MassHealth will be implementing a new claims detection on January 12, 2026, to ensure that dates of service (DOS) for claims submitted by independent nurses fall within one calendar week. A calendar week is defined as the hours from 12 am Sunday to 11:59 pm Saturday. This claims detection is being used to ensure that providers are following MassHealth regulations regarding the use of overtime units and the limit of hours in a calendar week.
As of January 12, if a claim is submitted with DOS that fall outside of a calendar week, the entire claim will be denied. Please review the email version of this message which includes examples.
As a reminder, MassHealth has other claim detections in place to ensure independent nurse providers are billing according to MassHealth regulations. Please review the email version of this message to see a full list of claims detections in place.
After these claim detections went into effect, MassHealth saw an increase in duplicate claims/lines. This occurs when a provider resubmits a claim/line that was previously paid or is currently suspended. As a reminder, if your claim is suspended, do not resubmit the claim. A member of MassHealth’s claims detection team will review the claim and then set the claim to pay or deny based on the manual review.
If you resubmit a suspended or paid claim/line, those duplicate claims/lines will be denied.
If you have questions, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.