Retro Claims Adjustment for Dates of Service Between 4/1/2020-9/11/2020 for Acute Outpatient Hospitals and Hospital Licensed Health Centers

Retro Claims Adjustment for Dates of Service Between 4/1/2020-9/11/2020 for Acute Outpatient Hospitals and Hospital Licensed Health Centers

MassHealth has identified certain claims which inadvertently used “lesser of” logic at the claim detail line and therefore paid the claim line’s billed amount, instead of paying the claim line’s Enhanced Ambulatory Patient Groups (EAPG) amount. MassHealth has corrected the error and reprocessed all of the impacted claims. All reprocessed claims will appear on this or future remittance advice.

If you have questions, please contact the MassHealth Customer Service Center at providersupport@mahealth.net or (800) 841-2900.