News and Updates >> Client Update
June 23, 2008
Important Medicaid Information (for MA clients only)
The following client update pertains only to Massachusetts Medicaid Participating Providers.
RE: New Medicaid Management Information System (MMIS) for Mass Health
As you may be aware, Mass Health is discontinuing the use of the REVS system and
implementing a new MMIS system effective September 29, 2008.
Here at PhyLogic, we have already been working to ensure a smooth transition to
the new MMIS system. Peggy Camerlin, PhyLogic’s Manager of Technical Operations has
provided the new claims specifications to AdvancedMD and has been working with them
in regards to electronic claim submission. Your Billing Team Supervisors and Managers
have attended Mass Health training sessions on the new system and are filtering this
information down to the staff level.
Below, please find a summary of changes as listed in Provider Bulletins 172 & 173.
In the next few months, Mass Health will be sending important information regarding new provider numbers and on line access directly to the providers physical location. It is imperative that when your office receives this information that it is forwarded to PhyLogic immediately. Failure to forward this information may result in the inability to process your Mass Health claims and will have a negative impact on cash flow.
Should have you any questions, please do not hesitate to contact your Billing Team
Supervisor or Kim Paradis, Manager of Billing Operations at 877-273-3100.
MASSHEALTH
MEDICAID MANAGEMENT INFORMATION SYSTEM (MMIS)
IMPLEMENTATION DATE: 09/29/2008
Highlights of changes
• All providers will be issued a new 10 digit provider #. Consisting of nine
digits and an alpha character to denote the provider’s service location.
(Reference example Provider Bulletion#172, page 2.) Provider Bulletin #173
states that this will be sent to the remittance address for provider around
7/29/08. Providers need to be sure that they forward this information to
Phylogic. This provider # will be needed to access the new on line service
center and will be on all RA and reports from Mass Health.
• All MassHealth members will receive a new 12 digit MassHealth id number and
a new card. This number will not be based on member ssn#. New cards will be issued
to member beginning approximately 7/29/08. The new Mass Health numbers are not to
be used until the new system is implemented 9/08. Old numbers should continue to
be used until then.
• Mass Health will send login instructions for the MMIS Provider Online Service Center
to providers. This will be to the physical office location. The first time login is as
the administrator and then password must be changed to a secure password. Additional
logins with assignment of level access will need to be created.
• Providers must check eligibility, verify PCC and obtain appropriate referrals
prior to seeing the patient. Eligibility will now be able to be verified retroactive
to 4 years. This includes PCC and TPL info.
• PCC#’s are being eliminated. PCC’S will now enter the referral # on line.
• PCP Referrals: Providers need to check on line for patients who are not their PCC
for the appropriate referral. If there is no referral in the system the provider should
ask the member if they have seen the PCP. If “yes” call PCP for referral; if “no” refer
the patient back to their PCP.
• Pre- Admission screening requests can now be submitted on line.
• Newborns will be listed under PCC of the parent. A PCC will be assigned by the
system if one is not selected within 30 days.
• Mass Health is eliminating all of the their custom forms (5,9). They will be accepting
standard CMS 1500 form.
• Mass Health is eliminating paper RA’s. All RA’s must be obtained from the new MMIS
on line service center. The denial codes on the RA’s will remain the same.
• Mass Health is discontinuing the use of separate TPL letters. All TPL information
will be located on the RA.
• Mass Health is discontinuing the use of the TCN (12 digit number) and replacing it
with ICN(13 digit number). The new ICN will be used in the same format as the old TCN.
• Mass Health will now process at the claim level adjudication instead of line item
adjudication. This means one ICN per claim.