What are the billing requirements and instructions in cases where the patient has a primary insurer other than MassHealth (such as LTC insurance)?
Providers need to follow job aids and supplemental instructions on how to bill when the member has MassHealth and another insurance. Both are available on the MassHealth Web page at www.mass.gov/masshealth/newmmis.MassHealth pays in full for a member who was on a 10-day medical leave of absence (MLOA). We submitted an adjustment but NewMMIS took back the entire payment. What do we do? We were told that it has to go to the 90-Day Waiver Unit. Providers need to carefully check the adjustment section of the remittance advice for both header and line detail explanation of benefits (EOB) codes. If an EOB code is listed in either field, there was an error on the submitted adjustment claim and the replaced claim had errors that did not allow the claim to be processed. If the payment has been recouped and the date of service is older than 90 days, you will need to submit the claim to the 90-Day Waiver Unit as a new claim along with a completed 90-Day Waiver Request Form and copies of the remit
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