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The Official Website of the Massachusetts Health Care Training Forum
Health Care Training Forum
90-Day Waiver Submissions for Medicare Crossover Claims
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.