Claim Denials – Billing Provider HPI is Mapped to Multiple PID/SLS

MassHealth is seeing large numbers of denials for 1945 – BILLING PROVIDER NPI IS MAPPED TO MULTI SERV LOC when the NPI cannot be mapped to the correct MassHealth Provider ID/Service Location (PID/SL).

Providers are reminded of the following to avoid these denials:

1. Do not bill with a taxonomy code in the 2000A PRV03 segment of the 837 unless MassHealth has directed you to include one. MassHealth has assigned a unique taxonomy code to each provider type and does not allow providers to self-attest taxonomy codes. MassHealth will not update a provider file with a taxonomy code if requested. There are times when MassHealth assigns a taxonomy code to a PID/SL to allow an NPI to crosswalk to the PID/SL. If you have two PID/SLs at the same address, taxonomy is required as part of the 837 and must be assigned/confirmed by MassHealth.
2. The MassHealth 837 Companion Guides outline that for adjudication, MassHealth expects to receive the billing provider identification and the doing business as (DBA) addresses in the 2010AA. Providers should not submit 837 files with a general billing address, including an out-of-state address. Providers must also be sure to use the current USPS Zip+4 code on their claim file. Billing with a dummy Zip+4 of 9998 or an incorrect Zip+4 may cause claims to be denied as noted above. Providers may use self-service options at https://masshealth.ehs.state.ma.us/ProviderSelfService/ to verify the address enrolled. Select “Check Enrollment Status and follow the prompts.

Providers should ensure that their billing companies and intermediaries follow the instructions above to avoid these denials.

For questions or concerns:

LTSS providers, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.

All other providers, please contact MassHealth at (800) 841-2900 or provider@masshealthquestions.com.