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Health Care Training Forum

Duplicate Claims Submissions

May 13, 2019

MassHealth would like to remind all claims submitters (providers, billing intermediaries, and clearinghouses) that duplicate billing is an unacceptable billing practice. MassHealth Regulation 130 CMR 450.307(B)(1) states that "duplicate billing, which includes the submission of multiple claims for the same service, for the same member, by the same provider or multiple providers" is forbidden. https://www.mass.gov/regulations/130-CMR-450-administrative-and-billing-regulations

MassHealth identifies and tracks providers, billing intermediaries, and clearinghouses who abuse this Regulation.

Providers are encouraged to check claims status (276/277) via the POSC first prior to the submission of a second claim. MMIS adjudicates claims real time and claims status is available within at least two business days. Medicare crossover claims for dually eligible members are automatically transmitted to MassHealth when at least one claim line is Medicare approved. Medicare crossover claim status can also be checked via the POSC.

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail providersupport@mahealth.net.