Message Text – July 2017

Message Text – July 2017

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:

  • emailing,
  • calling MassHealth Customer Services Center at 1-800-841-2900, or
  • sending a fax request to: 617-988-8973.


Behavioral health services reminder

This is a reminder for the following provider types: PT 26 – Mental Health Centers, PT 28 – Substance Use Disorder Treatment Programs, PT 05 – Psychologists, PT 65 – Psychiatric Day Treatment, and PT 20 – Community Health Centers. 

Claims involving behavioral health services require providers to cost avoid those claims when members are enrolled with the MassHealth Behavioral Health Vendor, MBHP. Claims for these members should not be directly billed to MassHealth.

Providers are reminded to reference 130 CMR 450.124: Behavioral Health Services in the All Provider Regulations.

For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or


Updated approved vendor list now available on web

All providers are advised: MassHealth has posted its newly-updated approved, HIPAA-compliant Vendor List to the web.

To access this new list and a helpful list of “Questions to ask your Vendor”, please go to:

Providers or vendors with questions about the approved vendor list process can contact MassHealth EDI (Electronic Data Interchange) at MassHealth Customer Service: 1-800-841-2900 or at


Ordering, referring and prescribing initiative update

MassHealth started informational messaging to providers in March 2016 on most professional claims that required an ordering provider NPI if they did not meet Ordering/Referring/Prescribing (ORP) requirements. As a next step in this initiative, informational messaging will begin running on all claims that require orders, referrals or prescriptions, including Medicare crossover claims, starting August 1, 2017.

Messaging will appear on any impacted claim that

  1. does not have the ordering/referring/prescribing (ORP) NPI on the claim; or
  2. has an  ORP NPI but that  ORP provider is not enrolled with MassHealth; or
  3. has an  ORP NPI from a provider type not authorized to order, refer or prescribe services.

The informational messages allow billing providers to understand the scenarios in which an authorized enrolled ORP provider’s NPI is required on a claim. 

It is critical that providers comply as quickly as possible with these important requirements as MassHealth will begin to deny claims that do not meet the ORP requirements later in the calendar year.

For information about the ORP requirements, including impacted claims and billing instructions, please see Provider Bulletin 259.

If you have any questions about the informational messaging or about the ORP requirements, please contact Customer Service:

Non-LTSS provider should contact the MassHealth Customer Service Center by e-mail at, by fax at 617-988-8974, or by phone at 1-800-841-2900.

LTSS providers should contact the LTSS Provider Service Center by phone at 1-844-368-5184 or by email at


Reporting of HIPAA claim adjustment group codes (CAGC) and claim adjustment reason codes (CARC) on MassHealth COB claims

All providers are reminded that claims containing Coordination of Benefits (COB) information must be submitted to MassHealth with valid HIPAA Claim Adjustment Group Codes (CAGCs) and Claim Adjustment Reason Codes (CARCs) as reported on the other insurers’ explanation of benefits (EOB).

MassHealth is not liable for payment of claims for which a member is not liable. Refer to CMR 450.316: Third-Party Liability: Requirements and CMR 450.317: Third-Party Liability: Payment Limitations on Claim Submission.

Providers are reminded to reference All Provider Bulletin 256 RE: The Overpayment Disclosure Process for information on how to report and return overpayments received from MassHealth.

For questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or


New updated version of the DME/OXY payment & coverage guideline tool

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, click on “Provider Library” and then on “MassHealth Payment and Coverage Guideline Tools”.

Procedure code update:

Place of service 30 & 31 were removed for procedure code K0552 Supplies for external non-insulin infusion pump, syringe type cartridge, sterile, each.

  • New codes added pursuant to Administrative Bulletin 17-06, effective January 1, 2017
  • A4224 Supplies for maintenance of insulin infusion catheter, per week (1 unit = 1 week (max is 4 per month))
  • A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each

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


Authorized PT-1 form reminder

MassHealth receives and processes paper Prescription for Transportation (PT-1) forms used by providers on behalf of covered members to request authorization for transportation to a medical appointment when the provider is unable to submit the form electronically.  The current version is PT-1 (Rev. 05/09). 

Requests for transportation submitted using any other version of the form will be rejected. A sample of the PT-1 form can be found at:

MassHealth is moving toward paperless PT-1 submission in 2018. To ensure compliance, to expedite submission of your PT-1 request, and to avoid rejection of an unauthorized PT-1 form, request access to the Customer Service Web Portal now by requesting a User ID at:

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


File invalid error

A recent change to the MMIS system resulted in some Provider Online Service Center (POSC) users to receive an error when uploading files through Internet Explorer (IE) browser.

To correct the issue you will need to make a change to the IE browser setting. The MMIS file upload issue appears to occur when the MMIS web site is part of the IE “Trusted sites” and the Trusted sites zone has the “Include local directory path when uploading files to a server” setting set to “Enabled”. 

NOTE: If it is necessary to maintain the MMIS web site in the trusted sites, the only solution to the file upload issue would be to change the “Include local directory path when uploading files to a server” setting to “Disabled” so that the file uploads work properly. 

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


To home health agency providers

There will be four Home Health Provider Outreach Forums the week of July 17th. 

Please register for one of the following forums:



  • Thursday, July 20, 2017 (Capacity 100)
    2:00pm - 4:00pm
    1 Ashburton Place, Boston, MA, 02108
    21st floor /McCormick Conference Rooms: 2 and 3

  • Register for the Boston session here:


During the open forums, MassHealth will discuss topics including MassHealth updated regulations, Guidelines on Medical Necessity for Home Health Regulations, Third Party Administrator update, Prior Authorization and Required Documentation.  The same information will be presented at each forum

Space is limited.  Please register early!

For questions, please contact LTSS Provider Service Center at or call 1-844-368-5184


UPDATED MESSAGE: New provider types – mid levels

Effective August 1, 2017, MassHealth regulations will be amended to expand the types of providers eligible to participate in MassHealth to include all categories of state licensed advanced practice registered nurses and physician assistants. The regulations will also allow physician assistants to serve as primary care clinicians. As a result, all Physician Assistants (PAs), Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNSs), Psychiatric Clinical Nurse Specialists (PCNSs), Nurse Practitioners and Nurse Midwives (NMWs) working for a group practice must participate in the MassHealth program in order for the group practice to receive payment for their services. PAs must work for a group practice with at least one physician in order to be eligible to participate in MassHealth. CRNAs, PCNSs, and CNSs will also be able to participate independently in MassHealth, and NPs and NMWs will continue to be able to do so. Physicians will no longer be able to bill using the physician’s NPI for services of any of these provider types, with the exception of NPs that are employed by an individual physician.

Updates to regulations found in 130 CMR 433.000, 450.000 and 508.000 for mid-level providers can be found at:

Some other highlights of these new regulations include:

  • The following modifiers will be deactivated effective 8/1/17: HN (physician assistant) and SB (nurse midwife).
  • The following modifiers must be used when billing for anesthesia effective 8/1/17: AA, QK, QY, QX, and QZ.
  • The following modifier remains in effect nurse practitioners who work for an independent physician ONLY: SA (Nurse Practitioner)

For Anesthesia billing, effective 8/1/17 Medical Direction by a physician is payable to a physician. Medical Supervision by a physician is not payable under MassHealth. See physician regulations at 130 CMR 433.454 (C) and (D) for definition of medical direction and medical supervision.  

Payment for Physician Assistants will be made to MassHealth participating group practices that have at least one physician as a member. Group Practices without a physician member cannot bill for PA services.

To assist providers with the provider enrollment process and the billing changes under these new regulations, MassHealth will be hosting 4 webinar sessions (June 20, July 13, 2017; July 25, 2017; and August 15, 2017).  To register for one of these webinars please visit

For questions or to request the application, please contact the MassHealth Customer Service Center by e-mail at or by phone at 1-800-841-2900.


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