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
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
Effective Sunday, October 20, 2024, the Virtual Gateway (VG) is implementing changes to ensure that the VG and the recently implemented Multi-Factor Authentication (MFA) profile updates via Azure are synchronized.… Continue Reading Virtual Gateway Multi-Factor Authentication (MFA) Profile Updates & Transition
Based on feedback received from providers and Community Case Management (CCM) families, CCM and MassHealth Office of Long Term Services and Supports (OLTSS) have been working on updating the CCM Nurse Directory… Continue Reading CCM Nurse Directory Updated Platform Live Now!
MassHealth identified an issue affecting some acute outpatient hospital claims that were processed under the Enhance Ambulatory Patient Group (EAPG) pricing methodology when another payer made a payment and/or applied… Continue Reading Adjustments of Acute Outpatient Hospital Claims with Coordination of Benefits (COB) Information
Effective September 1, 2024, MassHealth will no longer be able to support claims status inquiry calls. To determine if a claim is paid, denied, or suspended, you are encouraged to… Continue Reading Changes To Claims Status Checks
