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Message Text – March 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.

03/26/19

New updated version of the orthotics and prosthetics payment & coverage guideline tool

Orthotic and Prosthetic providers are advised that the MassHealth Orthotics and Prosthetics Payment and Coverage Guideline Tool has been updated on 3/7/19 and posted on the MassHealth website. To confirm that you are using the most recent version of the applicable Tool, go to http://tinyurl.com/y97ys39u.

Please note that HCPCS codes A9285, L3981 and L3761 have been added to the Tool effective as of 3/6/19.

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.

 

03/12/19

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 3, 2019.

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

 

Member eligibility – 270/271 batch transaction update

On June 23, 2019 MassHealth will implement a change to its member eligibility batch request response logic.  The agency will no longer conduct an alternate search of its eligibility database when an invalid Member ID (MID) is submitted in the 270 HIPAA transaction.

Once implemented, when a provider sends in a 270 request with an invalid MID, the provider will receive a 271 response indicating “member not found”. Specifically, it will state error code “72” Invalid/Missing Subscriber/Insured ID in the AAA03 – Reject Reason Code segment for Loop 2100B.

MassHealth strongly recommends providers make changes to your eligibility inquiry practices today to ensure that you do not receive unnecessary rejections when the new logic is implemented. Be sure to follow the guidelines posted here: https://www.mass.gov/service-details/eligibility-verification-system-overview.

If you have any questions regarding the member eligibility 270/271 batch transaction update, please contact the MassHealth Customer Service Center at 1-800-841-2900 or edi@mahealth.net. When sending an email, please include your MassHealth Provider ID / Service Location (PID/SL) or your National Provider ID (NPI) number.

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

 

Technical refresh update – important message for all MassHealth providers

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 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 beginning on 2/28/2019 through 04/04/2019.  Affected providers and vendors (Billing Intermediaries, Software Vendors, Clearinghouses) may sign up for sessions by clicking on the link: 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 at https://www.mass.gov/masshealth-technical-refresh.  It contains important information and updated Companion Guides for Phase I testing activities.  Phase II Companion Guides will be posted in mid-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.

 

03/05/19

To hospice agency providers regarding ORP guidelines

In February of 2018, MassHealth issued All Provider Bulletin (APB) 274 regarding continued implementation of the Ordering, Referring, and Prescribing (ORP) provider requirements, specifically noting the MassHealth services that require an ORP provider’s NPI on MassHealth claims to be payable. 

Hospice services do not require an order, referral or prescription and therefore hospice providers are not required to include an ORP provider’s NPI on the claim when billing MassHealth.  However, many hospice providers are including an ORP provider’s NPI on their claims. When ORP provider NPI information is incorrect it triggers edits on the claims.  These edits are currently informational, and are described in APB 274.  Once MassHealth activates these edits, any hospice claims submitted with incorrect ORP provider NPI information will deny. To avoid future ORP-related claims denials, hospice providers should not include any ORP provider’s NPI on their claims submissions to MassHealth.

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

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