Massachusetts State Seal
|
The Official Website of the Massachusetts Health Care Training Forum
Health Care Training Forum

Avoid Duplicate Submissions

February 4, 2019

This is a reminder to providers to use best practices when billing claims to MassHealth for all members including members who have other insurance (Medicare, Medicare Advantage, or Commercial) in addition to MassHealth. MassHealth encourages all submitters to ensure that excessive and duplicative transactions are not submitted.

There are several methods of electronic claim submissions available, including direct billing for electronic batch files through the Provider Online Service Center (POSC), the use of a vendor (billing intermediary or clearinghouse) that submits claims on your behalf, and direct data entry (DDE) of claims through the POSC.

Providers are reminded that in most cases, Medicare crossover claims for dually eligible members are automatically transmitted by the Medicare contractor (Benefits Coordination and Recovery Center (BCRC)) to MassHealth when at least one claim line is Medicare approved. MassHealth receives daily Medicare crossover files from BCRC which are adjudicated in MMIS, therefore there is no need to submit a second claim to MassHealth. Please refer to Subchapter 5 Administrative and Billing Instructions Part 7 'Other Insurance' for additional information about Medicare Crossover claims.

Claims status is available via POSC upon submission. Claims process and appear on Remittance Advice in approximately 30-45 days.

If you have questions about submitting claims or need further assistance, you may contact the MassHealth Customer Service Center at edi@mahealth.net or 1-800-841-2900.