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Message Text – May 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.

05/28/19

Providers of substance use disorder group counseling services (HCPCS H0005)

Administrative Bulletin 19-08: 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs: Codes for Group Counseling Billing outlines the changes to HCPCS codes and modifiers associated with substance use disorder (SUD) group counseling services, effective January 1, 2019. Refer to the bulletin at https://www.mass.gov/files/documents/2019/04/19/ab-19-08.pdf.

Providers who have received claims denials, or have not been paid for SUD group counseling claims submitted after January 1, 2019 may be eligible to receive payment for medically necessary services rendered. Providers should follow the instructions described in the scenarios below, as applicable. 

Scenario 1: A provider delivered 90-minutes of group counseling, and submitted two 45-minute units on the same claim. That claim (both units) was denied.

Provider Instructions: Submit a claim of one unit of the new 90-minute modifier outlined in Administrative Bulletin 19-08 for the original date of service.

Scenario 2: A provider delivered 90-minutes of group counseling, and submitted two 45-minute units on the same claim. Only one of the 45-minute units was approved, and the second 45-minute unit was denied.

Provider Instructions: Adjust the paid claim using the 90-minute modifier.

Scenario 3: A provider delivered 90-minutes of group counseling but only submitted one 45-minute unit on the claim to avoid denial of the claim.

Provider Instructions: Adjust the paid claim using the 90-minute modifier.

Scenario 4: A provider delivered group counseling but did not submit the claim at all to avoid denial of the claim.

Provider Instructions: Submit the claim for the date of service using either one 45-minute unit or one 90-minute unit, depending on the length of service delivered.  Please note that if the date of service occurred 90 or more days prior to the submission of the claim, the provider will need to submit a timely filing waiver.* 

*Links to information about the timely filing waiver process:

If you have a unique circumstance and require additional guidance, or if you have any questions, please contact the MassHealth Customer Service Center (CSC) at 1-800-841-2900 or e-mail providersupport@mahealth.net.

 

UPDATED MESSAGE – Member eligibility changes reminder – response logic update

On July 14, 2019, MassHealth will implement a change to its member eligibility 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 or via the POSC.  After implementation, if a provider sends in a 270 request with an invalid MID, the provider will receive a 271 response indicating “Invalid Member ID.” Specifically, it will state error code “72” Invalid/Missing Subscriber/Insured ID in the AAA03 – Reject Reason Code segment for Loop 2100C.  POSC transactions will also receive a “Member ID Missing or not on file” response.

MassHealth strongly recommends providers make changes to your eligibility inquiry practices today to ensure that you submit a valid MIDs on the request so 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. 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.

 

05/21/19

MassHealth timeframes for bill paying for nursing facility providers

MassHealth will be modifying the timeframes for paying Nursing Facility claims for May dates of service received by MassHealth in May or June. The payment schedule will be modified by approximately 2 weeks.  Please see the modified payment schedule outlined below.

  • RA DATE: 07/02/2019                                     
  • PAYMENT DATE CHECKS: 07/05/2019
  • PAYMENT DATE EFT: 07/08/2019

Claims for June dates of service will go back to the regular schedule. (Remittance Advice (RA) dated the third Tuesday of the month)

  • RA DATE: 07/16/2019
  • PAYMENT DATE CHECKS: 07/19/2019
  • PAYMENT DATE EFT: 07/22/2019

MassHealth is mindful of the difficulties imposed by fiscal management decisions and appreciates your patience and understanding.

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.

 

Technical refresh reminder – phase I implementation

MassHealth Electronic Data Interchange (EDI) Trading Partners must prepare for and participate in the Technical Refresh Phase I Trading Partner Testing (TPT). Phase I TPT will be conducted between 7/29/19 – 9/20/19, and includes the implementation of the eligibility transaction. If you currently submit and receive the following HIPAA transaction you must participate in TPT to validate that you will be able to send and receive the transaction, as well as the corresponding HIPAA (999/TA1) Implementation Acknowledgement for Health Care Insurance, successfully in production:

  • Health Care Benefit Inquiry and Response (270/271)

All Trading Partners must complete the following activities immediately in order to prepare for TPT and implementation:

  • Visit https://www.mass.gov/masshealth-technical-refresh to review the important information and download the updated MassHealth Companion Guides
  • Review the updated Companion Guides and assess any impacts to your business processes and systems
  • Modify your systems, where appropriate
  • Please stay tuned to register for upcoming fall information sessions that will be available soon at https://www.masshealthtraining.com
  • Prepare and submit your test file during the TPT timeframe

Please note that your transactions may be rejected if you do not fully comply with the Technical Refresh requirements.

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 along to the appropriate resources, including your vendor.

 

Member eligibility changes reminder – response logic UPDATE

On July 14, 2019, MassHealth will implement a change to its member eligibility 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 or via the POSC. After implementation, if 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.  POSC transactions will also receive a “member not found” response.

MassHealth strongly recommends providers make changes to your eligibility inquiry practices today to ensure that you submit a valid MIDs on the request so 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. 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.

 

Important reminder – any remaining EVSPC users

MassHealth would like to remind you that the EVSpc and EVScall software tools were terminated on September 1, 2015. You should have discontinued sending eligibility (270) and claim status (276) batch HIPAA files generated from EVSpc/EVScall at that time.

The EVSpc and EVScall software tools, that have been obsolete for the past 4 years, will not be compatible when the agency implements Phase I of its Technical Refresh project this fall. Your transactions will fail compliance. Providers must stop using the tool and transition to one of the following options immediately:

  • Use DDE (Direct Data Entry) in the Provider Online Service Center (POSC)
  • Hire a vendor to generate and send your 270 and receive 271 batch files
  • Submit and receive 270/271 or 276/277 batch files in accordance with the MassHealth specifications
  • Submit and receive a 270/271 or 276/277 batch files through the POSC or through a system-to-system connection

For questions or assistance, please contact the MassHealth Customer Service Center at 1-800-841-2900 or edi@mahealth.net.

 

05/14/19

Retroactive rate adjustments for adult day health (ADH) claims

Mass Health will be adjusting Adult Day Health claims for retroactive rates effective May 1, 2019. These adjustments should account for the rate increase indicated in the revised ADH rate regulations, which will be promulgated on May 17, 2019.

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.

 

Retroactive rate adjustments for adult foster care (AFC) claims

Mass Health will be adjusting Adult Foster Care claims for retroactive rates effective May 1, 2019. These adjustments should account for the rate increase indicated in the revised AFC rate regulations, which will be promulgated on May 17, 2019.

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.

 

Retroactive reprocessing for new HCPCS codes effective January 1, 2019

The current Remittance Advice may contain adjusted and/or reprocessed claims for the new HCPCS codes that were added effective 01/01/19. 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.

 

Duplicate claims submissions

MassHealth would like to remind all claims submitters (providers, billing intermediaries, and clearinghouses) that duplicate billing is an unacceptable billing practice. MassHealth Regulation 130 CMR 450.307(B)(1) states that “duplicate billing, which includes the submission of multiple claims for the same service, for the same member, by the same provider or multiple providers” is forbidden.  https://www.mass.gov/regulations/130-CMR-450-administrative-and-billing-regulations

MassHealth identifies and tracks providers, billing intermediaries, and clearinghouses who abuse this Regulation. Providers are encouraged to check claims status (276/277) via the POSC first prior to the submission of a second claim. MMIS adjudicates claims real time and claims status is available within at least two business days. Medicare crossover claims for dually eligible members are automatically transmitted to MassHealth when at least one claim line is Medicare approved. Medicare crossover claim status can also be checked via the POSC.

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

 

05/07/19

Retroactive reprocessing for early intervention (EI) codes effective January 1, 2018

MMIS will be reprocessing claims for EI codes H2019 (therapeutic behavioral services) and H0031 (mental health assessment, by non-physician) retroactive to January 1, 2018.  This Retroactive Reprocessing should correct any erroneous denials for edit 4020. 

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

 

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

Please note that the DME & Oxygen Payment and Coverage Guideline Tool has been updated on 5/1/19 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.

HCPCS codes and modifiers E0639NU, E0640NU, E0639RB, and E0640RB have had a rate update to AAC+35% per Administrative Bulletin 19-07. Please note that the HCPCS codes, modifiers, and rates will be effective for services rendered on or after February 22, 2019.

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.

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