MassHealth identified an issue affecting some acute outpatient hospital claims that were processed under the Enhance Ambulatory Patient Group (EAPG) pricing methodology when another payer made a payment and/or applied a patient responsibility to the claim. MassHealth corrected the issue, and the fix was implemented in MMIS on 6/9/2024. Claims adjudicated from 11/19/2023 to 6/9/2024 have been adjusted and will appear on future remittance advices.
If you have questions, please contact MassHealth at (800) 841-2900 or [email protected].
Adjustments of Acute Outpatient Hospital Claims with Coordination of Benefits (COB) Information