MassHealth is introducing a new Electronic Data Interchange (EDI) Inquiry Request form which will be accessible on Mass.gov in order to streamline how providers submit EDI related inquiries. Beginning later this month, all MassHealth providers will be required to use this online form for billing vendor updates, direct submission requests, and issues related to submitting… Continue Reading MassHealth EDI Inquiry Online Tool
On January 17, 2024, the Centers for Medicare and Medicaid Services (CMS) issued the Advancing Interoperability and Improving Prior Authorization Processes Final Rule (the “Final Rule”). The Final Rule emphasizes the need to improve health information exchange to achieve appropriate and necessary access to health records for patients, healthcare providers, and payers. The Final Rule… Continue Reading Advancing Interoperability and Improving Prior Authorization Processes
In August of 2024, MassHealth implemented the following claims detections: If an Independent Nurse (IN) bills for overtime units using modifiers TU or U4 before they bill for 40 hours of standard Continuous Skilled Nursing (CSN) services in a calendar week (starting Sunday 12am and ending Saturday 11:59pm). If an IN bills for greater than… Continue Reading Duplicate Claims Suspension – Independent Nurse (IN) Providers
