The Massachusetts Health Care Training Forum (MTF) sends out regular email updates on current program and policy information, meeting notices, learning opportunities and other relevant information and resources.
For more information about the Provider Services notices (manage claims and payment information), please visit MassHealth Provider Remittance Advice Message Text.
Claims Reprocessed for Updated Community Health Center Procedure Codes
MassHealth has updated the Service Codes and Descriptions (Subchapter 6) for J0696, Q9991 and Q9992 of the Community Health Center Manual. MassHealth updated its system for these coding changes effective… Continue Reading Claims Reprocessed for Updated Community Health Center Procedure Codes
101 CMR 339.00: Rates For Restorative Services Now Posted on Mass.gov
Provider Regulations 101 CMR 339.00: Rates for Restorative Services has been posted on Mass.gov and can be found at https://www.mass.gov/doc/rates-for-restorative-services-effective-june-6-2025-0/download. Effective June 6, 2025, MassHealth will be amending 101 CMR… Continue Reading 101 CMR 339.00: Rates For Restorative Services Now Posted on Mass.gov
Update For Quarterly Drug Code Rates Effective April 1, 2025
MassHealth has completed the rate updates for the April 1, 2025 Quarterly Drug codes. The impacted claims will be reprocessed and/or adjusted and will appear on a future remittance advice.… Continue Reading Update For Quarterly Drug Code Rates Effective April 1, 2025
Reminder: For MassHealth Members Who Have Elected the MassHealth Hospice Benefit and Need Services Unrelated to the Terminal Illness and Related Conditions
MassHealth providers must meet the necessary documentation requirements when the requested service or product is not related to the palliation or management of a member’s terminal illness, related conditions, or… Continue Reading Reminder: For MassHealth Members Who Have Elected the MassHealth Hospice Benefit and Need Services Unrelated to the Terminal Illness and Related Conditions
Reinstatement of Primary Care Referral Requirements
On March 20, 2020, as part of MassHealth’s COVID-19 response, the Executive Office of Health and Human Services suspended referral requirements for MassHealth covered services for the Primary Care Accountable… Continue Reading Reinstatement of Primary Care Referral Requirements
October 2024 HCPCS Code Updates to the Subchapter 6 Durable Orthotics and Prosthetics Manual
The Centers for Medicare & Medicaid Services (CMS) has published the HCPCS codes for October 2024. MassHealth updated Subchapter 6 of the Orthotic (ORT) and Prosthetic (PRT) Manual to incorporate… Continue Reading October 2024 HCPCS Code Updates to the Subchapter 6 Durable Orthotics and Prosthetics Manual
October 2024 HCPCS Code Updates to the Subchapter 6 Durable Medical Equipment Manual
The Centers for Medicare & Medicaid Services (CMS) has published the HCPCS codes for October 2024. MassHealth updated Subchapter 6 of the Durable Medical Equipment (DME) Manual to incorporate the… Continue Reading October 2024 HCPCS Code Updates to the Subchapter 6 Durable Medical Equipment Manual
Reminder: Health Connector Walk-in Center Closures
As a reminder, the Health Connector is closing its three walk-in center locations. These closures come as part of an effort to streamline services and expand access to other free… Continue Reading Reminder: Health Connector Walk-in Center Closures
Retroactive Medicare Recovery Project (RMRP) For Durable Medical Equipment (DME)
Effective May 1, 2025, and in accordance with MassHealth regulations 130 CMR 450.316(A)(6) and 130 CMR 450.316(F), the Retroactive Medicare Recovery Project (RMRP) will recover MassHealth claim payments for services… Continue Reading Retroactive Medicare Recovery Project (RMRP) For Durable Medical Equipment (DME)
Delay Reason Code Requirements on 90-Day Waiver Submissions for Medicare Crossover Claims
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