The Division of Medical Assistance (DMA), which runs the state's Medicaid program, recently embarked on several initiatives aimed at improving the relationship between MassHealth and its contracted providers. These new programs seek to achieve efficiencies by reducing administrative requirements.

The DMA developed these short-term initiatives based on feedback and suggestions from network physicians and ongoing collaboration with the MMS on its Business Practice Improvement Project. The DMA also continues to develop a new claims-processing system that will offer better functionality and flexibility to meet the demands of providers and patients.

Changes Affecting Physicians

• Simplified Resubmittal Procedure for Denied Claims: MassHealth will no longer require providers to reference a transaction control number (TCN) when resubmitting certain denied claims. Each line does not need a separate TCN, and providers would not check off the resubmittal box.
  Refer to All Provider Bulletin No. 123 at www.state.ma.us/dma/providers/bulletins/bull_2003.htm for more information.
• Combined Pay Cycles: To simplify provider reconciliation, the MassHealth, CommonHealth and Massachusetts Commission for the Blind pay cycles are now synchronized and appear on a combined remittance advisory.
• Provider-Focused Website: An Internet resource, www.mahealthweb.org, will feature information about MassHealth billing, HIPAA, provider enrollment, contact information, archived remittance advices messages and commonly used forms. The site will also offer downloadable lists of service codes (Subchapter 6) for all applicable manuals.

New MassHealth Resources

• MassHealth HIPAA Support Center: This center has been established to help providers with electronic claims submissions, pre-production testing, trading-partner administration and test scheduling. Contact them at (617) 576-4030 or mahipaasupport@unisys.com.
• MassHealth Drug List: This listing will be continually updated to identify drugs covered, along with applicable limitations and conditions of payment. Available at http://www.state.ma.us/dma/providers/pharmacy/MH-druglist/MH-DL.htm.
• E-Mail Inquiries to Final Deadline Appeals Unit: For inquiries on the status of appeals made to the Final Deadline Appeals Board, providers can e-mail fdappeals@nt.dma.state.ma.us.
• Revised Regulations: Administrative and billing-regulation language has been simplified and the policies clarified. The regulations are available at www.mass.gov/dma.

- Dana Holmes
- William Ryder, Esq.

If physicians have suggestions on how to enhance current procedures or policies, e-mail your recommendations to improve@nt.dma.state.ma.us.