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MassHealth Requirement FAQs

Monday, August 27, 2018   (0 Comments)
Posted by: Jamie Klufts
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Requirement for All LICSWs to apply to MassHealth as a Nonbilling Provider or as a Qualified Medicare Beneficiary (QMB) Only Provider

 

Section 6401 of the Affordable Care Act requires that, for MassHealth services that must be ordered, referred or prescribed, the provider who ordered, referred or prescribed the service must be enrolled with MassHealth, at least as a nonbilling provider in order for the claim for the service to be payable.

 

As LICSWs are eligible to order, refer or prescribe certain services for MassHealth members, under state law they  must apply to enroll with MassHealth at least as an “ordering and referring” (nonbilling) provider in order to obtain and maintain Massachusetts state licensure. Providers who are already enrolled with MassHealth have already met the requirement and do not need to take further action. 

 

MassHealth has created a Nonbilling Provider Application for provider types that are not eligible to enroll as billing providers. This application can also be used by provider types who are eligible to enroll in MassHealth as billing providers but who choose not to at this time.  

 

Providers who enroll with MassHealth as nonbilling providers via the Nonbilling Provider Application are not permitted to submit claims to MassHealth.

 

LICSWs are currently only eligible to enroll in MassHealth as nonbilling providers or as a special type of billing provider known as “QMB Only." QMB Only status only allows the provider to be paid by MassHealth for Medicare crossover claims for members who are eligible for both Medicare and MassHealth.

 

ALL Massachusetts licensed LICSWs must apply to MassHealth to be a QMB Only or a NonBilling provider. The law does not allow for any exceptions. This applies to all practicing and non-practicing Massachusetts licensed LICSWs, if you are renewing your license in 2018 or at any time in the future. LICSWs living in other states wishing to renew their Massachusetts license also need to apply to MassHealth to be a QMB Only or nonbilling provider.

 

Any and all questions regarding the application process should be directed to the MassHealth Customer Service Center at 1.800.841.2900

TTY services at 1.800.497.4648

 

Important points to know:

  • All applications are accepted and reviewed through MassHealth. The licensing Board does not review or approve any MassHealth provider applications.
  • To Apply:
  • All applications must be complete in order to comply with the state law requirement to apply to participate in MassHealth.
    • All applications, including the Nonbilling Provider Application, require an NPI number.  If you do not have an NPI number, you will need to obtain one in order to complete the application. The instructions on how to obtain an NPI are at: https://nppes.cms.hhs.gov/webhelp/nppeshelp/NPPES%20FAQS.html
    • All Applications require the inclusion of your Social Security Number (SSN) to allow MassHealth to perform the required review of the application in accordance with federal law.
  • All Massachusetts LICSW licenses expire on October 1, 2018. Upon renewal of that license, all LICSWs will be asked to attest that they have applied to MassHealth as a QMB Only or nonbilling provider. LICSWs who are unable to make this attestation will not be eligible for licensure renewal. 
  • We encourage LICSWs to apply to enroll with MassHealth as soon as possible so that their license renewals will not be delayed.

More information regarding how to enroll can be found here: http://www.mass.gov/eohhs/provider/insurance/masshealth/aca/aca-section-6401enrollment-information.html

 

 


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