MassHealth identified that certain Community Behavioral Health Center (CBHC) claims for Medicare Savings Plan (MSP) members (formerly known as Senior Buy-in) were incorrectly denied for edit 2609 “SBI benefit plan – not a covered service”.
Specifically, claims billed to MassHealth for the CBHC clinic per diem bundle that included a payment and/or patient responsibility from Medicare, or a Medicare advantage plan were denied in error for edit 2609. These impacted claims have been reprocessed and will appear on subsequent remittance advices. Claims that did not meet the above criteria were appropriately denied.
Providers are reminded that if an MSP member paid out of pocket for services that were incorrectly denied, providers must reimburse the member.
If you have questions regarding this message, please contact MassHealth at provider@masshealthquestions.com or (800) 841-2900.