MassHealth is working to improve the provider experience through the increased use of electronic self-service tools. Effective 5/1/2025, a new tool is available on Mass.gov, allowing providers and their credentialing… Continue Reading Provider Enrollment & Credentialing (PEC) Self-Service Tools for MassHealth Providers
Medicare recently notified MassHealth that it will be adjusting certain Outpatient Prospective Payment System (OPPS) claims to correct the coinsurance amounts apportioned to revenue code 636 and J-code lines. Adjustments… Continue Reading Medicare Adjustments on Certain Outpatient Claims
Effective May 1, 2025, and in accordance with MassHealth regulations 130 CMR 450.316(A)(6) and 130 CMR 450.316(F), the Retroactive Medicare Recovery Project (RMRP) will recover MassHealth claim payments for services… Continue Reading Retroactive Medicare Recovery Project (RMRP) For Durable Medical Equipment (DME)
In April 2024, providers were notified that the standard process of submitting 90-day waiver requests using delay reason codes 1, 4 and 8 was causing denials for Medicare Crossover requests… Continue Reading Delay Reason Code Requirements on 90-Day Waiver Submissions for Medicare Crossover Claims
The Centers for Medicare & Medicaid Services (CMS) have revised the HCPCS codes for 2025. MassHealth is updating the Service Codes and Descriptions (Subchapter 6) of the Physician Manual to… Continue Reading Claims Reprocessed for 2025 HCPCS/CPT Code Updates
MassHealth Independent Nurses (INs) may encounter an Explanation of Benefits (EOB) code on their Remittance Advice that prevents claims from paying. To understand what these EOB codes mean, INs may… Continue Reading MassHealth EOB Codes Appearing on the Remittance Advice
MassHealth will migrate its Medicaid Management Information System (MMIS) base application and Provider Online Service Center (POSC) to an Amazon Web Services (AWS) data center in early December. The migration… Continue Reading MassHealth MMIS POSC AWS Migration
This message serves as a reminder to providers about the standard RMRP process. In accordance with 130 CMR 450.316(A)(6) and 130 CMR 450.316(F), RMRP will recover MassHealth claim payments for… Continue Reading Retroactive Medicare Recovery Project (RMRP)
Effective October 10, 2024, MassHealth launched two new self-service tools for MassHealth providers: a Provider Enrollment Status tool & a Provider Application Status tool. These web-based tools will assist providers… Continue Reading Self-Service Tools for MassHealth Providers
Effective October 1, 2024, the MMIS and Virtual Gateway (VG) will begin deactivating accounts that have been inactive for more than 12 months. The initial deactivation event will affect accounts… Continue Reading Virtual Gateway Inactive Account Deactivation
