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
http://www.cms.hhs.gov/perm 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
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. 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 www.mass.gov/healthsafetynet. 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 www.mass.gov/masshealthpubs.
(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
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, www.mass.gov/masshealth 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
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 email@example.com.
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
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
www.mass.gov/masshealth. 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
www.mass.gov/masshealthpubs. 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.
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 www.mass.gov/dhcfp 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: firstname.lastname@example.org MassHealth Customer Service Phone: 1-800-841-2900
Web: www.mass.gov/masshealth P.O. Box 9118 Fax: 617-988-8974
Hingham, MA 02043
DECEMBER 2007 / VOLUME 7 / ISSUE 6 page 4