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News & Press: Clinical Alerts

Clinical Alert: Continuity of Care During the MassHealth Transition Period

Friday, June 1, 2018   (0 Comments)
Posted by: Jamie Klufts
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It is June 1, and the MassHealth Continuity of Care period is officially over.

 

During the past 90 days, all therapists were allowed to bill the insurance programs to which their MassHealth clients were transferred, whether or not the therapist was a provider for the new insurance.

 

As of today, a therapist is supposed to have applied to be on the new insurance and been accepted, arranged for a single case agreement, or arranged to transfer their out-of-network client; HOWEVER, there have been many glitches, and MassHealth has negotiated the following with each of the insurance companies covering their clients:

 

  1. Although MBHP stated that it would not start paying newly empaneled therapists until June 5, in fact they will cover all authorized sessions that occur from June 1-5.
  2.  The major problems at this time are with Tufts Health Public Plans. THPP has been slow to credential new therapists, at times stating they were not accepting applications; that applications would not be read until October 1; that new providers could not bill until they received a letter from their Credentialing Committee in addition to getting back their countersigned contract. MassHealth has insisted that THPP continue to accept applications, and that member care should not be disrupted while applications for credentialing are being processed.
 What to do:
  1. If you have applied to MBHP and been accepted on to their panel – begin billing as a provider today, June 1.
  2.  If you applied to THPP but your application was rejected or not yet processed - write to Nancy Carlucci at MassHealth with the specifics: nancy.carlucci@state.ma.us. She will triage your situation to the MassHealth contract managers, so they can work with the plans to resolve specific cases. 
    •  Please write to her even if you have contacted her before.
    • Include your NPI and describe the problem you are having.
    • And continue to see your clients during this ongoing transition. MassHealth wants all their members to be able to continue to see their therapists.
  3. If your MassHealth client has Fallon or BMC HealthNet, or NHP in Merrimack Valley (all 3 of which are part of Beacon), and you have been reimbursed, it is assumed that you can continue to bill as you have been over the past three months.
  4. All providers should be careful to track authorizations, and request additional authorizations when necessary.

 

 


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