MassHealth identified that certain CBHC claims were incorrectly billed resulting in improper payments. CBHC claims billed for an encounter bundle with the CBHC per diem service code (T1040), must be billed with at least one of the designated service codes listed in subchapter 6 of the CBHC provider manual. Claims that do not meet this requirement will be denied for edit 5130 “Missing procedure on CBHC bundle claim”.
Additionally, for members who have other insurance coverage, claims must be submitted to the primary payer before billing MassHealth (130 CMR 450.316 through 318). However, for Medicare members, if the rendering provider does not meet Medicare’s clinical criteria for Medicare enrollment, the claim can be billed directly to MassHealth according to Appendix D instructions in the CBHC provider manual.
Claims with dates of service on or after June 21, 2025, that did not meet these billing requirements have been adjusted in MMIS. These adjustments will appear on subsequent remittance advices.
If you have questions regarding this message, please contact MassHealth at (800) 841-2900 or provider@masshealthquestions.com.