These regulations are reproduced as Subchapters 1, 2, and 3 in this and all other manuals. Provider Manual The Health New England Provider Manual contains information, guidelines, and procedures that should be followed when rendering medical service to members and which are common to managed care in general. Welcome Massachusetts - Provider Express The Eligibility Verification System (EVS) provides important benefit information about MassHealth members. Toll-Free: 1-866-676-9226 (TTY: 711) Please limit your input to 500 characters. An official website of the Commonwealth of Massachusetts, This page, MassHealth Provider Manuals & Regulations, is, for the handbook, MassHealth Provider Handbook, MassHealth Provider Manuals & Regulations. Please limit your input to 500 characters. Our Medicare beneficiaries may receive services from any providers enrolled with Medicare. A lock icon ( You skipped the table of contents section. Please reference your provider manual to confirm that a service is covered, as the rate regulations house a repository of codes that are not necessarily reflective of covered services. Thank you for your website feedback! Share sensitive information only on official, secure websites. This appendix contains lists of third-party-liability (TPL) coverage-type codes and carrier codes to help you identify a member's other insurance. View the list of C3 participating health centers, MassHealth Provider and Dental Directories, and the MBHP Directory. Providers must agree to the 2701 0 obj <> endobj All MassHealth benefits are covered for C3 Members as they are covered directly under MassHealth or MBHP based on their MassHealth coverage type. Policies & Forms; Member Handbook; Provider Directory; MassHealth Steward Health Care Policies An official website of the Commonwealth of Massachusetts, This page, MassHealth provider regulations, is. This section contains the codes acute outpatient hospital providers need to bill MassHealth for their services. This Provider Manual has been developed for our participating Federally Qualified Health Centers (FQHCs) and Affiliated Participating Providers, and serves as an important tool for understanding what it means to be part of the C3 community. MassHealth Provider Manual Series Subchapter Number and Title 1. Find a Provider. Subchapter 5 (Administrative and Billing Instructions) is often referred to as the All Provider Regulations. The feedback will only be used for improving the website. A lock icon ( To view rate information, please refer to the, Hospital providers should refer to their RFA to research and find answers related to payment, MassHealth Provider Directory, Provider File Maintenance, and Revalidation. It is important that you follow these file submission guidelines to ensure a timely response to your file submission. The MassHealth LTSS Provider Service Center is open 8:00 a.m. to 6:00 p.m. CoCM services are provided for the purpose of (i) providing an initial behavioral health assessment, including the use of applicable validated rating scales, and behavioral health monitoring; (ii) developing a behavioral health treatment plan; (iii) facilitating and coordinating treatment, including referrals; (iv) providing proactive and system. Mass General Brigham ACO is a health plan for MassHealth members. 6/30/2023. We will use this information to improve this page. If you need assistance, please For help on some common issues, see here.. Provider Manual Section 1: General Information Section 2: Member Eligibility Section 3: Credentialing Section 4: Provider Responsibilities Section 5: Provider Resources This appendix lists the services required under the Early and Periodic Screening, Diagnosis and Treatment (EPDST) Program, and the ages at which those services must be provided. M-236 - April Medical Policy Network Notification. We ask that you only contact us if your application is over 90 days old. Top-requested sites to log in to services provided by the state, A Quick Reference Chart Showing the Contents of Each Section of the Manual(PDF), A Quick Reference Chart Showing the Contents of Each Section of the Manual(DOCX). MassHealth Provider Manual Series Subchapter Number and Title: 6. An official website of the Commonwealth of Massachusetts Here's how you know. share@communitycarecooperative.org, Notice of Nondiscrimination English | Espaol, Copyright 2023 Community Care Cooperative. Our goal is to help you see the doctors you need to improve your health. ASC X12 Implementation Guide 0 Service Codes and Descriptions : Page: 6-2 Continuous Skilled Nursing Agency Manual : Transmittal Letter : CSN-4 : Quincy, MA 02171. It provides a general overview of MassHealth provider requirements and expectations and includes resources to aid in serving MassHealth members. Footer. Some page levels are currently hidden. Appendices and documents listed in this section are available to our Participating FQHCs and Affiliated Participating Providers only. ST/SE segments that exceed this maximum number of members will be rejected. All claims should be submitted to Medicare or its vendor. Please limit your input to 500 characters. Home- and Community-Based Services Manual for MassHealth Providers If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. PDF Massachusetts - Aspe share@communitycarecooperative.org, Notice of Nondiscrimination English | Espaol, Copyright 2023 Community Care Cooperative. PDF MBHP Provider Manual Provider Directory | Steward Health Choice To request a copy of any of the MassHealth Companion Guides, or if you have any questions, please contact MassHealth Customer Service at (800) 841-2900. Please let us know how we can improve this page. MassHealth Provider Handbook | Mass.gov Share sensitive information only on official, secure websites. To find primary care providers (called Primary Care Clinicians "PCCs"), specialists, and hospitals, you can use the MassHealth Provider Directory . Providers who are missing a publication that cannot be located on this website should contact. MassHealth will pay for certain copayments, deductibles, and coinsurance amounts for certain MassHealth Family Assistance members under age 19. MassHealth Provider Manual - C3 - Community Care Cooperative MassHealth providers and vendors submitting transactions in conformance with. ) or https:// means youve safely connected to the official website. Pharmacy prescription processing:Pharmacies should use the following information when filing prescriptions for C3 Members: BIN: 009555PCN: MASSPROD Group: MassHealth. Please remove any contact information or personal data from your feedback. 6/30/2023. These rate regulations for therapist services may be found in. 75 Federal Street 7th Floor Boston, MA 02110. Please do not include personal or contact information. If a single match is found, eligibility information will be returned: 5. Please limit your input to 500 characters. Electronic Data Interchange (EDI) and HIPAA Information. This page is located more than 3 levels deep within a topic. A lock icon ( Please let us know how we can improve this page. While this handbook page touches on many subjects, it is not the sole source of information for these topics. endstream endobj startxref You skipped the table of contents section. This appendix lists the active Eligibility Verification System (EVS) codes and their respective service restriction messages. Please remove any contact information or personal data from your feedback. All services covered for C3 ACO REACH participants Members are paid for by Medicare. Learn More > Behavioral Health MA Regulations for PT/PTA; OT/OTA. hb```,l@(I:/G=|||ax}%cV8Oy%]J!r5Z8g(r8I d-9$ve[JyW 04e0j -UpP````Pj``nHk``n @`. Provider Resources - BMC HealthNet Plan This MassHealth Provider Manual serves as an important tool toward understanding what it means to be part of our community. Therapist Manual for MassHealth Providers | Mass.gov Mass.gov is a registered service mark of the Commonwealth of Massachusetts. If you are currently a MassHealth provider but do not know your Username and password, please contact the Customer Service Center at 1-800-841-2900. If youd like to see proposed changes to the regulations, as well as information about public hearings, youll find that at https://www.mass.gov/info-details/masshealth-proposed-regulations. Subchapter 6 of the MassHealth Physician Manual further limits the use of this code, reciting that it "may be used only for urgent care provided in the office . This appendix lists covered codes for children who are eligible for the Childrens Medical Security Plan (CMSP). EVS is available 24 hours a day, seven days a week. a valid member Medicaid Identification (MID) Number on the eligibility request, if known. 1. The following services are payable in addition to the initial, periodic, or interperiodic Early and Periodic Screening, Diagnosis and Treatment (EPSDT) or Preventive Pediatric Health-care Screening and Diagnosis (PPHSD) visit when they are performed and interpreted in the office of the provider who furnished the visit. YOU MUST INCLUDEa valid member Medicaid Identification (MID) Number on the eligibility request, if known. Massachusetts Provider Resources Optum Network Manual Network Manual Mass General Brigham Health Plan Provider Manual Addendum (Rev. check eligibility for those MassHealth members you will actually provide services to on that day or the following day. Please do not include personal or contact information. The Provider Enrollment Department is experiencing an application backlog. Primary Care Clinician (PCC) Plan for MassHealth Members This appendix describes the MassHealth billing instructions for Provider Preventable Conditions, as they apply to providers. How to Read Your Provider Manual A Abortion Clinic (ABR) Manual Acupuncture Services (ACU) Manual Acute Inpatient Hospital (AIH) Manual Acute Outpatient Hospital (AOH) Manual Adult Day Health (ADH) Manual Adult Foster Care (AFC) Manual Audiologist (AUD) Manual C Chiropractor (CRP) Manual For acute outpatient hospital providers, those matters are covered in 130 CMR 410.000, reproduced as Subchapter 4 in the Acute Outpatient Hospital Manual. An official website of the Commonwealth of Massachusetts, This page, Therapist Manual for MassHealth Providers , is, Therapist Manual for MassHealth Providers, The Executive Office of Health and Human Services (EOHHS) establishes rates for MassHealth services. 2751 0 obj <>stream Please let us know how we can improve this page. A quick reference chart for the most commonly requested information in the MassHealth provider manuals. Find a Doctor, Hospital, or Pharmacy An official website of the Commonwealth of Massachusetts, This page, How to Read Your Provider Manual, is. MassHealth coverage as set out in 130 CMR 450.105. We encourage you to read and evaluate the privacy and security policies of the site you are entering, which may be different than ours. MassHealth providers and vendors submitting transactions in conformance with Phase I CORE 155: Eligibility and Benefits Batch Response Time Rules, and in accordance with HIPAA ASC X12 and MassHealth policy, must follow these submission guidelines to ensure timely and efficient processing of transactions. The EDI specifications for MassHealth electronic claims are based on the following documents: An Implementation Guide is provided for each transaction. This MassHealth Provider Manual serves as an important tool toward understanding what it means to be part of our community. Provider Manual | Providers - Massachusetts | WellSense Health Plan Thank you for your website feedback! Important: If you do not verify a member's eligibility before providing services, you might not be paid for those services. National Provider Identifier (NPI) | Mass.gov If you are seeking a behavioral health provider (mental health and addiction), you can use the MBHP provider directory. You skipped the table of contents section. Program regulations cover matters that apply specifically to the type of provider for which the manual was prepared. *Hospital providers should refer to their RFA to research and find answers related to payment methodologies. We have compiled various provider focused content to create this presentation. The feedback will only be used for improving the website. Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR 450.000. The MBHP Provider Manual is an extension of MBHP Provider Agreements. Please do not include personal or contact information. Quincy, MA 02171. This page is located more than 3 levels deep within a topic. This page is located more than 3 levels deep within a topic. It is accompanied by a MassHealth Companion Guide and the appropriate billing instructions to guide providers on the submission of transactions to MassHealth. Use this button to show and access all levels. You are now leaving the WellSense website, and are being connected to a third party web site. Visitbecome a provider with MassHealthor call 800-841-2900. For help on some common issues, see here. Some page levels are currently hidden. The Home- and Community-Based Services Manual guides providers to the regulations, administrative and billing instructions, and service codes they need. This is a part of the MassHealth Provider Handbook. To be eligible for the C3 MassHealth ACO, patients must, Have MassHealth Standard, CarePlus, CommonHealth, or Family Assistance plan types, Reside in the community (not in a nursing facility or chronic inpatient hospital). Fee-For-Service (FFS) and MassHealth Provider Network, Primary Care Clinician Plan & Primary Care Accountable Care Organizations, Managed Care Organizations and Accountable Care Partnership Plans, MassHealth Provider Directory, Provider File Maintenance, and Revalidation, MassHealth Electronic Data Interchange (EDI), MassHealth Coordination of Benefits (COB)/Medicare Crossover, MassHealth Claim Status, Reconciliation, and Additional Claims Resources. This appendix lists events that are designated by the Massachusetts Department of Public Health (DPH) as Serious Reportable Events that are not considered Provider Preventable Conditions. Introduction (130 CMR 457.000) Page 4-4 Freestanding Birth Center Services Manual Transmittal Letter FBC-1 Date XX/XX/XX 457.410: Recordkeeping Requirements FBCs are governed by recordkeeping provisions at MassHealth regulations 130 CMR 457.410 To provide services to Medicare Members aligned to our ACO REACH program, providers should be enrolled with Medicare. Abortion Clinic Acupuncture Services Acute Outpatient Hospital Adult Day Health If you do not verify a member's eligibility before providing services, you might not be paid for those services. Fax:(617) 988-8973. 02/2023) Performance Specifications Medicaid Clinical Criteria Standard Clinical Criteria Best Practice Guidelines BP Guidelines Coordination of Care (COC) COC Flyer COC Checklist Massachusetts Quarterly Newsletter Boston, MA 02110, Monday - Friday 8am-5pm (EST) M-239 - Community Health Center and Federally Qualified Health Center Vaccine and Vaccine Administration Billing Change. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Refer to the MassHealth Guidelines for Medical Necessity Determinations and MassHealth Provider Manual Series to access complete Medicaid guidelines and clinical criteria that will be used in making coverage decisions for the services below. Member Information. . C3 uses theMassHealth List of Covered Drugs. Provider Provider Resources We encourage you to login to MyHealthNet for faster claims and authorization updates. MassHealth Provider Manual. Please let us know how we can improve this page. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Fee-For-Service (FFS) and MassHealth Provider Network, Primary Care Clinician Plan & Primary Care Accountable Care Organizations, Managed Care Organizations and Accountable Care Partnership Plans, MassHealth Electronic Data Interchange (EDI), MassHealth Coordination of Benefits (COB)/Medicare Crossover, MassHealth Claim Status, Reconciliation, and Additional Claims Resources, https://www.mass.gov/info-details/masshealth-provider-regulations, https://www.mass.gov/info-details/masshealth-proposed-regulations, https://www.mass.gov/lists/masshealth-provider-manuals. All Medicare benefits are covered for C3 Members as they are covered directly under Medicare Fee-For-Service. This MassHealth Provider Handbook page is intended for both new and existing providers. All MassHealth providers are required to understand and comply with applicable regulations. EVS provides easy access to current and complete member eligibility information on the date services are provided or within a specific date range. Some page levels are currently hidden. If a single match is found, eligibility information will be returned: an eligibility request returns a valid MID based solely upon the demographic data submitted in the 270, you populate all subsequent eligibility requests for that member with the correct MID, for Eligibility Verification System Overview, Email MassHealth Customer Service for Providers at, Call MassHealth Customer Service for Providers, Main: at, Call MassHealth Customer Service for Providers, TTY: at. Personal Care Manual for MassHealth Providers | Mass.gov Please do not include personal or contact information. ) or https:// means youve safely connected to the official website. Download the WellSense Provider Manual for detailed information on the Plan, including our MassHealth, Qualified Health Plan, and Senior Care Options programs. Please remove any contact information or personal data from your feedback. EVS provides easy access to current and complete member eligibility information on the date services are provided or within a specific date range. Nursing Licensing Provisions: M.G.L. 4/28/2023. By accessing the noted link you will be leaving our website and entering a website hosted by another party. Top-requested sites to log in to services provided by the state. If the Members Medicaid Identification Number is not known, you must include the following four demographic data elements so that the system may search for the member. This appendix includes the revenue codes that may be used by acute outpatient hospitals (AOHs) including hospital-licensed health centers and other provider-based satellites, when billing for MassHealthcovered services. They are password protected PDFs. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. The regulations shown apply to the MassHealth fee for service system and are organized by service provider rather than by specific services. All requests for prior authorizations should be submitted directly to MassHealth. Eligibility verifications through the POSC can be performed via Direct Data Entry (DDE) for a single member verification or via Batch for checking multiple member verifications at the same time. MassHealth has developed aProvider Pagethat includes important information on eligibility, coverage rules, claims submission, applicable forms, and becoming a MassHealth provider. Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR 450.000. EVS is available 24 hours a day, seven days a week. Community Behavioral Health Centers/MCI . The feedback will only be used for improving the website. Top-requested sites to log in to services provided by the state. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. Massachusetts also offers and regulates a Supportive Day Program through the Executive Office of Elder Affairs Program for Councils on Aging and Senior Centers. Download the WellSense Provider Manual for detailed information on the Plan, including our MassHealth, Qualified Health Plan, and Senior Care Options programs. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. PDF MassHealth Durable Medical Equipment Provider Bulletin 29 Oxygen and . A .mass.gov website belongs to an official government organization in Massachusetts. Contact us at 855-860-4949. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. MassHealth ET Monday through Friday, excluding holidays. Sign upto receive email notification of updates to MassHealth provider manuals, including regulations, and new provider bulletins. We value our relationships and are proud to partner with you to provide the best possible care, address social needs, and improve the overall wellness of our Members. Top-requested sites to log in to services provided by the state. Please let us know how we can improve this page. Box 278 This appendix lists the active Eligibility Verification System (EVS) codes and their respective service restriction messages. Toll-Free: 1-866-676-9226 (TTY: 711) Please limit your input to 500 characters. ) or https:// means youve safely connected to the official website. Please limit your input to 500 characters. Read this section if you are looking for general MassHealth regulations about billing and administrative practices. While all of the subchapters are important providers should pay attention to Subchapter 4, which outlines the requirement and conditions of the program that providers are required to be in compliance with at all times. The regulations on this website are listed alphabetically by provider type. Some page levels are currently hidden. Integrated Care Management Program. This appendix contains the names, addresses, and telephone numbers of units, agencies, and contractors that you may need to contact in the course of doing business with MassHealth. C3 Members receive primary care services from many of our participating health centers and affiliated providers. If you need assistance, please For help on some common issues, see here.. Providers will also need to review the Subchapter 6 that outlines the covered services (services and codes) for each program. All requests for prior authorization should be submitted directly to MassHealth or, for behavioral health services, to MBHP. Boston, MA 02110, Monday - Friday 8am-5pm (EST) Chapter 112, sections 74 to 81C. We encourage all our Participating FQHCs and Affiliated Participating Providers to use this manual as a resource when working with us and our Members. This appendix includes a list of information the admitting provider or designee must give the MassHealth Utilization Management contractor when proposing an elective admission. Available Services. This document is formatted for those using screen readers and assistive technology. %PDF-1.7 % For providers who bill using service codes, MassHealth publishes information about the service codes in Subchapter 6 of those provider manuals. Top-requested sites to log in to services provided by the state, MassHealth providers are automatically sent notice of all provider regulations issued that apply to them. We will use this information to improve this page. In combination, the MBHP Provider Manual and the MBHP Provider Agreement outline the current requirements for participation in the MBHP network. All services covered for C3 Members are paid for by MassHealth or, for behavioral health services, by MBHP. is available through the Provider Online Service Center (POSC). The Acute Outpatient Hospital Manual guides providers to the regulations, administrative and billing instructions, and service codes they need. Medicare limitations and prior authorizations apply. For details on MassHealth managed care eligibility, please visit mass.gov. Use this button to show and access all levels. These updates apply to MassHealth Standard, CommonHealth, CarePlus, Family Assistance, and Children's Medical Security Plan (CMSP) members whose pharmacy claims are paid through the Pharmacy Online Processing System (POPS), including members enrolled in MassHealth fee-for- service and the Primary Care Clinician (PCC) Plan or in a Primary Care Accountable Care Organization (PCACO). How to Read Your Provider Manual | Mass.gov Please limit your input to 500 characters. MassHealth's restated telehealth policy permits MassHealth providers to render all clinically appropriate, medically necessary MassHealth-covered services through All requests for prior authorization should be submitted directly to Medicare or its vendor. Our vision is to transform the health of underserved communities. This appendix lists events that are designated by the Massachusetts Department of Public Health (DPH) as Serious Reportable Events that are not considered Provider Preventable Conditions. Tufts Health Plan Senior Care Options (SCO) Prior Authorization List If you are participating with the PCC Plan or MBHP, you are already part of C3s network! PDF MassHealth All Provider Bulletin 303 November 2020 Subchapter 6 of the MassHealth provider manuals. Additional information on the scope of covered services in MassHealth can be found in Provider Bulletins, Provider Manuals and Guidelines for Medical . Email:publications@mahealth.net. A .mass.gov website belongs to an official government organization in Massachusetts. BMC HealthNet Plan | Provider Manual Share sensitive information only on official, secure websites. The process for obtaining authorizations from Medicare or a Medicare vendor does not change for Members aligned with C3 REACH program. A Mass General Brigham primary care provider will look after your care. While this handbook page touches on many subjects, it is not the sole source of information for these topics. These regulations are reproduced as Subchapters 1, 2, and 3 in this and all other manuals. Find a Provider - C3 - Community Care Cooperative Access the MassHealth Drug List to learn more about coverage rules. ) or https:// means youve safely connected to the official website. All of the benefit, referral, prior authorization, and claims submission rules for the participating health centers and affiliated providers, MassHealth medical or dental providers, and MBHP providers apply to providers serving C3 ACO members. Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR 450.000. The Provider manual includes general information about Community Care Cooperative (C3) as well as comprehensive information related to our programs, regulatory requirements, policies, and procedures.

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