Medicare recently notified MassHealth that it will be adjusting certain Outpatient Prospective Payment System (OPPS) claims to correct the coinsurance amounts apportioned to revenue code 636 and J-code lines. Adjustments only apply to multi-day outpatient claims received from January 3, 2024, to February 4, 2025.
Outpatient providers are reminded that Medicare claim adjustments do not automatically cross over to MassHealth. Providers should adjust the crossover claim previously paid by MassHealth and include the revised Medicare adjudication information on the claim.
If you have questions, please contact MassHealth at provider@masshealthquestions.com or (800) 841-2900.
Medicare Adjustments on Certain Outpatient Claims