Important Updates to MassHealth

Vital Signs: October 2013 

Has your practice started receiving MassHealth claim denials with a denial code of 1010?

If so, it may be because your service location is not properly registered. MassHealth is currently reviewing practice service locations for proper enrollment in order to be compliant with requirements outlined in the Affordable Care Act.

Just because you are receiving payment today for a service location does not mean it is properly registered. We recommend providers contact MassHealth Customer Service at (800) 841-2900 in order to confirm that all service locations are properly enrolled.

Starting October 1, 2013, MassHealth’s Primary Care Payment Reform Initiative is offering its new payment model to eligible primary care practices. These practices must seek Patient-Centered Medical Home certification by National Committee for Quality Assurance (NCQA) or, potentially, by the Health Policy Commission, once the Commission releases its criteria.

The revised payment model for these practices is comprised of the following three parts:

  1. Comprehensive Primary Care Payment.A risk-adjusted capitated payment for primary care services and a defined set of behavioral health services.
  2. Quality Incentive Payment.An annual incentive based on primary care quality metrics.
  3. Shared Savings Payment. If the total cost of providing care for a patient population, including hospital and specialist services, is less than budgeted, the primary care practice will share in the savings. There is also an option for practices to engage in shared risk in exchange for a greater shared savings payout. In the shared risk scenario, the practice shares in the financial loss if the total cost is greater than budgeted.

Kerry Ann Hayon and Georgia Feuer

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