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Reprocessing Medicare Crossover Claims for Certain Dually Eligible Members Impacted by the Public Health Emergency

June 1, 2021

In March 2021, MassHealth published the following notice: “Notification of Eligibility Workaround for Some Members with Medicare and MassHealth During the Public Health Emergency”. Due to the Medicaid continuous coverage requirement in effect during the COVID-19 federal public health emergency, MassHealth is generally keeping individuals in the same or similar benefit they had on or after March 18, 2020. Members can only be moved to a new coverage type (1) if they are eligible for it and (2) if the new coverage type would offer the same or higher tier of benefits as the coverage as of March 18, 2020. See the Federal Interim Final Rule and Request for Comment (IFC) in 42 CFR 433. See Federal register Vol. 85, No. 216, at 71197. The benefit they remain in may not be one that is designed to coordinate as a secondary payer and may have resulted in the unintended denial of crossover claims. MassHealth recently implemented a temporary resolution that will allow for the payment of such crossover claims. The impacted Medicare crossover claims have been reprocessed by MassHealth and will appear on this and subsequent remittance advices.

If you have questions regarding this message, please contact the MassHealth Customer Service Center at providersupport@mahealth.net or (800) 841-2900. LTSS providers should contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com