Enrolled MassHealth providers can conduct business with MassHealth online via the Provider Online Service Center.
Global Concepts
The “Global Concepts” FAQ provides users with answers to questions on the general use of the POSC and services available.
Q: What is the Provider Online Service Center (POSC)?
A: The POSC is a secure web-based portal that is available to MassHealth providers, business partners, and relationship entities to view information, submit and receive transactions, and effectively conduct business with MassHealth online. Providers, business partners, and relationship entities must be enrolled in and/or registered to use the POSC.
Q: How can users access the POSC?
A: Users can access the POSC via a secure user ID and password. Each person that is assigned a unique user ID and password is solely responsible for the use of that password and must not share it with anyone. Sharing User IDs and passwords is a violation of the Virtual Gateway (VG) Terms and Conditions. Each user is prompted to agree with the VG Terms and Conditions upon initial sign-in on any Commonwealth VG hosted application (e.g., MMIS). Any user that violates the Terms and Conditions will be subject to termination of their user ID.
Q: What types of services are available on the POSC?
A: Users may perform a wide variety of functions that will enable them to submit claims, authorization, and eligibility requests, as well as view notices, query report data, and access a host of other services. Please see the appropriate section below to view the available services.
Q: How can providers, business partners, and relationship entities register to use the POSC?
A: Providers, business partners, and relationship entities may register to use the POSC during the MassHealth online application process. You will be asked to supply registration information at the time of enrollment. Your user ID and password will appear on the screen and a confirmation email with registration instructions will be sent to the email address you provide. While this user ID and password will enable you to complete your application, full access to the POSC will be given only after you have been approved for participation in MassHealth.
If you elect to submit a paper application, you will receive a user ID and password to access the POSC after you have been approved for participation in MassHealth.
Q: While entering information on the POSC, do I need to complete fields that are not marked with a red asterisk (*)?
A: The absence of an asterisk does not indicate that a field is optional. Only certain fields that are consistently required in any given transaction are annotated with an asterisk. The remaining fields are conditionally required, depending on the transaction or the applicable function.
Q: I do not seem to have access to the POSC. What should I do?
A: The Primary User will be the person in your organization who will be responsible for the creation and inactivation of users’ accounts and password resets. Please contact the Primary User (account administrator) within your organization. It is important that the Primary User ensures that a back-up administrator has been assigned to support user access requests and issues in the Primary User’s absence.
If your organization has not registered, please identify a Primary User. The Primary User or office administrator must complete the Data Collection Form to obtain a user ID and password for the Primary User to access the POSC and Interactive Voice Response (IVR).
If you have previously registered for POSC access but do not have your username and password, please contact the Virtual Gateway Help Desk at (800) 421-0938. For questions on the Data Collection Form, contact the MassHealth Customer Service at (800) 841-2900 (TTY: 711).
Q: Where can I view up-to-date information issued by MassHealth about the POSC?
A: MassHealth issues standard broadcast messages to users via the POSC. Users can view these messages by logging into the POSC at https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal/providerLanding/providerLanding.jsf, clicking on Manage Correspondence and Reporting, and then on View Broadcast Messages. MassHealth encourages viewing messages daily for timely updates.
Q: Whom should I contact if I have questions about the POSC or technical requirements?
A: If you have any questions about the POSC, you may contact the MassHealth Customer Service by phone at (800) 841-2900, by fax at (617) 988-8974, or via email at provider@masshealthquestions.com.
Q: What are the minimum technical requirements for using the POSC?
A: To use the POSC, you will need a minimum of
- Internet Explorer 11, Google Chrome, or Mozilla Firefox and
- Adobe Acrobat Reader 7.1 or higher.
Q: Does the POSC allow users to upload and download HIPAA batch transactions?
A: Yes. Users may submit HIPAA (Health Insurance Portability and Accountability Act) batch transactions and receive batch responses that are supported by MassHealth via the batch upload process. To upload or download HIPAA transactions, access any of the batch-upload processes available under Manage Service Authorizations, Manage Members, or Manage Claims and Payment.
Q: Will anyone else have access to my organization’s data on the POSC?
A: Other POSC users will not be able to view your information unless your systems administrator (Primary User) gives them access to your information by selecting the Administer Account function on the POSC.
Q: How secure is my information on the POSC site?
A: The Commonwealth of Massachusetts recognizes the importance of protecting the information entrusted to us. To ensure that the information is protected, we have followed industry-standard security procedures and implemented a solution that protects the data in all stages. While the data is in transit between your browser and our servers, we use 128-bit Secure Socket Layer (SSL) security. After the transmission to our systems, the data is protected by multiple layers of firewalls. The data is stored on secure, “hardened” servers that allow access only to a minimum set of authorized users. Additionally, the HIPAA privacy guidelines are followed while data is accessed.
Q: Is any online help available on the POSC?
A: Online field-level help is available on every panel within the POSC. Simply hover over a field and the “help” information will appear on the screen.
Q: Where can I find information about scheduled system maintenance and other information about POSC access?
A: MassHealth posts information about scheduled system maintenance and other important information in the “Manage Correspondence and Reporting” section of the POSC. Additionally, announcements and updates are posted on the MMIS web page. You can access any MMIS-related announcements directly at the MassHealth Remittance Advice Message Text page.
Providers should make every effort to take advantage of these resources to stay informed. If neither of these suggestions works, please contact the Virtual Gateway Help Desk at (800) 421-0938.
Additional Resources
Access Issues
Q: I have been granted access to the POSC but am having difficulty logging in to the site. It seems to be unavailable. What should I do?
A: Please wait 15 minutes and try logging in again. Make sure that the difficulty is not occurring during scheduled system maintenance (usually at night or on weekends). You should always check for broadcast messages on the POSC when you log in each day.
Q: I am the Primary User for my organization and cannot locate my login information. What should I do?
A: Some providers have found this information routed to their spam or junk email folder. Check alternative sources to see if this information was inadvertently misrouted to such a folder. If you still cannot locate the user ID and password information, contact the MassHealth Customer Service at (800) 841-2900.
Q: What happens if an organization's Primary User leaves?
A: In the event the Primary User and assigned backup leaves the provider, trading partner, or relationship entity organization, that organization must immediately identify a replacement Primary User, complete a new Data Collection Form (DCF) and submit it to MassHealth to officially notify the agency of the change.
If you have questions, contact the MassHealth Customer Service at (800) 841-2900.
Q: What happens if a Primary User creates a subordinate ID for one of his or her staff and someone else tries to establish an ID for that same person?
A: The system will not allow the creation of a second ID with the same attributes. Each person who requires access is assigned a unique user ID. Sharing user IDs is not permitted. If you are still experiencing duplication errors, contact the MassHealth Customer Service at provider@masshealthquestions.com or call (800) 841-2900.
Q: I am having trouble creating a subordinate ID for POSC access. Where can I go for help?
A: Only the Primary User and backup Primary User can create a subordinate ID. The Primary User should revisit the Create Subordinate Accounts job aid to get information about establishing additional access for your users.
Q: I am having trouble accessing and/or entering information on the POSC and keep getting a "you are not authorized" message. What should I do?
A: Please contact the Primary User within your organization. The Primary User within each organization is responsible for managing user access to their information on the Provider Online Service Center (POSC). This includes all information data entered or exchanged with MassHealth via the POSC and its connectivity methods. Your Primary User should confirm that you are set up with the appropriate subordinate user privileges that allow you to submit and/or access certain information via the POSC. If you are the Primary User and are experiencing issues accessing the POSC, contact the MassHealth Customer Service Center at (800) 841-2900.
Q: How can I remove access for a user who no longer requires access to a specific provider?
A: Only the Primary User and backup Primary User can deactivate POSC access for a user. The Primary User or backup Primary User must contact the MassHealth Customer Service at provider@masshealthquestions.com or call (800) 841-2900. The representative will ask for the following information: primary/subordinate user ID, name (first and last), e-mail address, and reason for change. The representative will use this information to update system data.
Q: Does the POSC allow users to upload and download HIPAA batch transactions?
A: Yes. Users may submit batch transactions and receive batch responses that are supported by MassHealth via the batch-upload process. Please provide access to the batch-upload processes available under Manage Service Authorizations, Manage Members, or Manage Claims and Payment.
Q: Can I access MassHealth policies, billing, and other documentation from the POSC?
A: Users can access MassHealth policies, billing, and other documentation by selecting the appropriate link on the right-side navigation. Users can link to provider bulletins and billing instructions there, as well as other important information.
Q: How long will standard letters, notices, and reports generated by MMIS, be available for users to download?
A: Any/all standard letters, notices, and reports (including financial data queries) generated by MMIS will be available for download on the POSC for six months.
Q: Will the metrics and financial data reports be available for my specific organization?
A: Yes. The metrics and financial data reports will be available to any organization that submits transactions and receives payment. The POSC will only display the information related to your individual organization.
For example, the top 10 claims-denials report will display the top 10 claims denials for your provider ID and service location number.
Note: The sections listed below align with the POSC left-side navigation. Click on a subject for FAQ related to a specific area of business.
Additional Resources
Manage Service Authorizations
The “Manage Service Authorizations” function allows the user to manage prior authorization (PA), preadmission screening (PAS), and referrals. Users can enter requests, inquire about requests, and modify requests under certain circumstances.
Preadmission Screening (PAS)
Q: What is a PAS request and how do I use it?
A: PAS is the MassHealth authorization process for elective, acute inpatient hospital admissions, or rehabilitation services provided in an acute inpatient hospital, or chronic hospital stays for MassHealth members who require these services. MassHealth providers are required to obtain permission from MassHealth before the elective admission.
The screenings determine if the admission is medically necessary and if the inpatient setting is appropriate.
For additional information about preadmission screening requirements, see MassHealth regulations at
- 130 CMR 450.207 through 130 CMR 450.209 for acute admissions and
- 130 CMR 435.408 through 130 CMR 435.415 for rehabilitation services provided in an acute inpatient hospital and chronic or rehabilitation admissions and extensions.
Q: How do I submit a PAS request?
A: Providers can submit their PAS request through the POSC as a single transaction using direct data entry (DDE).
Q: What type of PAS requests can providers submit online?
A: Providers can submit the following types of PAS requests online.
- New admission for elective inpatient hospital stays in acute, chronic, or acute with rehabilitation facilities
- Concurrent review (extensions) for chronic or rehabilitation stays and acute stays with rehabilitation services
- Conversion from other insurance for chronic or rehabilitation stays and acute stays with rehabilitation services
Q: What provider information do I need to submit a PAS request?
A: The facility and attending physician provider ID and service location must be on the PAS request, as well as the provider contact name, phone, and fax numbers. All required fields must be filled in or the PAS request will not be processed.
Q: How do I send in documentation to support an elective inpatient submission?
A: Supporting documentation is easily uploaded using the online POSC. Printed documentation may be scanned and then added/uploaded as an attachment. Another option is to make a copy of printed documentation using an up-to-date copier, e-mail the copied information to a secure email, and attach the newly created electronic image as instructed above. Please refer to the Create a PAS Request job aid for more information. Supporting documents must be submitted to substantiate the reason for the elective inpatient admission.
Q: May I use a CPT (Current Procedural Terminology) code when submitting a PAS request?
A: No. ICD (International Classification of Diseases) codes are required for all PAS requests. No other code set will be accepted on a PAS request.
Q: How long will it take Permedion to respond to PAS requests entered through MMIS? Are there any specific guidelines for shortening response time?
A: The turnaround time depends upon how much lead-time providers give Permedion when they submit their requests. The regulations at 130 CMR 450.208(A) state that providers must give seven days' lead-time, but in the majority of cases they do not. Permedion prioritizes submitted requests daily. Last-minute requests may affect Permedion's processing time. Please remember to submit PAS requests seven days before admission to prevent system delays. Please use the online POSC as the turnaround time is faster. Please refer to the Create a PAS Request job aid for instructions to request a PAS online.
Prior Authorization
Q: How do I use the PA Service?
A: Providers may use the Prior Authorization (PA) service to obtain approval prior to providing certain services to MassHealth members. This service enables MassHealth to review, assess, approve, modify, or deny selected nonemergency medical services prior to payment.
For regulatory information about prior authorizations, see MassHealth regulations at 130 CMR 450.303 and other applicable program regulations.
Q: How do I submit a PA request?
A: Providers may submit PA requests via the POSC, using direct data entry (DDE).
Q: What type of PA requests and functions can providers perform online?
A: Providers can perform the following requests and functions online using the POSC.
- Submit requests for medical services and products
- Check the status of a request
- Receive PA notices communicating decision information
Q: The drop-down field for selecting a transmission code within in the PA entry panels on the POSC lists several options. How do I know which one to use to submit my PA requests?
A: Providers submitting electronic PA requests must select the "electronically only" option. Do not select any other option from this field. The choices for sending a PA request and its associated attachments are electronically—submitting the PA request electronically with electronic versions of the attachments—or on paper —submitting the paper PA-1 form along with any necessary paper attachments.
Q: What is the Control Number field located under the Attachment tab in the PA entry application in MMIS? Am I required to complete it?
A: The control number is a system-assigned key and is unique for each attachment. Its purpose is to link the attachment to the PA request. As such, a user cannot populate it; the number is assigned by the system.
Q: What is the number to fax PA requests and PA attachments to MassHealth?
A: Providers who have scanning capability should submit their PA requests and attachments electronically via the POSC. Providers who do not have scanning capability should contact the MassHealth Customer Service Center at (800) 841-2900 to inquire about an eFax account. EFax works like an ancillary scanner, preparing documents for electronic submission. Only a limited number of eFax accounts can be established, though. If you already have electronic scanning capability, MassHealth encourages you to use it. Providers having trouble with their eFax transmissions should contact the MassHealth Customer Service Center at (800) 841-2900.
Q: Where should I mail my paper PA request form?
A: MassHealth
ATTN: Prior Authorization
100 Hancock Street, 6th Floor
Quincy, MA 02171-1745
Primary Care Clinician (PCC) Plan Referral
Q: When is a referral required to see a PCC Plan member?
A: A MassHealth member is enrolled with the PCC Plan at the service location/site level. MassHealth services provided by a provider other than the member’s PCC require referral from the member’s PCC in order to be payable, unless the service is exempted. Referral requirements and exceptions are noted in MassHealth regulations at 130 CMR 450.118(J).
Please see MMIS Job Aids:
- Submit a Referral
- Update a Referral
- Inquire on a Referral
Q: If the PCC Service Location is participating in the Primary Care Payment Reform Initiative (PCPRI) with other service locations of a PCC entity, does the requirement to submit a referral still apply?
A: Yes. MassHealth services provided by a provider other than the member’s PCC require referral from the member’s PCC in order to be payable, unless the service is exempted. Referral requirements and exceptions are noted in the Administrative and Billing Regulations at 130 CMR 450.118(J).
Please see MMIS Job Aids:
- Submit a Referral
- Update a Referral
- Inquire on a Referral
Transportation
Q: Where can I request transportation services?
A: Providers can link to the Request Transportation for a Member page for more information on completing and submitting prescriptions for transportation (PT-1) requests.
Additional Resources
Pharmacy Prior Authorization
The “Pharmacy Prior Authorization” function allows MassHealth-enrolled providers to submit electronic drug PA requests to the MassHealth Drug Utilization Review (DUR) program.
Q. How do I submit a pharmacy PA request?
A. To submit a pharmacy PA request, MassHealth-enrolled providers should use the Online PA function located on the MassHealth Drug List web page or on the MMIS Provider Online Service Center.
Follow the directions outlined in the Instructions to Assist MassHealth Providers to Submit Electronic Drug Prior Authorization Requests located at Request a prior authorization for a drug.
Manage Correspondence and Reporting
The “Manage Correspondence and Reporting” function allows the user to view Broadcast Messages, Notifications, and Metrics Reports. Users can inquire upon Financial Data and view Contracts and Documents. This function may also be used to submit feedback on the POSC.
View Broadcast Messages
Q. Where can I view broadcast messages?
A: Broadcast messages are viewable by providers once they log in to the POSC. Broadcast messages are generally intended as alerts, a notice of important information, and reminders (maintenance notifications). To ensure you have the most up-to-date information, please check the POSC daily for new broadcast messages.
View Metrics/Reports
Q. Where can I download reports and remittance advices?
A: This service allows providers to view and download metrics and reports about activity with MassHealth (for example, remittance advices, PCC enrollment roster, top 10 claims denials, etc.).
View Contracts and Documents
Q: Can I view contracts and documents on the POSC?
A: Yes. The POSC allows providers to view their provider applications for enrollment and contract documentation, where applicable.
Q: Will I have access to older enrollment contracts and documents?
A: Yes. You may view all enrollment contract and documents that you have submitted online via the POSC.
Inquire Financial Data
Q: What type of financial data will providers be able to view?
A: Financial data is available at a provider ID and service location number level. The summary includes a count of paid claims, denied claims, and total payment amounts. A provider can search by year and month to quickly determine, for a given period, how much the provider has been paid and how many claims have been paid and denied.
Q: How often will the financial data be available?
A: Providers can view data 24 hours a day, seven days a week. Updates are made once a week, typically after the weekend claim cycle has been run.
Q: Who can view financial data on my account?
A: This service allows a MassHealth provider to view the summary of claims-payment-related data compiled from the provider’s remittance advices and 835 transactions. This information is viewable according to the user’s security access and the PID/SL that received payment.
Submit Feedback
Q: How can I submit feedback to MassHealth?
A: Providers can access submit questions or comments to MassHealth using the POSC. Use the “submit feedback" link on the left navigation of the POSC that is located under the "manage correspondence and reporting" listing.
Additional Resources
Manage Members
The “Manage Members” function allows the user to view eligibility and enrollment as well as long-term care. Users can also submit Management Minutes Questionnaires (MMQs) via the POSC.
Eligibility
Q: How do I verify a member's eligibility?
A: MassHealth offers the following eligibility verification methods.
- DDE via the Provider Online Service Center (POSC) (single request, online in real-time);
- Batch-upload process via the POSC; and
- Health Care Transaction Service (HTS), a system-to-system transaction.
Q: Can I verify a member's eligibility for a span of time?
A: You can verify member eligibility for up to a 31-day span of time in a single transaction. You can verify a member’s eligibility up to four years before the current date.
Q: How can I check eligibility if I do not have the member ID?
A: You may use any of the following sets of information to check member eligibility.
- Member’s ID from Department of Children and Families (DCF) or Department of Youth Services (DYS);
- Member’s social security number or other agency ID; or
- Member’s last name, first name, date of birth, and gender.
Q: Does the eligibility response return information about the member’s other insurance plan?
A: Yes, if a member has other insurance in addition to MassHealth, the eligibility response will return information about the member’s other insurance plans on file with MassHealth for the search-request dates.
Q: How can I tell if a member is a Qualified Medicare Beneficiary (QMB)?
A: The Eligibility Verification System (EVS) will return the following system-generated, eligibility restrictive message: 611 Member is Qualified Medicare Beneficiary. See 130 CMR 519.010 to learn how to indicate that the member is QMB.
Q: How do I correct a member’s other insurance information in EVS (Eligibility Verification System)?
A: Refer to Subchapter 5: Administrative and Billing Instructions, Part 7, Other Insurance, of your provider manual. See section “Updating Other Insurance Information.”
Long-Term Care
Q: Can I enroll my SCO and PACE members via the POSC?
A: Yes. PACE (Program for All-inclusive Care for the Elderly) and SCO (Senior Care Options) plans can enroll or disenroll MassHealth members in either the PACE or SCO programs.
Q: How do I enroll and disenroll an individual member using DDE from PACE or SCO?
A: Log on to the POSC. On the left side, click Manage Members. Click on PACE or SCO enrollment/disenrollment. The search screen will appear. Enter the member ID, last name, and first name, and click the Submit button. Either an enrollment or disenrollment panel will be returned, depending on the member’s status. For additional information, please review the following appropriate job aid.
Q: Can I submit enrollment/disenrollment batch transactions?
A: Yes. PACE and SCO providers may submit the following transactions through the portal.
- Batch HIPAA 834 enrollment/disenrollment files
- Provider directory files
- Enrollment history requests
Submission of HIPAA 834 transactions and history requests are optional for PACE and SCO plans.
Q: Can I upload/download HIPAA transactions?
A: Yes. PACE and SCO providers are able to download the HIPAA 834 enrollment confirmations and 820 payment files from the portal.
Q: Will I receive confirmation after I enroll or disenroll a member?
A: Yes, every transaction receives confirmation.
Q: Which reports are available for download for PACE and SCO?
A: PACE and SCO plans can download the following enrollment and capitation payment reports under the View Metrics Reports section of the POSC.
- Monthly Member Enrollment
- Monthly Member Disenrollment
- Monthly Capitation Payments
- Quarterly and Annual Capitation Reconciliation
Q: Will I also have access to reports older than six months?
A: You will not have online access to reports more than six months old. To obtain copies of older reports, contact the Coordinated Care Systems Unit at the Office of Long-Term Services and Supports at the following phone numbers.
PACE: (617) 222-7518; SCO: (617) 222-7418
Q: Can I submit an MMQ to MassHealth online?
A: Yes. Nursing facility providers or their agents can submit Management Minutes Questionnaires (MMQs) via the POSC, either individually or as a batch.
Q: How do I submit my MMQ?
A: MassHealth providers must log into the POSC to submit MMQs. Providers may submit MMQs either individually by DDE or as a batch. Refer to Appendices D and E of the Nursing Facility Manual for instructions on submitting MMQs.
Q: Will I receive confirmation once I submit my MMQ?
A: Yes. If you submit your MMQs using DDE, you will receive a confirmation immediately after submission. If you submit your MMQs as a batch, a confirmation screen panel will provide you with a tracking number for your submission.
Q: Can I update previously submitted MMQs via DDE for my semi-annual submissions?
A: Providers may copy and modify previous MMQs for their semi-annual submissions.
Q: If I have questions about my MMQ, whom should I contact?
A: You may contact the MassHealth LTSS Provider Service Center by phone at (844) 368-5184, or via e-mail at support@masshealthltss.com.
Additional Resources
Open the “Manage Claims and Payments” POSC page at POSC Job Aids page. Then scroll down to the SCO/PACE Additional Resources section to find resources for enrolling or disenrolling in PACE and SCO.
The “Manage Claims and Payments” function allows the user to enter single or batch claims and inquire about claims status, as well as to view PACE and SCO payments. Users may also download capitation information.
Additional Resources
Manage Claims and Payments
Q: How do I submit claims to MassHealth?
A: Claims may be submitted online individually using DDE or a batch process via MassHealth’s connectivity method using SOAP + WSDL, as well as HTTP MIME submission methods.
DDE. Use this service to submit electronic claims to MassHealth individually. Providers do not need to submit test files in order to submit claims via DDE. Providers may log into the POSC and begin submitting claims via DDE 24 hours a day, seven days a week, and receive immediate results on the status of the claim: Paid, Denied, or Suspended.
Batch Processing. Use this service to submit electronic, HIPAA-compliant claims to MassHealth in batches. Providers must successfully submit a test file and be approved to submit production claims before they may submit files for batch processing through the POSC or system-to-system.
MassHealth advises providers about the need to update their submitter field with the appropriate MassHealth ID as a preparation step for submitting 837 transactions in MMIS.
Confirm that 837 files are sent as production files, with a "P" entered into the ISA15 field. Files submitted with a "T" are processed as test files only. If all of the aforementioned information has been confirmed, the 837 file may have failed precompliance. Mistakes in completing the ISA06 field of the 837 file are among the most common submitter mistakes to cause a pre-compliance failure. The ISA06 is a fixed field. The submitter must enter exactly 15 characters and spaces into the field. Providers must enter their 10-digit provider ID/service location number followed by five spaces.
Please note that the MassHealth EDI team is tracking the submission of 837 files and, for a time, is contacting those providers with files that have failed precompliance to assist in correcting the issue further. For more information about the ISA06, ISA, and GS02 fields, refer to the HIPAA Implementation Guide.
Inquire Claim Status. Use this service to check the status of claims submitted via batch, DDE, or paper.
Test 837. Use this service to submit test non-Healthcare Transaction Service (HTS) batch files.
View PACE/SCO Payments. This service is for PACE and SCO providers only. Use this service to check PACE payments, download PACE payment reports, and download PACE 820 payment confirmations.
Download Capitation Information. This service is for managed-care organizations only. Use this service to download capitation reports.
Q: Will I receive confirmation once I submit my claims?
A: If you submit your claims using DDE, you will receive a response indicating the status of the claim immediately after submission.
If you submit your claims using system-to-system processing (HIPAA-compliant files), a confirmation screen panel will provide you with a tracking number for your submission. After your claims are processed, a HIPAA-compliant acknowledgement (TA1 and/or 999) will be posted on the POSC under your account.
Q: Can I check the status of my claims?
A: If you submit your claims using DDE, you can check the status of a claim by clicking on the Inquire Claims Status link in POSC. In addition, when you submit your claims via DDE, you will receive an immediate response indicating the status of the claims.
If you submit your claims using batch processing, you may submit a 276 request to check the status. This action will generate a 277 response.
Q: Why do my claims keep getting denied?
A: Refer to your weekly remittance advice to identify the denial reasons.
Please ensure that you are billing in accordance with the current billing instructions.
Refer to the Companion Guides
Companion guides provide instructions for submitting HIPAA transactions to MassHealth. When submitting electronic files to MassHealth, be sure to review the instructions in the appropriate companion guide.
To request a copy of any of the MassHealth Companion Guides, contact the MassHealth Customer Service Center at (800) 841-2900.
Billing Tips Flyers
MassHealth has prepared a number of billing tips as part of the POSC e-learning courses at billing tips.
Get Trained
MassHealth has prepared a number of job aids as part of the POSC e-learning courses.
Q: How can I exit a tab in the DDE function so that I can continue in the system?
A: Remember to click on "cancel the item" if you clicked on a tab. This prompts the system to exit and allows you to continue. Do not select the command "cancel the service" or your entire transaction will be lost. It is important to note that you should click on "Add Item" to save your updates periodically when prompted by the system.
Q: How can I locate my 999 Acknowledgement file?
A: You can locate your 999 Acknowledgement on the POSC under the download panel. Typically, 999 responses are issued within one hour of MassHealth's receipt of an 837 file. Please allow 24 hours following the submission of your 837 file before calling the MassHealth Customer Service Center at (800) 841-2900 to inquire about your 999 acknowledgement.
Q: Where do I download my 835?
A: Providers should log on to the POSC to download 835 responses. If you submit your transaction through HTS, you can also retrieve your 835 through that method.
Q: Where can I obtain the MassHealth Proprietary Remittance Advice?
A: Providers should log on to the POSC, click Manage Correspondence and Reporting, then View Metric/Reports.
Third-Party Liability (TPL)
Q: Where can I find MassHealth Third-Party Liability Billing regulations?
A: Refer to Subchapters 1 through 3: Administrative and Billing Regulations at MassHealth Administrative and Billing Regulations (130 CMR 450.316 through 450.321 in your provider manual).
Q: Where can I find TPL billing and submission information?
A: Please refer to Subchapter 5, Section 7 of your provider manual to address questions you may have on the following topics.
- Coordination of Benefits Claim Submission – information on how to submit COB claims electronically
- Supplemental Instructions – information on the provider types that can submit TPL exception claim billing and other general billing instructions
- Medicare Crossover Claims – information on crossovers adjudicated by Medicare but not processed by MassHealth
- When Medicare Denies Your Entire Claims – information on submitting claims to MassHealth if Medicare has denied services on the claim
- Adjusting a COB Claim – information on adjusting a COB claim when other insurance (Medicare or commercial) has voided or adjusted the claim or service lines that were previously paid by MassHealth
- Updating Other Insurance Information – information on how to correct a member’s other insurance information in EVS
Q: Where can I find a complete listing of MassHealth-assigned carrier codes?
A: Refer to Appendix C: Third-Party Liability Codes of your MassHealth provider manual for a list of MassHealth-assigned carrier codes, including carrier names and addresses.
Q: If I identify other insurance that does not have a MassHealth-assigned carrier code, how do I submit the claim?
A: Refer to Appendix C: Third-Party Liability Codes of your MassHealth provider manual for a list of MassHealth-assigned carrier codes. If you are unable to locate one for the insurance in Appendix C, you should complete a Third-Party Carrier Code Request form, which follows, and submit via fax to the following address.
MassHealth
Third-Party Liability Unit
Fax: (617) 886-8134
Do not send claim forms to the FAX number.
Additional Resources
Manage Provider Information
The “Manage Provider Information” function allows the user to manage their provider enrollment information as well as maintain their profile. Business partners may also use this function to maintain their enrollment information.
Business Partner Enrollment
Q: How can I manage my information on the POSC?
A: MassHealth works closely with a variety of entities that support our provider and member communities. Business partners may enroll and maintain their profile via the POSC. What follows are examples of the types of business partners who may enroll via the POSC.
- Billing intermediaries and/or clearinghouses – This type of business partner submits electronic claims for their clients who are providers. They need to be enrolled in the POSC in order to submit electronic claims for their clients.
- Health-care advocacy groups – These are groups that represent providers or members.
- Provider associations – These associations represent various provider types (i.e., physicians and hospitals, nursing facilities, etc.).
- Software vendors – These are health care-related software vendors.
Enrollment
Q: What other features does the POSC provide for my provider enrollment application?
A: This service allows you to
- initiate an application for enrollment as a MassHealth provider;
- save a partially completed provider application;
- continue work on a saved provider application; and
- inquire on the status of a provider application.
Q: I am a current MassHealth provider. How can I update my information online?
A: Providers may submit changes to their profile online. Some changes may require original documents with a “wet signature” (blue ink) for the changes to be made. The following documents will also require a wet signature.
- W-9 forms
- Electronic Funds Transfer (EFT) form
- Provider Contract
Q: How will I know that the request for changes to my profile was received and my file was updated?
A: All requests for changes to your provider information via the POSC will be tracked. Providers will also receive written confirmation of any requested changes once this change is processed. Providers will be able to check the status of an update request by contacting the MassHealth Customer Service by phone at (800) 841-2900, by fax at (617) 988-8974, or via email provider@masshealthquestions.com.
Administer Account
The “Administer Account” function allows the user to manage his or her account access and user profiles and to change passwords.
Change Password
Q: I am a Primary User and need to change my password and/or POSC account information. What should I do?
A: Contact the MassHealth Customer Service for a Data Collection Form (DCF) to update your information and change your password.
Q: I am a subordinate user. How can I change my POSC password?
A: Please contact your Primary User if you have questions about how to change your password. If you do not know who your Primary User is, please contact the MassHealth Customer Service at (800) 841-2900. You can also revisit the Change a Password job aid for detailed instructions on changing your password. To view all POSC job aids, go to Job Aids for the Provider Online Service Center (POSC).
Manage Subordinate Accounts
Q: Who has access to administer services on a provider or business partner’s account?
A: This service is restricted to the Primary User for the provider or business partner. Providers and business partners must designate a person as the security administrator (Primary User) for their organization. The security administrator can give access to the POSC to other people within their organization and to business partners, such as software vendors and billing intermediaries who perform MassHealth-related tasks on behalf of the provider. The security administrator can perform the following actions using this service.
- Change the Primary User's password for accessing the POSC Manage subordinates' accounts. The security administer may perform the following actions from this option.
- set up user accounts for subordinates;
- reset subordinates' passwords;
- manage subordinates' authorization to perform services online; and
- link account information to allow other entities to view data or perform services on the provider's behalf.
Additional Resources
Reference Publications
The “Reference Publications” function allows the user to view and order publications and review regulations, as well as to download forms. Users can also view training and assistance materials and FAQs, and select their preferred communication method.
View Publications
Q: Where can I view MassHealth publications?
A: Providers are able to link to the MassHealth Provider Library and Member Eligibility Library to view and download MassHealth publications, such as regulations, provider bulletins, forms, brochures, and booklets. Providers may also use this service to request a supply of forms and other publications, such as brochures and booklets.
Training and Assistance Materials
Q: Where can I find training and assistance materials?
A: Providers may link to the MassHealth Provider Training site, where they can view and download training and assistance materials.
Training Registration
Q: How do I register for training?
A: Providers and business partners should click on Training Registration on the POSC to register for provider trainings and educational sessions. Providers may use this service to
- view upcoming trainings available for MassHealth providers;
- register for upcoming trainings available for MassHealth providers;
- choose the location and view availability of upcoming trainings; and
- view training materials from past provider educational sessions.