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Acute Outpatient Hospital Adjustments on Certain Coordination of Benefits (COB) Claims

September 19, 2022

MassHealth identified a pricing error with acute outpatient hospital claims. The error processed through the Enhanced Ambulatory Patient Groups (EAPG) methodology when another payer made a payment and/or applied a patient responsibility to the claim. This error caused certain acute outpatient COB claims to be overpaid. MassHealth corrected the error which was implemented in MMIS on 8/28/2022. The affected claims have been adjusted and will appear on this or a subsequent remittance advice.

If you have questions regarding this message, please contact the MassHealth Customer Service Center at providersupport@mahealth.net or (800) 841-2900.