What Massachusetts LICSWs Need to Know About the MassHealth Registration Requirement
Wednesday, May 04, 2016
April 29, 2016
Update: What Massachusetts Licensed Independent Clinical Social Workers Need to Know About the
MassHealth Registration Requirement
All Licensed Independent Clinical Social Workers (LICSWs) in Massachusetts will be required to register with MassHealth as either billing or non-billing providers. This requirement was put in place to ensure that MassHealth is complying with the Affordable Care Act. NASW-MA Chapter has been advocating for a delay in this requirement. We are pleased to announce that the Board of Registration of Social Workers has informed us that LICSWs will not need to attest to this requirement for their 2016 license renewal; the deadline for which is September 30, 2016. The Board of Registration expects that registering with MassHealth will be a requirement for the next license renewal (in 2018). The Chapter strongly advises LICSWs to move forward to meet this requirement as soon as they can.
In the message below, we will explain the two ways to complete this requirement, and provide answers to frequently asked questions.
If you are a LICSW in Massachusetts, you may complete the MassHealth registration requirement by registering as either a billing provider or a non-billing provider. A billing provider is a LICSW who is registered with MassHealth and is authorized to bill MassHealth directly for client services. A non-billing provider is a LICSW who does not bill MassHealth directly for any client services but is nonetheless must become registered with MassHealth as a non-billing provider in order to satisfy this new requirement.
To register as a non-billing provider, complete the application and contract and mail them to the address printed on the application. You can download these two documents at: http://www.mass.gov/eohhs/provider/insurance/masshealth/aca/aca-section-6401enrollment-information.html.
To register as a billing provider: Contact MassHealth Customer Service Center at 1-800-841-2900 in order to request an application.
Note: If you are currently a MassHealth provider or a QMB-only provider (in order to receive secondary payments from MassHealth for some Medicare enrollees), then you don’t have to do anything—you are already enrolled in MassHealth.
If you still have questions about how to complete this requirement, or if questions come up as you go through the process of completing the form, please consult these instructions and questions and answers, below.
Step by Step Instructions and Q&As:
A Guide to the New Requirement and to Filling-out the
Non-Billing Provider Application and Contract
Filling out the Non-Billing Provider Application
· How are you legally known, as a person, to the government? Example: the name on your license and/or how the IRS knows you. If your middle name is in one of those places and your middle initial or there’s no middle name in another place, it’s not a problem.
· Make sure you put the identical name where it asks for your name elsewhere on the application and on the contract.
· If you have a DBA, don’t include it.
SSN or EIN:
· If you have an EIN for your health care business operation, write in a box (missing on application form) and check it. You are required to send in a photocopy of the letter from the IRS giving you your EIN along with the application.
o If you have an EIN but cannot locate the letter from the IRS, you can do any of the following:
§ Contact the IRS and ask for a duplicate copy of the letter.
§ Submit instead a copy of a pre-printed “tax coupon/payment voucher” from the IRS that contains your name, address and tax ID.
· Use your social security number instead of your EIN.
Primary Taxonomy Code:
· LICSWs should leave this part blank; it’s only for medication prescribers.
· LICSWs should leave this blank; it’s only for medication prescribers.
License from another state?
· If no, leave blank.
Home Street Address and contact information:
· Has to be where you actually reside—no PO Boxes permitted.
o Note: MassHealth will not display this information anywhere; it’s just for their records.
Primary Service Location (PSL):
· If different from your Home Address, put here information about the location where you spend the majority of your time doing clinical social work-related work.
· If not different from your home address, leave blank.
· Note: The address you have listed with the NPI registry (which it’s a good idea to update as needed) is irrelevant to this application.
PSL name and PSL MassHealth provider ID:
· If you work most of the time at a clinic or hospital or agency that has a name, put it here.
· If that facility has a MassHealth provider ID, put it here.
· If it doesn’t have a MassHealth provider ID, leave it blank.
Section 2A: Owners, Managing Employees, and Agents of Applicant:
· This section refers only to your business of providing health care. Read the material below--If your business has co-owners, or paid managers, or agents, if your business is paying a mortgage on property that belongs to it, or if you have a family member involved as owner, managing employee, or agent of the business, indicate yes and provide the information. Otherwise, check “none”.
· Note: If you employ a billing person or company, they count as an agent.
Section 3: Certification Statement:
· Make sure that your Printed Legal Name is the same as the name you put at the beginning of the application.
Non-Billing Provider Contract:
· Legal Name must be the same as on the application
· For Title, put your academic degree.
· IF YOU HAVE A DBA, DO NOT INCLUDE IT.
Questions and Answers:
· What is the turnaround time for approval of applications? “A few weeks” but if your application has inconsistencies on it, it may take longer for you to get a response.
· Are we going to have to be enrolled as either non-billing or billing MassHealth providers in order to renew our licenses in September, 2016? We have heard from the Board of Registration of Social Workers that enrollment will not need to be completed in time for the September 2016 license renewal. They recommend all LICSWs complete this process as soon as possible, but you will not have to attest to fulfilling this requirement until your next license renewal (2018).
· What if I already submitted an application but haven’t heard back about it? Wait a month for MassHealth to contact you. If you still don’t receive a response, LICSWs may contact Adrian Figueroa at MassHealth/Maximus via email: email@example.com or telephone: 857-472-5744.
· What if I don’t do any clinical work even though I am a LICSW? You will still need to be enrolled in MassHealth either as a billing or non-billing provider as a condition for licensure or relicensure (renewal).
· What if I am a provider for MBHP, Beacon or another Managed Care Organization and work with people on MassHealth? Do I still need to be enrolled separately as a MassHealth provider? Yes, you do. Being a provider for a managed care company that has a contract with MassHealth does not satisfy the requirement.
· If I am treating people on MassHealth as a Beacon or MBHP provider, am I required to also be a billing MassHealth provider? No, you do not. The two are totally separate. You can be a non-billing MassHealth provider if you prefer.
· Do I have to be a Medicare provider in order to be a MassHealth provider? You are not required to be a Medicare provider to be a non-billing MassHealth provider. However, you are required to be a Medicare provider to be a billing MassHealth provider.
· The Affordable Care Act requires that any time a provider bills MassHealth for certain types of services, the provider has to put the NPI number of a referring clinician who is a MassHealth provider on the claim in order for the provider to get paid. I have billing-related questions that pertain to meeting this requirement: No date has been set yet for that requirement to go into effect. A detailed bulletin describing the new billing procedures will be coming out in 4-6 weeks. Meanwhile, the rollout starts simply with “informational messaging” on the EOB’s. For a list of the services and categories of professionals that this requirement applies to, go to the link listed above.
· I work in a hospital and we bill MassHealth under their MassHealth number. I do not have my own individual MassHealth provider number. Do I need to register? Yes, you do. If you cannot individually bill MassHealth under your own name, you must register with them.
· Does my multidisciplinary group practice (which is not a MassHealth provider) need to do the paperwork for the application and contract? For groups who do not accept MassHealth, the individual providers under that group must register with MassHealth to be compliant.
· What does ORP and O&R refer to? ORP stands for “ordering, referring and prescribing”, which is the category of activities that non-billing providers are able to do. O&R stands for “ordering and referring”. These terms are synonymous with “non-billing provider”.
· Whom do I contact if I still have a question about the application process? What if I already submitted an application but I know I didn’t do it according to these instructions? Contact Adrian Figueroa at MassHealth/Maximus via email: firstname.lastname@example.org or telephone: 857-472-5744.
If you have other questions, please contact:
Jonas Goldenberg, LICSW,
Director of Clinical Issues & Continuing Education
NASW-MA Chapter would like to thank the Massachusetts Psychological Association (MPA) for their permission to excerpt this article, and to Michael A Goldberg, PhD. and James Leffert, Ed.D, who wrote the original article and Q&As for MPA (March, 2016).