MassHealth published its June “All Provider Bulletin 391” with orders ALL 361, ALL 376 and ALL 380 announcing the start dates for enforcing the ordering, referring and prescribing (ORP) requirements. With the exception of the information in the bulletin, all information in ALL 361, ALL 376 and ALL 380 remains in effect. Opportunity for payment of claims initially denied due to unenrolled ORP provider as described in ALL 376, billing providers should take certain steps to avoid claim denials due to unenrolled ORP providers. If a claim is denied because of an unenrolled or unauthorized ORP provider on or after June 9, 2024, the claim will be placed in suspense status. The claims system will continue to check to see if the ORP provider has enrolled with MassHealth for up to 90 days after the first date of service on the claim. Once the ORP provider is enrolled, the claim will then be payable. This will allow billing providers time to follow the steps related to unenrolled ORP providers outlined in ALL 376. If the ORP provider is not enrolled by 90 days from the first date of service on the claim, the claim will be denied. Also, effective June 9, 2024, billing providers can resubmit claims that were previously denied due to an unenrolled or unauthorized ORP provider if the first date of service on the claim is no earlier than September 1, 2023. If the ORP provider is enrolled with MassHealth within 90 days of the first date of service on the claim, the claim will be payable.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.