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Message Text – February 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.

02/26/19

Updated DME/OXY payment & coverage guideline tool and subchapter 6 of the provider manuals

Pharmacy providers with a Durable Medical Equipment and Supplies (DME) or Oxygen and Respiratory Therapy Equipment (OXY) specialty, and DME and Oxygen providers, are advised that the MassHealth DME and Oxygen Payment and Coverage Guideline Tool and Subchapter 6 in the Provider Manuals have been updated and posted on the MassHealth website. To confirm that you are using the most recent version of the applicable Tool, go to https://tinyurl.com/y97ys39u.

This update accommodates the CMS January 2018 DMEPOS HCPCS & Modifier changes that MassHealth has adopted from the EOHHS DME/OXY current fee schedule effective 3/1/18 and related EOHHS administrative bulletins available at https://tinyurl.com/y9axyg6d.

Added HCPCS Codes: A4207; A4208; A4209; A4224; A4225; A7048; E0118; E0472, E0617; E2204; K0010; K0011; K0012; K0553; K0554; S5162.

Providers can contact the LTSS Provider Service Center to obtain assistance with claim(s) related to the added codes and for assistance with the 90 Day Waiver Appeal and Final Deadline Appeal processes.

Reminder: Providers need to remain current with EOHHS fee schedules and administrative bulletins.

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

 

02/19/19

Technical Refresh – Important Message for All MassHealth Providers

MassHealth will implement Phase II of its technical refresh activities in March, 2020. Phase II of 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 of 2019 and early 2020.  MassHealth strongly recommends that all affected trading partners update their systems and conduct TPT with MassHealth to validate compliance. MassHealth will hold a series of 1 hour information sessions about TPT on Thursdays from 2:00 – 3:00 pm in late February through early April 2019.  Affected providers and vendors (BI, SWV, CH) may sign up for sessions at www.masshealthtraining.com.

MassHealth will make available a dedicated webpage for the Technical Refresh on www.mass.gov. It will be available in late February and will contain supporting documentation related to the implementation.

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 email 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.

 

Medicare crossover claims with edit 6215 HCAC claim eligible for cost outlier payment – UPDATED MESSAGE

MassHealth currently suspends Medicare Part A crossover claims with edit 6215 hcac claim eligible for cost outlier payment when the claim includes HCAC charges and qualifies for outlier payment in addition to the APAD.

In order to align Crossover claims with the current Non-Crossover claims process, effective for claims received by MassHealth on or after February 11, 2019, all Crossover claims submitted with the charges associated with the HCAC and outlier payments will deny for edit 6215.

If your hospital has a crossover claim denied for edit 6215, you may continue to resubmit the claim through the POSC with an attachment identifying the charges associated with the HCAC, as follows:

  1. Do not include a delay reason code.
  2. Within the attachment, list the hospital’s name and the denied claim’s 13-digit ICN.
  3. Indicate which medical services have any charges that represent or resulted from an HCAC.
  4. Revise the charges to show what they would have been had the HCAC(s) not occurred.
  5. (a) Provide the name of the HCAC (b) Briefly indicate the rationale for determining the revised charges.

MassHealth will review the attachment and if in agreement with the revised charges, will recalculate the payment and process the claim. If the attachment does not support the revised charges, MassHealth will again deny the claim or will request additional information, along with a comment in a claim note. 

Providers should refer to Appendix V, Transmittal Letter ALL-214, dated 10/1/15 for more detailed billing instructions for submitting claims associated with HCAC and/or other Provider Preventable Conditions.

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

 

02/12/19

Retroactive payments for substance use disorder outpatient services

Rates for the following substance use disorder outpatient service codes were increased effective January 1, 2019.

H0020, H0004-TF, T1006-HR, H0005-HQ, 90882-HF, H0001, H0004, H0005, Tl006, H0004-HD, T1006-HD, H0005-HD, H0006-HD, H1005, and H1005-HQ.

Providers who submitted claims for these service codes between January 1, 2019 when the rates became effective and January 22, 2019 when the rates were updated in MMIS will receive a retroactive payment totaling the difference between the new rates and the old rates.

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

 

Medicare crossover claims with edit 6215 HCAC claim eligible for cost outlier payment

MassHealth currently suspends Medicare Part A crossover claims with edit 6215 hcac claim eligible for cost outlier payment when the claim includes HCAC charges and qualifies for outlier payment in addition to the APAD.

In order to align Crossover claims with the current Non-Crossover claims process, effective for claims received by MassHealth on or after February 11, 2019, all Crossover claims submitted with the charges associated with the HCAC and outlier payments will deny for edit 6215.

If your hospital has a crossover claim denied for edit 6215, you may continue to resubmit the claim through the POSC with an attachment identifying the charges associated with the HCAC, as follows:

  1. Do not include a delay reason code.
  2. Within the attachment, list the hospital’s name and the denied claim’s 13-digit ICN.
  3. Indicate which medical services have any charges that represent or resulted from an HCAC.
  4. Revise the charges to show what they would have been had the HCAC(s) not occurred.
  5. (a) Provide the name of the HCAC.
    (b) Briefly indicate the rationale for determining the revised charges.

MassHealth will review the attachment and if in agreement with the revised charges, will recalculate the payment and process the claim.  If the attachment does not support the revised charges, MassHealth will again deny the claim or will request additional information, along with a comment in a claim note. 

Providers should refer to Appendix V, Transmittal Letter ALL-214 for more detailed billing instructions for submitting claims associated with HCAC and/or other Provider Preventable Conditions.

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

 

Radiology rate adjustments for 2019 rates

MassHealth has updated the technical component (TC) of certain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) services, as well as one computed tomography (CT) service. This change was effective January 1, 2019.

Please be advised that incorrectly priced claims have been adjusted and may appear on this or subsequent remittance advices. 

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

 

02/05/19

Avoid duplicate submissions

This is a reminder to providers to use best practices when billing claims to MassHealth for all members including members who have other insurance (Medicare, Medicare Advantage, or Commercial) in addition to MassHealth. MassHealth encourages all submitters to ensure that excessive and duplicative transactions are not submitted.

There are several methods of electronic claim submissions available, including direct billing for electronic batch files through the Provider Online Service Center (POSC), the use of a vendor (billing intermediary or clearinghouse) that submits claims on your behalf, and direct data entry (DDE) of claims through the POSC.

Providers are reminded that in most cases, Medicare crossover claims for dually eligible members are automatically transmitted by the Medicare contractor (Benefits Coordination and Recovery Center (BCRC)) to MassHealth when at least one claim line is Medicare approved. MassHealth receives daily Medicare crossover files from BCRC which are adjudicated in MMIS, therefore there is no need to submit a second claim to MassHealth. Please refer to Subchapter 5 Administrative and Billing Instructions Part 7 ‘Other Insurance’ for additional information about Medicare Crossover claims. 

Claims status is available via POSC upon submission. Claims process and appear on Remittance Advice in approximately 30-45 days.

If you have questions about submitting claims or need further assistance, you may contact the MassHealth Customer Service Center at edi@mahealth.net or 1-800-841-2900.

 

Preadmission screening and resident review (PASRR) level II add-on

Nursing facilities may bill for the add-on code S0317, also known as the “PASRR Level II add-on,” for dates of service on or after January 1, 2019. Billing instructions and related materials can be found on the PASRR page of the MassHealth LTSS Portal: https://www.masshealthltss.com/s/PASRRTrainingMeterial?language=en_US.

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

 

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

The following policies related to authorizing and scheduling brokered nonemergency medical transportation will take effect on February 1, 2019. MassHealth members will need to contact their RTAs to schedule transportation at least three business days in advance of the day on which the transportation will occur. When a MassHealth member reports a new residential address, PT-1 forms authorizing transportation for the member to and from his or her residential address will remain valid until the sooner of the PT-1 form’s end date and 30 days after the date of the address change. Providers will need to submit new PT-1 forms to authorize future transportation.

The CWP changes to the Customer Web Portal (CWP) user interface scheduled to take effect on February 1, 2019 and outlined in All Provider Bulletin 280 are delayed. These changes will take effect in March 2019.

CWP webinar training sessions will be available to review these enhancements. To enroll in a CWP webinar training session, please register at the MassHealth Learning Management System (LMS) via www.masshealthtraining.com and create your profile. Once you are registered, select the preferred course date and time available.

For additional details, please refer to All Provider Bulletin 280 released in January 2019 available at www.mass.gov/files/documents/2019/01/16/all-280.pdf.

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

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