4/1/2014 Introduction N/A N/A Please Note: Effective January Please Note: Effective January 1, text changed 1, 2012, MassHealth is moving 2012, MassHealth adopted an toward an all-electronic claims electronic claims submission submission policy to achieve policy to achieve greater greater efficiency. All claims efficiency. All claims must be must be submitted submitted electronically, unless the electronically, unless the provider has received an approved provider has received an claim submission approved electronic claim waiver. 90-day waiver requests submission waiver. 90-day and final deadline appeals may be waiver requests and final submitted either electronically via deadline appeals may be the Provider Online Service Center submitted either electronically (POSC) or on paper. via the Provider Online Service Center (POSC) or on paper. 4/1/2014 The sample N/A N/A- N/A N/A CMS-1500 form was replaced with the updated form. 4/1/2014 Member 1a Insured’s I.D. Enter the complete 12-character Enter the complete 12-character identification Number member identification (ID) member identification (ID) number (ID) number is number that is printed on the that is printed on the MassHealth required in all MassHealth card. If the card. cases. Medicare box is checked in Field 1 (and if this is a crossover claim), enter the member’s HIC (health insurance claim) number. 4/1/2014 Field name 8 Reserved for N/A N/A changed. NUCC Use 4/1/2014 Changes to 9 Insured’s If Field 11d has an entry, If Field 11d has an entry, complete instructions for Name complete Fields 9 and 9a Fields 9, 9a, and 9d, as applicable. completing the through 9d, as applicable. When When additional group health field. additional group health coverage coverage exists, enter the name of exists, enter the name of the the other insured in the following other insured in the following order: last name, first name, order: last name, first name, middle initial. middle initial. 4/1/2014 Field now 9b Reserved for Enter the eight-digit date of birth Not required reserved for NUCC Use of the other insured in NUCC use. MM/DD/YYYY format. Enter an X in the applicable box to indicate the gender of the other insured. Only one box can
4/1/2014 Introduction text changed N/A N/A Please Note: Effective January 1, 2012, MassHealth is moving toward an all-electronic claims submission policy to achieve greater efficiency. All claims must be submitted electronically, unless the provider has received an approved electronic claim submission waiver. 90-day waiver requests and final deadline appeals may be submitted either electronically via the Provider Online Service Center (POSC) or on paper. Please Note: Effective January 1, 2012, MassHealth adopted an claims submission policy to achieve greater efficiency. All claims must be submitted electronically, unless the provider has received an approved electronic claim submission waiver. 90-day waiver requests and final deadline appeals may be submitted either electronically via the Provider Online Service Center (POSC) or on paper. 4/1/2014 The sample CMS-1500 form was replaced with the updated form. N/A N/A- N/A N/A 4/1/2014 Member identification (ID) number is required in all cases. 1a Insured’s I.D. Number Enter the complete 12-character member identification (ID) number that is printed on the MassHealth card. If the Medicare box is checked in Field 1 (and if this is a crossover claim), enter the member’s HIC (health insurance claim) number. Enter the complete 12-character member identification (ID) number that is printed on the MassHealth card. 4/1/2014 Field name changed. 8 Reserved for NUCC Use N/A N/A 4/1/2014 Changes to instructions for completing the field. 9 Insured’s Name If Field 11d has an entry, complete Fields 9 and 9a through 9d, as applicable. When additional group health coverage exists, enter the name of the other insured in the following order: last name, first name, middle initial. If Field 11d has an entry, complete Fields 9, 9a, and 9d, as applicable. When additional group health coverage exists, enter the name of the other insured in the following order: last name, first name, middle initial. 4/1/2014 Field now reserved for NUCC use. 9b Reserved for NUCC Use Enter the eight-digit date of birth of the other insured in MM/DD/YYYY format. Enter an X in the applicable box to indicate the gender of the other insured. Only one box can Not required
changes-to-5010-billing-guides.docx