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Health Safety Net (HSN) UpdatesMassachusetts Health Care Training ForumApril 2019

HSN Updates – Agenda Billing Updates and Reminders HSN Claim Adjudication/Claim Status Billing Intermediary Reminderso HSN and Billing Intermediarieso Claim Denial Emails Carrier Codes for HSN Claims Partial Requirements for HSN Claims CHC Covered Code List FY 2017 Closing Eligibility Reminders Presumptive Determination Application FPL UpdatesMassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices1

HSN Updates and Reminders – Claim Adjudication/Status HSN claims that deny at MMIS do not adjudicate tothe HSN system HSN claims that deny at MMIS – denials can befound on the MassHealth 835 as well as theMassHealth EOBs MassHealth 835 – passed or denied within theMassHealth system – this can be determined inLoop 2100; CLP Segment CLP02 – Claim Status CodeMassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices2

HSN Updates and Reminders – Claim Adjudication/Status HSN claims that pass at MMIS will adjudicateinto the HSN system HSN claims that pass at MMIS will adjudicate intoHSN but has denied at HSN – denials can befound on the Validation Reports in INET If your facility utilizes a Billing Intermediaryyour BI has access to the Validation Reports(and should be sending you such reports)MassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices3

HSN Updates and Reminders –Validation Reports HSN FER/Validation Reports – HSN denials only – INET INET .aspx If your facility has a BI submitting your 837 files, theBilling Intermediary is the only entity that candownload the FER/Validation Report from INET, filenames would look like this: xxxxx xx 555555555A.WEB.0000000001.003good401708924.837.hsn xxxxxxx Production837PEditReport CSV.CSV xxxxx xx 666666666A.WEB.0000000001.003good401708924.837.hsn xxxxxxx Production837P EditReport.docMassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices4

HSN Updates and Reminders –Validation Reports HSN claims that pass at MMIS and also pass at HSN –payments will be on HSN’s Remits – INET – can bedownloaded by your facility HSN Remit Reports – shows HSN payments – INET This document is not an 835 file – this documenthas been downloaded by your facility on a regularbasis The best way to reconcile your HSN claims is byutilizing the MassHealth 835/EOB, The HSNFER/Validation Report, as well as the HSN Remit(both available on INET)MassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices5

HSN Updates and Reminders – Billing Intermediaries(BIs) When a facility uses a billing intermediary for claim submission, pleasenote the following: HSN claim questions from a BI will be redirected to the facility dueto the facility retaining a contract with the BI The BI is the only entity that has access to downloadValidation Reports from INET (HSN denial reports) Facilities that require claim information from Validation reportswill need to speak to their BI Facilities can contact HSN regarding claim billing questions or claimpayments**Please note** Facilities utilizing a BI for the first time or changing a BImust notify MassHealth EDI; must also notify HSN via email in addition tofilling out an HSN Business Partner Agreement located in INETMassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices6

HSN Updates and Reminders – Claim Denial Emails HSN continues to send emails to both BillingIntermediaries and their contracted facilities (if eligiblefor HSN payment) Please note: Some facility’s claims may not be includedin the Billing Intermediary’s denial rate Facilities should contact your Billing Intermediary(if receiving the email) to ensure all your facilityclaims are accurately adjudicatedMassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices7

HSN Updates and Reminders – Carrier Codes for HSNClaims Fatal edits for carrier code reporting data elements have beenpostponed until further notice Once the edits are turned on, any claims submitted without a carriercode will receive a fatal edit and will not be considered for HSNpayment All seven characters or digits, including preceding zeros, arenecessary for the carrier code to passHSN has implemented these new carrier codes to reduce the difficulty withusing specific naming conventions for MassHealth claims:1. Carrier Code DMA7384: This carrier code should be used to reportany MassHealth Comprehensive coverage (i.e. MassHealth Standardor other comprehensive plans)2. Carrier Code 0007001: This carrier code should be used to report anyMassHealth Non-comprehensive coverage (i.e. MassHealth Limited orother non-comprehensive plans)3. Carrier Code 0007002: This carrier code should be used to reportCMSP (only) that has been processed by MMISMassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices8

HSN Updates and Reminders – Carrier Codes forHSN Claims A complete listing of the carrier codes is provided byMassHealth in the All Provider Manual under TransmittalLetter ALL-213 dated 11/01/2014; see Section II, rovidermanual/appx-c-all.pdf Using the above carrier codes eliminates the use ofnaming conventions and no longer effect whether aclaim is paid by HSN (or delay payment of claims due tonaming convention)MassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices9

HSN Updates and Reminders – 837I & 837P PartialReporting Fatal edits for partial claim reporting data elementshave been postponed until further notice Please continue to report partial deductibles using themethodology that your facility is currently utilizing Remaining HSN Deductible that has yet to beincurred 837I and 837P Partial Data Elements can be found inthe Billing Update below: usettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices10

CHC Covered Code List HSN is currently reviewing covered procedures forCHC’s Once reviews are completed, listings will be posted onthe HSN website Providers should continue to monitor the Billing Updatesand Reminders for additional information Working closely with MassHealth, HSN will updatecodes for Hospitals and CHCs on a regular basisMassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices11

HSN Updates and Reminders – HSN Fiscal Year2017 (FY17) Closing FY 2017 Closing: Providers are reminded that FY17 willbe closing on September 30, 2019 Any claims or corrections for FY17 must becompleted before the FY is closed Any claims trying to process after the FY close will bedenied by HSN If providers have questions regarding the FY17 closing,please contact the HSN Helpdesk [email protected] HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices12

HSN Eligibility Reminders – PresumptiveDetermination Application As a reminder, Facility Representatives should alwaysuse the most up-to-date HSN-PD application whenrequesting a HSN Presumptive Determination for apatient Facility Representatives should make sure to followthe 2019 FPL Guidelines The HSN-PD application and training materials can befound on the HSN website n-0MassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices13

QUESTIONS?MassachusettsDivisionof HealthCareFinanceand PolicyExecutive Officeof HealthandHumanServices14

HSN Updates and Reminders - Claim Denial Emails HSN continues to send emails to both Billing Intermediaries and their contracted facilities (if eligible . A complete listing of the carrier codes is provided by MassHealth in the All Provider Manual under Transmittal Letter ALL-213 dated 11/01/2014; see Section II, page C-2