required to bill the last seven days of life for SIA separately for each day of service for a maximum of 16 units each day.
The SIA rate is an addition to the Routine Home Care (RHC) rate when all of the following criteria are met: 1) The day is a RHC level of care day 2) The RHC day occurs during the last 7 days of the member’s life, and the patient is discharged expired 3) Direct patient care is furnished by a registered nurse (RN) or social worker that RHC day. Additionally, the SIA rate will equal the continuous home care hourly payment rate, for a minimum of 15 minutes and up to 4 hours per day. The time of a social worker’s phone calls is not eligible for an SIA rate payment.
REMINDER – Pharmacy, DME and Oxygen providers be advised that the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool has been updated and posted on the Web. To confirm that you are using the most recent version of the applicable Tool, go to http://www.mass.gov/eohhs/gov/laws-regs/masshealth/, click on “Provider Library” and then on “MassHealth Payment and Coverage Guideline Tools”.
New added modifiers to procedure code A9900: