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Technical Refresh Update - Important Message for All MassHealth Providers

March 11, 2019

MassHealth will implement its technical refresh activities in 2 phases through March, 2020. This initiative requires that MassHealth replace its "end of life" HIPAA compliance and translator tool. The tool is used to validate HIPAA compliance and translate the HIPAA compliant transactions to an XML format so that they can be processed within MassHealth's Medicaid Management Information System (MMIS). This change will affect the submission of all HIPAA transactions supported by MassHealth:

  • Health Care Benefit Inquiry and Response (270/271), 
  • Health Care Claim Status Request and Response (276/277),
  • Health Care Claim Payment/Advice (835),
  • Health Care Claim: Institutional (837I) and Professional (837P), and
  • HIPAA (999/TA1) Implementation Acknowledgment for Health Care Insurance. 

MassHealth will conduct Trading Partner Testing (TPT) with providers and entities that directly send or receive transactions to/from MassHealth in the summer of 2019 and early 2020. MassHealth strongly recommends that all affected trading partners update their systems and conduct TPT with MassHealth to validate compliance. MassHealth will hold a series of 1 hour information sessions about TPT on Thursdays from 2:00 - 3:00 pm beginning on 2/28/2019 through 04/04/2019. Affected providers and vendors (Billing Intermediaries, Software Vendors, Clearinghouses) may sign up for sessions by clicking on the link: www.masshealthtraining.com.

MassHealth will conduct compliance only testing of eligibility batch files (270/271) from 7/29/2019 - 9/20/2019 (Phase I) and the claims, remittance advice files and claim status (837I, 837P, 835, 276/277) from 1/27/2020 - 3/27/2020 (Phase II). Please note that MassHealth requires that all trading partners modify their systems, where appropriate, and test compliance during the defined testing phases.

MassHealth made available a dedicated webpage for the Technical Refresh at https://www.mass.gov/masshealth-technical-refresh. It contains important information and updated Companion Guides for Phase I testing activities. Phase II Companion Guides will be posted in mid-March. Please review the contents and check periodically for updates.

Please continue to monitor MassHealth communications regarding the technical refresh over the coming months.

If you have any questions regarding this message, please contact the MassHealth Customer Service Center at 1-800-841-2900 or edi@mahealth.net.

If you are not the person within your organization that handles EDI testing, please forward this information to the appropriate staff within your organization or to your vendor.