Author: aguirrea

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…
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Notification of Eligibility Workaround for Some Members with Medicare and MassHealth During the Public Health Emergency

During the public health emergency, you may have provided services to an individual with both Medicare and MassHealth and received a claim’s denial for the portion of the claim submitted to MassHealth for payment. Due to the Medicaid continuous coverage requirement in effect during the COVID-19 public health emergency, MassHealth is generally keeping individuals in…
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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…
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