90-Day Waiver Submissions for Medicare Crossover Claims
April 1, 2024
All Provider Bulletin 220, dated December 2011, instructs providers to use delay reason code 1, 4 or 8 when submitting a 90-day waiver request. MassHealth recently became aware that Medicare crossover claims submitted with one of these delay reason codes are denying for edit 851 “Orig claim has exceeded 90-day billing deadline” instead of suspending for review with edit 818 “Special handling 90-day waiver”.
MassHealth is working on an MMIS systems change to correct this issue to allow Medicare crossover claims to suspend. In the meantime, as a temporary workaround, providers may use delay reason code 10 when submitting a 90-day waiver request for Medicare crossover claims. The claims will suspend for review with edit 827 “Special Handling - paper waiver providers - 90-day waiver”. All other claims, including Medicare denied claims, must continue to be submitted per All Provider Bulletin 220.
If you have questions regarding this message, please contact MassHealth at (800) 841-2900 or provider@masshealthquestions.com. LTSS providers should contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.