(Medicaid and OOD Managed Note: EDD Population is allowed in Care) and OOD do Medicaid Medicaid Claim Population allowed not have Claim Certificate with 12 (NOTE type error Payer Type Certificated numeric character Prohibited returned, when not as a field (MassHealth MassHealth ID (NOTE MassHealth ID) entry but ID) type error if invalid) the Payer - Expected to be Source Code prohibited in FY19 List is a data Population is allowed Population was source to for Health Plan required for Health determine Member ID, with NOTE Plan Member ID only. Payer Type Health Plan type error, if populated. Dec. ’17 - Added to the Prohibited for those file Member ID Should be in Medicaid exclusion list for Health types. Claim Certificate Plan Member ID, with – Expected to be “H” NOTE type error. Payer prohibited in FY19 (Health Source Code Safety ‘310’ will be Net”) Population is allowed in assigned a Medicaid Medicaid Claim default Claim As of Dec. ’17, allowed Certificate (NOTE type Payer Type Certificated in Medicaid Claim Required error if missing or Code entry (MassHealth Certificate. invalid) of ‘7’ for ID) – Expected to be EDD and required in FY19. OOD only
(Medicaid Managed Care) and OOD Note: EDD and OOD do not have Payer Type as a field entry but the Payer Source Code List is a data source to determine Payer Type for those file types. Payer Source Code ‘310’ will be assigned a default Payer Type Code entry of ‘7’ for EDD and OOD only Medicaid Claim Certificated (MassHealth ID) Population allowed (NOTE type error returned, when not MassHealth ID) Population is allowed in Medicaid Claim Certificate with 12 numeric character MassHealth ID (NOTE type error if invalid) - Expected to be prohibited in FY19 Prohibited “H” (Health Safety Net”) Health Plan Member ID Population was required for Health Plan Member ID only. Dec. ’17 - Added to the exclusion list for Health Plan Member ID, with NOTE type error. Population is allowed for Health Plan Member ID, with NOTE type error, if populated. Should be in Medicaid Claim Certificate – Expected to be prohibited in FY19 Prohibited Medicaid Claim Certificated (MassHealth ID) As of Dec. ’17, allowed in Medicaid Claim Certificate. Population is allowed in Medicaid Claim Certificate (NOTE type error if missing or invalid) – Expected to be required in FY19. Required
FY18-Payer-Code-and-related-Payer-Type-Code-Enhancements-May-2018.docx