December 2007 (PDF)

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					Inside This Issue                                                                                        A Newsletter for MassHealth Providers

          Get Ready for HEDIS 2008. . . . . . . . . . . . . . . . . . . . . . 2             Standardized Behavioral-Health Screens for
          Health Safety Net Replaces Uncompensated                                           MassHealth Members Under Age 21 . . . . . . . . . . . . . 2
           Care Pool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2     MassHealth Reminders. . . . . . . . . . . . . . . . . . . . . . . . 4
          Differentiating Commonwealth Care Alliance. . . . . . . . 2

   Going Electronic: A Success Story of Transitioning to Electronic Billing
   After making the transition to electronic                     did involve a bit of trial and error before         connection to the Internet. This ease and
   claims submission, a MassHealth                               she became familiar with the protocols,             portability translates into high time-sav-
   provider shares her experience on how                         she felt it was easy to understand, and the         ings, and fits into busy and hectic work
   going electronic has greatly improved                         benefits received from electronic billing            schedules.
   business procedures.                                          made the transition worthwhile.
                                                                                                                     Sue and her office were so impressed
   Sue (not her real name) works in a small,                     She was quick to mention how the                    by the benefits of moving to electronic
   independent practice. Before October                          responsiveness and knowledge of the                 claims submission that they began to
   2007, all the practice’s MassHealth billing                   MassHealth Health Insurance Portability             use some of MassHealth’s other auto-
   was done using the paper-submission                           and Accountability Act (HIPAA) Support              mated solutions. For example, Sue’s
   process.                                                      representatives were a big help in ensur-           office now uses MassHealth’s Web-based
                                                                 ing a seamless and stress-free billing              Recipient Eligibility Verification System
   In October 2007, Sue decided to try
                                                                 transition.                                         (WebREVS) to verify member eligibil-
   electronic claims submission using
                                                                                                                     ity and check claims status. Previously,
   MassHealth’s Provider Claims Submis-                          The best thing about claims submission?
                                                                                                                     they had relied upon the Automated
   sion Software (PCSS). The result was a                        Sue says without a doubt is its easy acces-
                                                                                                                     Voice Response (AVR) system, but since
   success. In fact, claims are now process-                     sibility. Other providers have shared this
                                                                                                                     transitioning to WebREVS, they have
   ing faster than in the past, and the denial                   sentiment, mentioning that with a laptop,
                                                                                                                     been impressed with its ease of use and
   rate has been reduced.                                        claims can be submitted from any loca-
                                                                                                                     efficiency over AVR.
                                                                 tion, at any time, as long as they have a
   While Sue admitted the testing process
                                                                                                                                              (continued on page 4)

   Payment Error Rate Measurement Project
   Massachusetts Medicaid is one of 17                           will be asked to verify name and address            a claim-processing error and subsequent
   states participating in the 2007 Centers                      information, determine how they want to             adjustment against the claim. Addition-
   for Medicare & Medicaid Services                              receive the request for information (RFI)           ally, the provider may be subject to an
   (CMS) Payment Error Rate Measure-                             for medical records (fax or U.S. mail),             on-site review.
   ment (PERM) project, an intiative                             and provide medical records and sup-
                                                                                                                     Visit CMS’s PERM Web site at
   designed to estimate a national and state                     porting documentation for the sampled
                                                                                                            for com-
   Medicaid payment error rate and identify                      claim(s).
                                                                                                                     plete information about the CMS PERM
   opportunities for improvement.
                                                                 Selected participants are required to               Project.
   In participation with this program,                           respond to the RFI within 90 days of re-
                                                                                                                     For questions about a medical-record
   roughly 2,000 paid or denied claims                           ceipt. Livanta LLC will follow up to ensure
                                                                                                                     request, call Livanta’s customer service
   received by MassHealth for the CMS fis-                        that selected parties have adequate time
                                                                                                                     representatives at 1-301-957-2360.
   cal year ending September 30, 2007, will                      to submit the documentation before the
   be randomly selected by CMS and their                         90-day time frame expires. If there are             Additional information is also available
   partners. Sampling will be taken from                         any discrepancies or errors after the re-           from MassHealth in All Provider Bulletin
   four quarterly claim-file extracts through-                    cords have been received and processed,             166 (June 2007), accessible from the Pro-
   out the 2007 fiscal year, and tested by                        providers will be notified and given the             vider Library at the MassHealth Web site,
   CMS for accuracy and medical necessity.                       opportunity to respond.                             and from the December 2007 Feature of
                                                                                                                     the Month, accessible from the Informa-
   Providers randomly selected for partici-                      Participation for selected providers is
                                                                                                                     tion for MassHealth Providers link on
   pation will be contacted directly by the                      essential, as failure to respond to the RFI
   CMS contract, Livanta LLC. Providers                          in the specified time frame will result in

                                                             DECEMBER 2007 / VOLUME 7 / ISSUE 6                                                                       page 1
Update                                                                                 A Newsletter for MassHealth Providers

 Get Ready for HEDIS 2008
 The Healthcare Effectiveness Data and          require chart reviews include:                 selected PCC Plan members’ records
 Information Set (HEDIS), previously                                                           directly to MedAssurant. It is imperative
                                                ■ childhood immunization status; and
 known as the Health Plan Employer Data                                                        to the success of the project that all medi-
 and Information Set, is a set of standard-     ■ well-child visits in the first 15 months.     cal records be retrieved. Every record
 ized performance measures designed to                                                         counts, so please respond to all requests
 ensure that purchasers and consumers                                                          from MedAssurant in a timely manner.
 have the information they need to reliably       Your assistance in responding                Your participation and cooperation
 compare the performance of managed-
                                                  to requests for this intiative is            throughout this endeavor is greatly
 health-care organizations.
                                                       greatly appreciated.                    appreciated.
 The Primary Care Clinician (PCC) Plan
                                                                                               MassHealth thanks you in advance for
 is gearing up for HEDIS 2008 and needs
                                                                                               your assistance.
 your assistance. The PCC Plan expects
 to contract with MedAssurant to perform        The medical record reviews will begin in       Note: HEDIS is a registered trademark of
 the medical-record-review component.           March 2008. The reviews may be con-            the National Committee for Quality
 The HEDIS 2008 measures that will              ducted at your office or you may be re-         Assurance.
                                                quested to mail or fax copies of randomly

 Health Safety Net Replaces the Uncompensated Care Pool
  Effective October 1, 2007, the Health         To access regulations for the HSN and          System (REVS) message changes. TL
  Safety Net (HSN) succeeded the                frequently asked questions, go to              ALL-153 is available from the Transmittal
  Uncompensated Care Pool (UCP). The                    Letters section of the online
  links listed below give more information                                                     MassHealth Provider Library, at
                                                You can also review Transmittal Letter
  related to the transition, including new                                           
                                                (TL) ALL-153 (October 2007) for a listing
  patient and provider frequently asked
                                                of all the Recipient Eligibility Verification

 Differentiating Commonwealth Care Alliance
 When using the Recipient Eligibility           Do not confuse the Commonwealth Care           Customer Service at 1-877-MA-ENROLL
 Verification System (REVS) to verify            Alliance with Commonwealth Care health         (1-877-623-6765).
 coverage type and options for members          insurance. Commonwealth Care is a pro-
                                                                                               If you have questions about a SCO plan,
 enrolled in a Senior Care Options (SCO)        gram for people without access to health
                                                                                               contact the CCA at 1-866-610-2273.
 plan, you may receive the REVS code 201        insurance who are less than 300% of the
 with the following message:                    federal poverty level. Commonwealth
                                                Care is not affiliated with the CCA.                      Please Note: The
   Payment limited to SCO. Authorization
   needed for all services except emergen-      If you have a question about Common-              Commonwealth Care Alliance
   cies. Call CCA at 1-866-610-2273.            wealth Care health insurance, contact            is a program separate from the
                                                the member’s managed-care organization             Commonwealth Care health
 If you receive this message, contact the
                                                (MCO) or Commonwealth Care                             insurance program.
 Commonwealth Care Alliance (CCA).

  Standardized Behavioral-Health Screens for MassHealth Members Under Age 21
 Behavioral-health screenings are a criti-    Using Standardized Tools to Screen for           ioral-health screen at each Early and
 cal component of preventive, primary-        Behavioral-Health Concerns                       Periodic Screening, Diagnosis and Treat-
 care visits for children.                                                                     ment (EPSDT) and Pediatric Preventive
                                                Effective December 31, 2007, all primary-      Healthcare Screening and Diagnosis
 MassHealth is implementing new re-             care providers (including providers            (PPHSD) visit, as described by Appendix
 quirements for behavioral-health screen-       enrolled in the Primary Care Clinician         W of your MassHealth provider manual.
 ings for children under the age of 21.         (PCC) Plan) who serve MassHealth-              Appendix W contains a menu of approved
                                                enrolled children and young adults             screening tools from which to choose.
                                                under the age of 21 (except MassHealth
                                                Limited) must offer to conduct a behav-

                                              DECEMBER 2007 / VOLUME 7 / ISSUE 6                                                        page 2
Update                                                                                       A Newsletter for MassHealth Providers

  Standardized Behavioral-Health Screens for MassHealth Members Under Age 21                                                   (continued from page 2)

 Menu of Standardized Behavioral-Health               July 1, 2008, MassHealth will deny any           for you to learn more about how to
 Screening Tools                                      claim for Service Code 96110 that is sub-        administer and score the standardized
                                                      mitted without a modifier. The modifiers           behavioral-health screening tools
  The menu of behavioral-health screen-               are provider type-specific and indicate           (including tips for implementing the tools
  ing tools in Appendix W accommodates                whether the screen identified a behav-            in your practice) and how to bill for the
  a range of ages while permitting some               ioral health need or not. Identification of       tools. The training on administering and
  flexibility for provider preference and              a behavioral-health need includes needs          scoring the tools became available in
  clinical judgment. The menu of behav-               identified in the areas of social-emotional       December 2007. The training on billing
  ioral-health screening tools is displayed           well-being and mental health. Consult            the tools will be available in January.
  below. Please note that this table is for           the billing guidelines in your provider
  your information only. Appendix W is the                                                             Stay tuned to the MassHealth Children’s
                                                      manual for more information the modi-
  controlling reference for the approved                                                               Behavioral Health Initiative Web site for
                                                      fiers and about how to bill the behavioral-
  behavioral-health screening tools.                                                                   links to the training, information about
                                                      health screen.
                                                                                                       when training becomes available, and
 Billing for Standardized Tools                       To review any of the information outlined        other updates about children’s behavioral
  MassHealth will pay for the administra-             in the MassHealth Provider Manuals, go           health issues.
  tion and scoring of a standardized behav-           to the Provider Library link at
                                                                                                       The program’s Web site at www.mass.
  ioral-health screening tool in addition to, and select
  and separately from, the office visit.               MassHealth Provider Manuals.
                                                                                                       is effective starting in January 2008. We
  Effective December 31, 2007, providers             Training Opportunities                            recommend checking it periodically for
  must submit claims using Healthcare                                                                  the latest updates.
                                                      MassHealth will be offering online
  Common Procedure Coding System                      training opportunities in the future
  (HCPCS) Service Code 96110. Starting
 Tool            MassHealth-Approved Standardized Behavioral-Health Screening           Tool Completed by      Tool Application Age Group
 Acronym         Tools for Children under the Age of 21
 ASQ:SE          Ages and Stages Questionnaires: Social-Emotional                        Parent                4-60 months

 BITSEA          Brief Infant and Toddler Social and Emotional Assessment                Parent                12-36 months


 CBCL            Achenbach System:                                                       Parent                1.5-18 years
 YSR             Child Behavior Checklist                                                Youth                 11-18 years
 ASR             Youth Self-Report                                                       Young Adult           18-59 years
                 Adult Self-Report

 CRAFFT          Car, Relax, Alone, Forget, Friends, Trouble                             Youth                 14+ years
                 Screening for Substance Abuse
 M-CHAT          Modified Checklist for Autism in Toddlers                                Parent                18-30 months
                 Screening for Autism
 PEDS            Parents’ Evaluation of Developmental Status                             Parent                Birth-8 years
 PHQ-9           Patient Health Questionnaire-9                                          Young Adult           18+ years
                 Screening for Depression

 PSC             Pediatric Symptom Checklist                                             Parent                4-16 years
 Y-PSC           Pediatric Symptom Checklist-Youth Report
                                                                                         Youth                 11+ years

                                                  DECEMBER 2007 / VOLUME 7 / ISSUE 6                                                             page 3
Update                                                                                   A Newsletter for MassHealth Providers

  Going Electronic: A Success Story of Transitioning to Electronic Billing                                  (continued from page 1)

  So would Sue recommend electronic                she has no regrets and admits she would       claims electronically, contact MassHealth
  claims submission and MassHealth’s               never go back to the antiquated paper-        HIPAA Support at 1-800-841-2900 or e-
  other self-service options to providers?         claim processes.                              mail
  An enthusiastic “absolutely.” She now
                                                 Be the Next Success Story
  spends significantly less time process-
  ing claims, has dramatically cut down on         Don’t miss out—you could experience
  paper accumulation, and receives fewer           all the benefits Sue’s office now shares.
  denied claims. After making the change,          If you are not currently submitting your

  MassHealth Reminders
 Make Sure We Have Your Information              Healthcare Common Procedure Coding System       been, and will continue to be, returned to
                                                 (HCPCS) Code 90732                              the provider unprocessed.
  Ensure that MassHealth has your ac-
  curate provider-file information. Any             Effective for dates of service on or after   Updated Durable Medical Equipment (DME) and
  time your business address, mailing              September 1, 2007, the pneumococ-            Oxygen Tool
  address, or phone number changes, we             cal polysaccharide vaccine (HCPCS
                                                                                                 The MassHealth DME and Oxygen
  need to know. Updating your information          code 90732) is no longer covered by
                                                                                                 Payment and Coverage Guideline Tools
  is as simple as completing the Provider          MassHealth. For MassHealth-eligible
                                                                                                 have been updated and posted to the
  Change of Address form, accessible from          members, the state-supplied vaccine
                                                                                                 MassHealth Web site. To ensure that
  the Provider Forms link on                       should be ordered from the Massa-
                                                                                                 you are using the most recent version of                         chusetts Department of Public Health
                                                                                                 the tools, the date in the upper left of the
                                                   (DPH). Providers are advised to check
  Not updating your correct doing-busi-                                                          header should be 11/05/07.
                                                   the Recipient Eligibility Verification
  ness-as (DBA) information will impact
                                                   System (REVS) to verify eligibility before    To access the updated tools, go to the
  processing of your MassHealth claims
                                                   administering the vaccine.                    MassHeallth Provider Library at
  information. Therefore, it is essential that
                                                                                        Click on
  you report your correct information to         Updated Rates for Hospice Providers             Provider Library, then MassHealth Pay-
  MassHealth any time your contact infor-
                                                   Please be advised that the Division           ment and Coverage Guideline Tools.
  mation changes.
                                                   of Health Care Finance and Policy
                                                                                                Claim Denials for Certain Service Codes
 Service Code 90715 and 90716                      (DHCFP) has updated the hospice rates
                                                   for MassHealth hospice providers, pursu-      Certain claims submitted after June 01,
  When submitting a claim to MassHealth
                                                   ant to regulation 114.3 CMR 43.04. This is    2007, with Service Codes L4205, L4210,
  for dispensing the tetanus, diphtheria
                                                   effective for dates of service on or after    L7510, and L7520 have denied for error
  toxoids and acelullar pertussis vaccine
                                                   October 1, 2007.                              255 (“The procedure code entered on the
  (Service Code 90715), or varicella vac-
                                                                                                 claim requires prior authorization”).
  cine (Service Code 90716) to an eligible         To obtain the revised hospice rates by
  MassHealth member, MassHealth will               county, refer to DHCFP-issued Informa-        Also, certain claims billed with Service
  cover the vaccines only when adminis-            tional Bulletin 07-12, which is available     Code L2275 denied for error 591 (“The
  tered to eligible members 19 years of age        at by clicking on          procedure code entered on the claim
  or older. For members 18 years of age            DHCFP Regulations, then Hospice Ser-          exceeds the amount allowed.”)
  and under, the state-supplied vaccine is         vices, and Bulletin: Rate Update (under
                                                                                                 MassHealth has corrected the issue and
  provided free of charge and should be            regulations at 114.3 CMR 43).
                                                                                                 providers can now resubmit these claims
  ordered from the Massachusetts Depart-
                                                 Using Only CMS-1500 for Claims Submitted        for payment.
  ment of Public Health (DPH). Provid-
                                                 on or after September 1, 2007                   Please Note: The orthotics and prosthet-
  ers are advised to check the Recipient
  Eligibility Verification System (REVS) to         Effective September 1, 2007, MassHealth       ics payment tool will be updated to reflect
  verify member eligibility before adminis-        accepts only the new CMS-1500 (Rev.           changes in prior-authorization require-
  tering vaccines.                                 08/05) for all Medicare Part B crossover      ments in the near future.
                                                   claims submitted on paper. Any claims
                                                   received after this date submitted on the
                                                   previous version of the HCFA-1500 have

   E-mail:                   MassHealth Customer Service                           Phone: 1-800-841-2900
     Web:                                P.O. Box 9118                                    Fax: 617-988-8974
                                                              Hingham, MA 02043

                                                 DECEMBER 2007 / VOLUME 7 / ISSUE 6                                                       page 4