Electronic Claims HIPAA File and Provider Online Service Center (POSC) Updates

Electronic Claims HIPAA File and Provider Online Service Center (POSC) Updates

On March 14, 2021, MassHealth will implement minor changes to the requirements for professional and institutional claim submissions to ensure that relevant information is captured on the claim. The changes will impact both 837 batch claims transactions and the Provider Online Service Center (POSC) Direct Data Entry (DDE) claims transactions. These changes apply to claims that include:

Operating physician information,
A service facility location, and
Supervising physician information
Additionally, any Operating, Supervising, or Attending physician entered on a claim should be actively participating/enrolled with MassHealth at least as a non-billing provider. Informational edits will be issued for any claim that includes an Operating, Supervising, or Attending physician that is not actively participating/enrolled with MassHealth. MassHealth will issue further guidance with advance notice before implementing denials for these specific edits.

MassHealth began conducting general information sessions for providers, trading partners, and vendors in January 2021. Register for the final information session, here.

MassHealth trading partners, vendors, and providers may submit 837 test files or DDE test claims on the MMIS Test Portal between March 1- March 12, 2021.

Providers can submit a DDE test claim on to the MMIS Test Portal using their existing POSC log-in credentials. Providers who would like to submit an 837 test file must contact MassHealth’s EDI department at edi@mahealth.net to arrange the test.

If you have questions, please contact the MassHealth Customer Service Center at providersupport@mahealth.net or (800) 841-2900. If you are an LTSS provider, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.