Effective May 1, 2025, and in accordance with MassHealth regulations 130 CMR 450.316(A)(6) and 130 CMR 450.316(F), the Retroactive Medicare Recovery Project (RMRP) will recover MassHealth claim payments for services provided by Durable Medical Equipment (DME) providers that meet the following criteria:
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- MassHealth was the primary claims payor at the time services were rendered,
- Medicare coverage is identified retroactively after the date MassHealth paid the claim, but no more than 36 months after such claim’s date of service, and
- The service rendered is a Medicare-covered service.
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A summary of the RMRP process is described in MassHealth All Provider Bulletin 329 at https://www.mass.gov/doc/all-provider-bulletin-329-changes-to-the-retroactive-medicare-recovery-project-rmrp-0/download, which was issued to all MassHealth providers in November 2021.
MassHealth will send the RMRP Notice outlining the provider process instructions with the accompanying paid claims report to the provider’s Doing Business As (DBA) address on file with MassHealth.
It is important to note that Medicare allows for a timely filing exception for claims that have been identified for recoupment by MassHealth due to retroactive Medicare coverage. Providers must follow Medicare’s billing instructions for submitting claims for these members and should refer to the Noridian site at https://med.noridianmedicare.com/web/jadme/topics/nmp and direct any questions regarding Medicare requirements to Noridian at (866) 419-9458.
Additional provider resources may be found at the following:
Medicare Learning Network (MLN) Bulletin – Processing Claims Affected by Retroactive Entitlement: https://www.cms.gov/files/document/mm13402-processing-claims-affected-retroactive-entitlement.pdf.
Beneficiaries Entering Medicare: https://med.noridianmedicare.com/web/jadme/claims-appeals/billing-situations/entering-medicare.
Providers may direct any questions about the RMRP notice to the RMRP mailbox at RMRP@umassmed.edu or call (833) 251-2767.