As instructed in the provider notice dated November 20, 2024, MassHealth will begin voiding claims for Group Practice Paid for Services Provided by Non-Independent Nurse Practitioner for Dates of Service on April 24, 2025, and will have completed voided claims by April 30, 2025. MassHealth will only void impacted claims as instructed by providers.
Process Reminder:
Direct Data Entry (DDE) Resubmission:
Any such claim must be resubmitted electronically via DDE on the Provider Online Service Center (POSC) using Delay Reason Code 3. Providers must scan and submit the Waiver form, the remittance advice depicting the denied claim, and any other documentation in support of the request for review. If you are submitting multiple claims for the same member, you must submit each claim separately with a copy of the Waiver form, the remittance advice for the voided claim, and supporting documentation.
These documents must be scanned and included with a DDE claim submission. Use the Attachment tab on the POSC to upload the document(s). Once resubmitted into the POSC, these claims will appear in a suspense status on your remittance advice with Edit 826 (SPECIAL HANDLING PAPER WAIVER PROVIDER). A final decision will be reflected on a subsequent remittance advice once the Waiver form is reviewed.
Electronic Data Interchange (EDI) Resubmission:
To begin the claims resubmittal process, email the 90-day waiver request to the EDI email box at EDI@MAHealth.net. That initial email must include:
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- Completed 90-Day Waiver Request Form; for an EDI batch submission, only one form is required.
- A letter, on the provider’s letterhead, with the details of the request; The letter must include the date of service range, claim count and dollar value, and the reason the claims were not submitted within 90 days of the date of service. The letter must also be signed with a typed/printed name with a date.
- Any supporting documentation; and
- A copy of this Provider Notice.
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If the 90-day waiver request is approved, the EDI team will notify the provider of the approval and request the claim file. The claim file must contain only those claims to be considered for the 90-day waiver.
If the 90-day waiver is denied or additional information is needed, the EDI team will notify the provider.
The claim file must be in an ANSI X12 format and 5010 compliant. We request that you send only one claim file.
When the claim file is ready to be emailed, send the email securely or send the file as a password protected file and send the password in a separate email.
After the EDI team receives the file, they will review it and let the provider know if there are any claim file formatting issues or if it is missing any required documentation. The provider will have up to 30 days from the approval date to submit the batch claim files.
For further information on 90-day waivers, please go to the following link: https://www.mass.gov/service-details/billing-timelines-and-appeal-procedures. The 90-Day Waiver Request form is located at the following link: https://www.mass.gov/how-to/submit-a-90-day-claim-waiver-request-form.
If providers have any questions about resubmitting claims, please contact MassHealth at (800) 841-2900 or provider@masshealthquestions.com.
Please note, MassHealth may conduct an audit of the adjusted claims to confirm the identity of the actual servicing provider, that the servicing provider was fully enrolled in MassHealth and was enrolled and approved by MassHealth as a member of the group practice on the applicable date(s) of service.