MassHealth providers must meet the necessary documentation requirements when the requested service or product is not related to the palliation or management of a member’s terminal illness, related conditions, or is not part of the member’s hospice plan of care. This is especially important for non-hospice providers submitting claims to MassHealth. Hospice providers must coordinate with and provide documentation to the non-hospice provider, offering clarification that the requested service or product is not related to the conditions outlined in 130 CMR 437.426: Payment of Hospice Services (I) Non-hospice Providers.
This information should minimally include the following information:
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- Date of service,
- MassHealth Member ID,
- Reason for denial (e.g., not related to hospice, non-covered hospice service, etc.),
- Hospice letterhead, and
- Contact information including name of coordinating person at the hospice location.
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Failure of the billing provider to submit the required documentation may result in the claim being denied. If a hospice provider determines that the requested treatment is related to the member’s terminal illness, the hospice provider must document this in the member’s plan of care and the hospice provider is responsible for payment as required by 130 CMR 437. At no time should the MassHealth member be billed per 130 CMR 450.403(A) and 130 CMR 450.403(B).
If you or your agency has questions regarding this communication, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.