Message Text – October 2017

Message Text – October 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 publications@mahealth.net,
  • calling MassHealth Customer Services Center at 1-800-841-2900, or
  • sending a fax request to: 617-988-8973.

10/30/17

Update for vaccines – effective 10/01/17

MassHealth has moved the following vaccine codes from Non-payable to Payable with IC (Individual Consideration) status, effective 10/1/17. The codes are available in the Pricing regulations as IC. The codes will move from section 602 Non-payable CPT Codes to section 603 Codes That Have Special Requirements or Limitations in the January Subchapter-6 update.

90281, 90283, 90284, 90287, 90384, 90386, 90389, 90396.

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

10/24/17

Change to MMQ payment due to audit – effective 10/01/17

Beginning 10/01/17, MassHealth will identify and systematically adjust any previously paid claims where a change to the MMQ or level of care as a result of the site audit requires a change in the claim payment amount. Providers no longer need to submit adjustments for these claims. MassHealth will adjust the claims no sooner than 30 days after the audit to allow providers ample time to appeal audit findings. These adjusted claims will appear on your remittance advice with EOB code 9040 – Retroactive MMQ or levels of care change.  No adjustments will be made to claims where a change to the MMQ or level of care does not require changes in the claims payment amount.  In the coming weeks, providers may see adjusted claims resulting from audits that occurred during calendar year 2017 on their remittance advices. 

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

10/17/17

Payment and care delivery innovation – new health plans are coming to MassHealth effective march 1, 2018

Beginning this month, MassHealth Customer Service will be hosting webinar sessions for providers to provide an overview of MassHealth Payment and Care Delivery Innovation (PCDI). This is the first in a series of webinars related to changes coming to MassHealth.  This session’s objective is to provide all attendees with an understanding of MassHealth PCDI and its impact on providers and managed care members. This webinar will include an overview of the MassHealth ACO/MCO structure, timelines, information on how members will be assigned to new or existing health plans, an overview of enhancements in the Eligibility Verification System (EVS), and other resources and tools that will be available to providers and their practice staff. 

Webinar sessions are available for the month of October and November. Please register for one of these sessions as space is limited.

To enroll in a webinar session, please register at the MassHealth Learning Management System (LMS) via www.masshealthtraining.com and create your profile. Once registration is complete, please select the preferred course date and time.

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

10/10/17

09/29/17 – Financial cycle run number change

The 09/29/2017 financial cycle had a skip in sequence. As a result, the cycle number changed and this week’s number is one ahead of what providers are expecting. The 09/29/2017 run should have been number 100436, however the skip resulted in run number 100437. The upcoming 10/06/2017 run cycle will be in sequence and, therefore, will be 100438.

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

10/03/17

New billing instructions for adult day health (ADH) providers

Adult Day Health (ADH) providers must bill for the ADH service codes S5100, S5100 TG, S5102, or S5102 TG, prior to billing for any transportation services. If providers bill for the Transportation codes T2003 or T2003 U6 prior to an ADH visit code, or without an ADH visit code, claims will deny for Edit 8165 – T2003 REQIRES A PAID ADH VISIT S5100 OR S5102.

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

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