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Over the past few months MassHealth has undergone a number of changes beginning with the inception of Health Care Reform on July 1, 2006, followed by the transition to a sole Coordination of Benefits contractor on September 1, 2006, and more recently the implementation of the Commonwealth Care Health Insurance Program effective October 1, 2006.

My past communications with your organization have heralded the importance of the MassHealth web site in keeping abreast of these changes and my message remains unchanged. As a tool for the provider community, www.mass.gov/masshealth, offers information on program regulations and policies and background on new initiatives introduced by MassHealth. Specifically, information is available on the new Commonwealth Care program and the coordination of benefits contract that MassHealth recently engaged in under the News and Update section of the homepage. Regular information available in the “Provider Library”, includes MassHealth Provider Manuals, MassHealth Bulletins and Transmittal Letters and the bi-monthly MassHealth “Update” newsletter. Please continue to take advantage of this self-service option and feel free to contact me if any questions arise.

In order to facilitate this information accrual, I have provided your organization with details of the major initiatives undertaken by MassHealth in the past few months. Please review the details to find answers to any questions that you may have.

Coordination of Benefits Agreement

Effective September 1, 2006 MassHealth began processing electronic crossover claims under the Coordination of Benefits Agreement (COBA) program described in the COBA Implementation Guide (www.cms.hhs.gov/COBAgreement). As many of your providers may have noticed, a number of issues resulted from the implementation of this agreement.

The Customer Service Team along with various MassHealth Departments have been working together to identify and resolve any erroneous denials as a result of the Coordination of Benefits Agreement. For further details regarding the COBA please refer to All Provider Bulletin 158 :Coordination of Benefits for Crossover Claims within the “Provider Library” or click here for important information about Medicare/MassHealth Crossover Claims.

MassHealth will continue to keep providers updated with any changes made, through the distribution of Message Text and other publications. Listed below are the most pertinent message text related to claims processing made available by MassHealth subsequent to the COBC transition.

COORDINATION OF BENEFITS CONTRACTOR (COBC) CLAIMS
CERTAIN COBC CLAIMS SUBMITTED TO MEDICARE CROSSED OVER TO MASSHEALTH INCOR-

RECTLY PAYING ZERO DOLLARS. IF MEDICARE MADE A PAYMENT AT THE CLAIM LEVEL

AND MASSHEALTH MADE A PAYMENT AT THE LINE LEVEL THE CLAIMS MUST BE VOIDED AND

RESUBMITTED. [I.E. EXPLANATION OF MEDICARE BENEFITS (EOMB) HAS 1 DETAIL LINE

AND MASSHEALTH REMITTANCE ADVICE (RA) HAS MULTIPLE LINES]. TO CORRECT THIS,

SUBMIT A PAPER VOID REQUEST FORM AND MASSHEALTH RA SHOWING THE LINE(S) TO

VOID. IF YOU’RE APPROVED TO SUBMIT COB CLAIMS ELECTRONICALLY, VOID THE INCORRECT CLAIMS, THEN REBILL THE CORRECTED CLAIM. SEE THE COMPANION GUIDE 3.3 DETAIL

DATA FOR HOW TO SUBMIT COB CLAIMS.

Crossover Claims and the Coordination of Benefits Contractor (COBC)

At this time, MassHealth is not processing Institutional COBC claims as they are not processing correctly. We are working on a resolution and will process these claims once the issue is resolved. We apologize for any inconvenience. CONTACT MASSHEALTH AT PROVIDERSUPPORT@MAHEALTH.NET OR 1-800-841-2900 FOR QUESTIONS

COORDINATION OF BENEFITS CONTRACTOR (COBC) CLAIMS

CERTAIN COBC CLAIMS SUBMITTED TO MEDICARE CROSSED OVER TO MASSHEALTH AND PAID ZERO DOLLARS INSTEAD OF PAYING THE APPLICABLE COINSURANCE AND DEDUCTIBLE AMOUNT (UP TO THE MASSHEALTH ALLOWED AMOUNT.) TO CORRECT THIS ISSUE, IF YOU ARE APPROVED TO SUBMIT COB CLAIMS ELECTRONICALLY, REBILL THE CLAIM USING THE 837 VOID AND REPLACE TRANSACTION AND ENTER THE MEDICARE PAYMENT DETAILS ON THE REPLACEMENT CLAIM. TO SUBMIT THE ADJUSTMENT CLAIM ON PAPER, SEND THE CLAIM, EXPLANATION OF MEDICARE BENEFITS (EOMB), THE MASSHEALTH REMITTANCE ADVICE SHOWING THE ZERO PAYMENT, AND A COVER LETTER TO MASSHEALTH. WE ARE WORKING ON A RESOLUTION AND APOLOGIZE FOR ANY INCONVENIENCE. IF YOU HAVE ANY QUESTIONS, CONTACT MASSHEALTH CUSTOMER SERVICE AT PROVIDERSUPPORT@MASSHEALTH.NETOR 1-800-841-2900

CROSSOVER CLAIMS AND THE COORDINATION OF BENEFITS COORDINATOR (COBC)

THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) CONSOLIDATED THE MEDICARE CROSSOVER CLAIMS PROCESS BY APPOINTING A SINGLE COBC .THE TRANSITION TO A NEW COBC WILL BE COMPLETED BY 11/2006. BY THIS DATE, ALL FILES RECEIVED FROM THE COBC DURING THE TRANSITION WILL BE PROCESSED BY MASSHEALTH. THE NEW CROSSOVER CLAIMS PROCESS DECREASES THE NEED TO SUBMIT CROSSOVER CLAIMS ON PAPER. SHOULD YOU NEED TO SUBMIT PAPER CROSSOVER CLAIMS TO MASSHEALTH, CONTINUE TO INCLUDE YOUR MASSHEALTH PROVIDER NUMBER AND THE MEMBER IDENTIFICATION (RID) ON THE EXPLANATION OF MEDICARE BENEFITS (EOMB).CONTACT MASSHEALTH AT PROVIDERSUPPORT@MAHEALTH.NET OR 1-800-841-2900 FOR QUESTIONS.

Recredentialing Initiative

Because MassHealth is committed to ensuring the integrity of its provider network, MassHealth recently communicated plans to recredential all MassHealth providers over the next three years. The recredentialing initiative will be managed by MassHealth Customer Service with the assistance of MedAdvantage, a credentials-verification organization.

Over the next three years, MassHealth will select a different one-third of the provider population each year for re-credentialing. Along with the one-third selected for full recredentialing by June 30, 2007, MassHealth will perform an abbreviated review on the remaining two-thirds of providers.

MassHealth will contact selected providers and send a full recredentialing package for them to complete and return with the requested documentation within 30 days. The two-thirds of providers undergoing the abbreviated review will only be contacted if additional information is needed.

Please keep in mind that the recredentialing project does not replace the requirement to report changes in provider information or status (i.e. address, contact details, licensure, etc.) to MassHealth in writing.

For further information please refer to Transmittal Letter ALL-160

Please know that in order to facilitate this recredentialing process, MassHealth will be contacting your organization shortly for collaborative purposes. MassHealth will contact your organization with more information at a later point in time.

Additional MassHealth Publications

Listed below are the most recent MassHealth publications that may be of interest to you and your members. All of the following publications (Transmittal Letters and Bulletins) can be accessed on the MassHealth Web site, here: “Provider Library”.

All Provider Bulletin 159: Managed Care Enhancements on REVS

The Recipient Eligibility Verification System (REVS) has been revised to display both the corporate and local site names of the member’s primary care clinician (PCC), when available.

MassHealth Vision Care Bulletin 13: MassHealth Essential to Cover Visual Analysis by Optometrists

MassHealth Essential members are eligible for eye exams and related treatment services. However, the types of providers from whom MassHealth Essential members could receive these benefits have been limited.

Transmittal Letter ALL-143: Revised Appendix A

Appendix A in all provider manuals was updated to reflect a change in the contact information for the Third Party Liability (TPL) Unit and a fax number change for the Home Health Service fax number.

Transmittal Letter ALL-142: Revisions to Appendix Y Due to Commonwealth Care Coverage

Appendix Y has been updated to include six new restrictive messages that will be displayed in REVS for members that are enrolled or determined eligible to enroll in the new health care program, the Commonwealth Care Health Insurance Program.

Transmittal Letter ALL-141: Revised Appendix Y

TL 141 was issued to transmit changes in REVS service codes such as the new code 608 and its message, CMSP message updates for existing codes 035, 490, 602, 604, and 605, and updates to contact phone numbers for codes 021,061,281.

Transmittal Letter ALL-140: Revised Appendix C

TL 140 was issued to transmit an updated Appendix C for all provider manuals. Appendix C includes all Third-Party-Liability Coverage-Type Codes and Carrier Codes.

Provider Specific Message Text:

Please refer to the provider specific message text listed below. Message text is included with the weekly Remittance Advice received by Providers. Message text is another tool used by MassHealth in order to keep providers informed of new initiatives or program updates.

MASSHEALTH PROVIDER RE-CREDENTIALING PROJECT

MASSHEALTH HAS INITIATED THE RE-CREDENTIALING OF ALL MASSHEALTH PROVIDERS. PROVIDERS. THIS IS A STANDARD PROCESS NECESSARY TO PROTECT THE INTEGRITY OF PROVIDER FILE INFORMATION AND INVOLVES VERIFICATION OF INFORMATION SUCH AS BUSINESS NAME, ADDRESSES, LICENSE NUMBERS, AND ANY OTHER INFORMATION AS REQUIRED FOR ALL EXISTING MASSHEALTH PROVIDERS. PLEASE REFER TO ALL PROVIDER BULLETIN 160 IN THE PROVIDER LIBRARY, UNDER THE “MASSHEALTH REGULATIONS AND OTHER PUBLICATIONS” LINK ON WWW.MASS.GOV/MASSHEALTH

I will continue to update your organization as necessary. Thank you for your continued support of the MassHealth program. As always please contact me with any questions or concerns.