The State Organization Index provides an alphabetical listing of government organizations, including commissions, departments, and bureaus.
Top-requested sites to log in to services provided by the state
You can send any feedback about MMQ software to email@example.com.
When you create a discharge record, the system will carry over the MMQ category submitted on the last MMQ received. The category has no effect on the discharge record.
If the MMQ pends for three months without a long-term-care segment being opened on the eligibility file, it will be rejected, and a new MMQ submission will be required.
NewMMIS will know by the effective date of an MMQ which ICD-9-CM codes are valid.
This information is needed for statistical purposes.
The new audited casemix scores should be posted to NewMMIS within a month from the time the audit nurse was at the facility. If the category has not been adjusted within a month, call the Casemix Unit at 1-800-841-2900.
MassHealth did not receive an MMQ for that period. You should submit the MMQ.
Providers need to carefully check the adjustment section of the remittance advice for both header and line detail EOB (explanation of benefits) codes. If an EOB code is listed in either field, then there was an error on the submitted adjustment claim. If an adjustment is submitted and there is an error on the replacement claim, MassHealth will recoup the original payment and deny the replacement claim. You will need to resubmit the claim with the correction as noted in the EOB code listed on the remittance advice.
Viewing the status of electronic claims through the POSC varies, based upon the media type used and the time that the claim is submitted. If your claim is submitted via direct data entry (DDE) using the POSC, the status of that claim will appear immediately upon submission of the claim, along with the associated EOB code, if the claim is denied. If you submit a batch of claims using the 837 batch claim submission option, you will be able to view the status of the claims (that is, paid, denied, or suspended) within approximately one hour of submission, assuming that you submit directly to MassHealth.
For claims that have been denied from the batch claim file, you will see the HIPAA adjustment reason code after the financial cycle has been performed for that week (typically on Fridays). Please note that when you check the status of an 837I file in the POSC, the 277 transaction will return the HIPAA adjustment reason codes and HIPAA entity codes and not the proprietary MassHealth edit codes. MassHealth has provided a of these two code sets on the MassHealth Web site to assist providers.
Providers are able to resubmit or adjust only claims that were processed by the new claims processing system. They cannot adjust or resubmit claims that were processed by the old claims processing system.
MassHealth has posted on its website Special Instructions for Submitting Claims on a UB-04 for Members with Other Health Insurance. The document identifies fields on the UB‑04 that must be completed when billing on paper for a member who has TPL, and provides additional instructions for providers who bill using the UB-04 claim form.
Providers need to verify if the paper claim was filled out according to the instructions in the Billing Guide for the UB-04. Improperly completed claims may be returned to the provider. Submitting a paper claim without the NPI or listing the NPI in the incorrect field on the claim form will prevent your claim from being entered into the system.
The process has not changed for claims that are over one year beyond the date of service. You must follow the previously established guidelines for requesting a final deadline appeal. (See All Provider Bulletin 186.)
If a previously paid claim is within one year, the provider can submit an adjustment according to the appropriate guidelines for the type of submission. For electronic claims, review the 837I Companion Guide for detailed loop/segment information. For direct data entry (DDE), refer to the e-Learning tool available on the Provider Online Service Center. For paper claim submissions, please refer to the Billing Guide for the UB-04 on the MassHealth website.
Please note that if the claim was processed in the previous (legacy) system, then the provider must submit a paper adjustment to correct an incorrectly paid claim.
There are no plans at this time to allow providers to submit 90-day waiver claims electronically.
The PPA should be deducted only once. However, if a provider includes the full PPA on both claims, then the system will default to the PPA on the provider's claims. In this case, the provider should not report the PPA on the claim; the system will deduct the PPA automatically.
The claim can be adjusted. The provider should not report the PPA on the claim; the system will default to the PPA on the provider's claim if it is submitted.
If the claim was processed in the previous (legacy) system or was a paper submission, the provider must send the correct claim on paper as an adjustment according to the instructions in the Billing Guide for the UB-04 . If the claim was processed in NewMMIS, the provider can pull up the paid claim and replace it using the POSC. If performing adjustments via batch (837I), providers must follow the instructions outlined in the 837I Companion Guide.
When I submit an adjustment, why does the system take back the whole amount?
Providers need to carefully check the adjustment section of the remittance advice for both header and line detail explanation of benefit (EOB) codes. If an EOB code is listed in either field, there was an error on the submitted adjustment claim and the replaced claim contained errors that did not allow the claim to be processed.
Providers need to follow job aids and supplemental instructions on how to bill when the member has MassHealth and another insurance. Both are available on the MassHealth webpage at www.mass.gov/mmis-and-posc-information.
Providers need to carefully check the adjustment section of the remittance advice for both header and line detail explanation of benefits (EOB) codes. If an EOB code is listed in either field, there was an error on the submitted adjustment claim and the replaced claim had errors that did not allow the claim to be processed. If the payment has been recouped and the date of service is older than 90 days, you will need to submit the claim to the 90-Day Waiver Unit as a new claim along with a completed 90-Day Waiver Request Form and copies of the remittance advice showing where the claim was adjusted.
The 997 is a text file. The ".285" is the file extension, which is comprised of the Julian date of the creation date of the file. Just right-click the file and choose "open with" (Microsoft Word, for example). You should then be able view the 997 file.
For those files that get downloaded as an H.323 Internet Telephony file, rather than the usual type, follow the steps below.
This issue is being researched by the technical team.
It is important that providers review the MassHealth billing guidelines applicable for MLOA/NMLOAs with their billing intermediaries and software vendors in order to ensure that the batch claim files are being submitted properly.
Because claims are adjudicated more quickly in NewMMIS, providers can check claims status via the POSC soon after claim submission. The adjudication cycle is different than the payment cycle, however. Claims in a denied or suspended status will appear on the very next remittance advice after the claims are adjudicated. Claims in an approved-to-pay status will not appear on a remittance advice until payment is released. Paid claims will not, therefore, appear on the same remittance advice as denied or suspended claims from the same batch submission. MassHealth will typically issue payments three weeks after the claim has been adjudicated as paid.
There is no longer a special processing period specifically for nursing facilities.
The 835 format has always been available to providers, as it was in the previous system. To request access to 835s, contact HIPAA/EDI at 1-800-841-2900. Select Option 1, then Option 8, then Option 3.
Providers need to review the EOB codes on the remittance advice to see why the claim has been denied. Reviewing the EOB code will help to determine if the claim was submitted properly. This is especially important when there are claims with multiple lines.
All Provider Bulletin 165 informed providers that the PPA would be deducted from crossover claims.
Yes, an SC-1 form is required, but a level-of-care (LOC) screening is not. Make sure to indicate in Block 20 that the claim is for coinsurance.
Effective August 21, 2009, an LOC screening is not needed.
No. As stated in Long-Term-Care Facility Bulletin 99, a physician's signature is required.
If the member joins a Medicare Advantage plan, a clinical screening may be needed depending on the health plan that is chosen.
A clinical screening by MassHealth or an Aging Service Access Point (ASAP) is not required for SCO members (see 130 CMR 508.008 ). A clinical eligibility determination (screening) is required when MassHealth will be the primary payer at 100 percent.
Per MassHealth regulations at 130 CMR 516.004(A) and (B):
(A) For applicants who do not apply on the basis of a disability, a determination of eligibility must be made within 45 days from the date of receipt of the completed SMBR. All requested information must be received within 30 days of the date of request.
(B) For applicants who apply for MassHealth on the basis of a disability, a determination of eligibility must be made within 90 days from the date of receipt of the completed SMBR, including a disability supplement, if required.
As indicated in Long-Term-Care Bulletin 99, Block 16 of the SC-1 form is the date of admission. Block 19 should reflect the start date that MassHealth payment is being requested.
For denial of an application: 45 days
For the termination of MassHealth benefits: 90 days
For a nursing-facility-initiated transfer/discharge (not expedited): 45 days
The timeline may be longer due to overall appeal volume, jurisdictional problems (such as the death of the applicant or the incompetence of the applicant and the need to seek appointments (administrator, guardian, conservator)), multiple appeals on the same application, rescheduled hearings, and record open period (see 130 CMR 610.015(D)).
MCOs send a list of enrollees and disenrollees to MassHealth on a regular basis. MassHealth does not disenroll a member from an MCO until it receives all of the appropriate information from the MCO. If the facility's claim has been denied because of a discrepancy in enrollment dates, the facility should contact Lisa Gardner via e-mail at firstname.lastname@example.org or 617-348-5554.
The MassHealth Enrollment Center (MEC) is responsible for processing and coding residents based on the SC-1/LOC documentation. This also includes the patient paid amount. The MEC is also responsible for establishing a segment for long term care (LTC). This information is automatically sent to NewMMIS, and should be available the day after the case is updated for MassHealth eligibility.
The MassHealth member ID is a system-generated number and is created only after an applicant is approved for MassHealth. Therefore, the number does not appear on any notice sent before approval. The member ID will appear on the MassHealth card and will also be available on NewMMIS.
In this situation, please call the MassHealth Enrollment Center to resolve the issue.
No, the Taunton Integration Team is responsible for processing SC-1 forms from the nursing facilities geographically assigned to the Taunton MEC.
If there is a need to send an additional SC-1 form, the original admit date and the MassHealth Request Date should be indicated. Please clearly identify the concern or problem in Block 20.
Per regulations at 130 CMR 520.026(D) , MassHealth allows the deduction for HMNA for maintenance of the member's home when a competent medical authority certifies in writing that a single individual with no eligible dependents is likely to return home within six months after the month of admission. The HMNA is equal to 100 percent of the federal poverty level.
As indicated in Eligibility Operations Memo 09-09 , in order for the HMNA to be given, the MEC worker must receive an SC-1 form with the short-term block checked, a physician's signature, and clinical eligibility approval stating short-term stay (Block 21). The HMNA is to be given for a continuous period of institutionalization. If a member returns to the community and remains there for a 30-day period and then reenters a nursing facility for another short-term stay, an HMNA may be given again. There is no limit to the number of HMNAs an applicant or member may receive, as long as there is a break from institutionalization of at least 30 days between stays.
If the individual is on a short-term stay and returns home for less than 30 days, a new HMNA may not be given. The previous HMNA would continue until the end of the six-month period.
No, once the Eligibility Review Form is received and processed, the worker will update NewMMIS to reestablish the segment.
If a currently active, single MassHealth Standard or CommonHealth-eligible community member is screened for a short-term stay, the Chelsea MEC (short-term-care processing unit) will open a segment on NewMMIS. They will not establish a PPA.
Whenever a MassHealth Standard member aged 65 or older is admitted to a nursing facility and has a spouse residing in the community, a Supplement A and Asset Assessment must always be completed to determine if the member is eligible for nursing-facility payment. A nursing-facility payment cannot be established until this determination has been made.
As indicated in Eligibility Operations Memo 09-09 , if the six-month short-term period expires and the member is still a patient at the nursing facility or is no longer on a short-term stay, the following will take place.
The payment segment will be closed by the Short-Term-Care Processing Unit worker. The Short-Term-Care Processing Unit will send an Expiration of Short-Term Stay and Home Maintenance Needs Allowance (ST-CL) cover letter and a Supplement A detailing the need for the supplement to be completed by the nursing facility on behalf of the member. (If the member is under the age of 65, a MER/TRANS form will also be sent to the nursing facility.) The completed forms must be returned to the appropriate MEC with an SC-1 form, stating that the member is transitioning from a short-term stay to a stay of more than six months. A new level-of-care determination form is notneeded. If all required documentation is received, the segment will be coded with the original date.
NewMMIS retains a history of all PPAs.
It is important that the facility properly indicate the location code on the SC-1 form. The worker enters the code that is listed on the SC-1 form. If sending an additional SC-1 to correct a problem, please be sure to make a note in Block 20 of the incorrect location code.
It is critical that discharge SC-1 forms and SC-1 admit forms be sent to the appropriate MassHealth Enrollment Center as soon as the change occurs. This will ensure that the file is up to date.
Yes. Clinicians from the ASAP network receive oversight from the MassHealth Office of Long Term Care and the Office of Elder Affairs.
Policy and procedural updates are shared with all MEC staff.
Depending on the circumstances of the case and the procedures necessary to enter the information into the system, it can take an average of three to four days for a segment to be opened after the case has been approved.
Per MassHealth regulations at 130 CMR 516.007(C) , nursing facilities may receive written notices without the need for either Permission to Share or an Eligibility Representative Designation Form.